For Referring Doctors: Ocular Oncology Referral Criteria

This page is for ophthalmologists, optometrists, pediatricians, oncologists and other clinicians who want to refer a patient for ocular oncology assessment in Türkiye. Prof. Dr. Elif Betül Türkoğlu is a Professor of Ophthalmology and ocular oncologist with more than 20 years in ophthalmology. Her academic career was at the Akdeniz University Faculty of Medicine, where she became a full professor in 2022. Her ocular oncology training includes a one-year research fellowship at Wills Eye Hospital, Philadelphia (2015–2016), and an observership at the National Cancer Center of Japan (2019). She sees adults and children with intraocular, conjunctival, eyelid and orbital tumors at her practice in Antalya and reviews imaging sent from other cities and countries. The criteria below follow published triage tools; they support, and do not replace, your clinical judgment.

Urgent referral

Please refer promptly — by phone or WhatsApp, stating that the case is urgent — when you see:

MOLES and TFSOM-DIM in brief

MOLES, developed by Professor Bertil Damato for optometrists and general ophthalmologists, scores five features from 0 to 2: Mushroom shape, Orange pigment, Large size, Enlargement and Subretinal fluid. A total of 0 suggests a common nevus; 1–2 a low- or high-risk nevus that warrants non-urgent referral for imaging; 3 or more a probable melanoma that warrants urgent referral. In validation series from Moorfields (222 tumors) and from Germany (695 nevi and 53 melanomas), a score of 3 or more identified every melanoma, with a specificity of about 96%.

TFSOM-DIM, from the Wills Eye Ocular Oncology Service (3,806 nevi), lists six imaging features: Thickness over 2 mm on ultrasound, subretinal Fluid on OCT, Symptoms with vision of 20/50 or worse, Orange pigment on autofluorescence, Melanoma acoustic hollowness on ultrasound, and DIaMeter over 5 mm on photography. Five-year transformation rose from about 1% with no factor to 11% with one, 22% with two, 34% with three and about half with four or more. The choroidal nevus page explains both systems for patients.

Routine referral

• Choroidal nevi with one or two risk factors (MOLES 1–2), for baseline multimodal imaging and a follow-up plan; published guidance suggests re-imaging such lesions every 4–6 months at first.
• Benign-appearing lesions that need documentation or a second opinion — for example a stable conjunctival or iris nevus, congenital hypertrophy of the retinal pigment epithelium (CHRPE) or a small, stable eyelid lesion.
• Atypical pterygium or pinguecula — temporal only, leukoplakic, unusually vascular or quickly recurrent — to exclude OSSN.
• Cataract in eyes treated for an intraocular tumor and other complex lens surgery — see complex cataract surgery.

Before you refer

• Please avoid incisional biopsy of a suspected nodular conjunctival melanoma or of a well-circumscribed lacrimal gland mass that may be a pleomorphic adenoma; both should be excised intact.
• In a child with suspected retinoblastoma, prefer MRI to CT, and do not biopsy the eye.
• Send every excised pterygium for histopathology: unsuspected OSSN has been reported in 1.7–9.8% of specimens.
• If an intraocular tumor cannot be excluded — for example when the fundus is not visible — obtain an ultrasound before any evisceration.

What to send with a referral

• Patient details, contact information and preferred language, and the question you would like answered.
• History: onset and timeline of symptoms, previous eye treatment, previous cancers, relevant family history (for example retinoblastoma, uveal melanoma or BAP1-related tumors), general health and medicines.
• Visual acuity and intraocular pressure of both eyes.
• Dated imaging: wide-field color fundus photographs; A- and B-scan ultrasound with thickness and largest basal diameter; OCT; fundus autofluorescence; angiography if performed. For surface lesions, slit-lamp photographs including everted lids and fornices, and anterior segment OCT. For orbital lesions, MRI or CT.
• Earlier images for comparison — documented change is often decisive.
• Pathology reports, operative notes and details of previous treatment; where possible, slides or blocks for review.
• For children: red reflex findings, family photographs showing leukocoria and any RB1 genetic results.

Please send scans as DICOM files or full-resolution images through a secure cloud link rather than screenshots, and share records with the patient's consent (see the privacy notice). The tests themselves are described on the page about eye tumor diagnosis.

Shared care and reports back

After the consultation you are informed of the examination and imaging findings, the working diagnosis, the options discussed with the patient, and the recommended plan and follow-up interval. Where it suits the patient, follow-up examinations and imaging can take place with you and be sent for remote review, so that the patient does not need to travel for every visit.

Prof. Türkoğlu evaluates each case and plans treatment with the patient. Where a method needs specialized facilities — plaque brachytherapy, proton or stereotactic radiotherapy, intra-arterial chemotherapy or systemic therapy — it is delivered together with the relevant specialist teams, and you are informed of the plan.

How to reach the practice

For urgent cases, call or send a WhatsApp message and say that the referral is urgent. Routine referrals and images can be sent by e-mail. Correspondence can be in English or Turkish.