Spitz Naevus — SCE Dermatology MCQ

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ModerateSkin CancerSpitz NaevusSCE Dermatology

A 52-year-old man presents with a painless firm papule on his nose. Dermoscopy shows a starburst pattern with symmetrically distributed peripheral streaks/pseudopods. What is the most likely diagnosis?

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Correct answer: B — Spitz naevus (Reed naevus variant)

The starburst pattern — characterised by symmetrically distributed peripheral streaks or pseudopods radiating from a central homogeneous pigmented area — is the characteristic dermoscopic pattern of a Spitz/Reed naevus. The key differentiating factor from melanoma is the SYMMETRY of the peripheral structures. In melanoma, pseudopods and radial streaming are asymmetrically distributed. However, the starburst pattern can evolve over time, and in adults (particularly >40 years), the threshold for excision should be low as melanoma can mimic Spitz naevus. Excision biopsy is prudent for new or changing spitzoid lesions in adults.

Reference: BAD 2016 Dermoscopy Guidelines; Argenziano