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Reed Naevus — SCE Dermatology MCQ

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HardSkin CancerReed NaevusSCE Dermatology

A new 8 mm dark papule in a 55-year-old has a strikingly symmetric starburst of peripheral streaks on dermoscopy. There are no previous images. What is the safest interpretation and action?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Possible Reed or Spitz naevus, but adult-onset melanoma mimicry warrants excision for histology

Explanation lettering: C = shown as B · B = shown as C · E = shown as D · D = shown as E

C is correct. A symmetric starburst is characteristic of a pigmented Spitz or Reed naevus, but it is not histologically self-validating. In a 55-year-old with a new lesion, melanoma is an important mimic and excision for expert histopathology is appropriate. Symmetry lowers suspicion but does not justify discharge in this age and context. Definitive wide melanoma margins are selected only after diagnostic histology and Breslow staging. Dermatofibroma usually has a peripheral delicate network with a central white patch, while pigmented basal-cell carcinoma shows structures such as blue-grey ovoid nests and arborising vessels. The original item incorrectly treated the dermoscopic pattern as proof of benignity in an older adult.

Reference: PCDS Spitz and Reed naevus guidance: https://www.pcds.org.uk/clinical-guidance/spitz-naevi-including-pigmented-spindle-cell-naevus-of-reed