TsoS, etal. BMJ Case Rep 2017. doi:10.1136/bcr-2017-222002
Spindle cell tumour of Reed is a benign mela-
nocytic naevus which usually presents as a
deeply pigmented mole. It is more commonly
found on the lower extremities of young girls.
It is an uncommon naevus but its incidence and
prevalence are not known. A Reed naevus typi-
cally goes through a rapid initial growth phrase
before stabilising in size and then regresses
over time.1 Awareness of Reed naevus has been
demonstrated to be low, even among derma-
The main dermoscopic patterns (when
observed under magnification using a derma-
toscope) observed are the starburst pattern
(50.6% of cases), pattern of dotted vessels
(19.3%), globular pattern (17%) and atypical
Figure 1A illustrates a 7 mmx5 mm symmet-
rical deeply pigmented plaque on the right
knee of a 5-year-old girl. Figure 1B shows the
dermatoscopic symmetrical starburst pattern
with regular pigment network. The size and
the extent of pigmentation of the Reed naevus
regressed over a 2-year observation period and
almost disappeared as shown in the photograph
International guidelines recommend that a
flat Reed naevus with symmetrical morphology
may be observed until its growth is stabilised or
the naevus completely disappeared.3 However,
an excision biopsy should be considered if a
skin lesion resembling a Reed naevus occurs in
adulthood or if there is any concern about the
lesion, such as having asymmetrical morphology
A regressing spindle cell tumour ofReed
Simon Tso,1 William Hunt,1 Joanna E Gach1,2
To cite: TsoS, HuntW,
GachJE. BMJ Case Rep
Published Online First:
[please include Day Month
1Department of Dermatology,
University Hospitals Coventry
and Warwickshire NHS Trust,
2Department of Dermatology,
Birmingham Women’s and
Children’s NHS Foundation Trust,
Dr Simon Tso,
simontso@ doctors. org. uk
Accepted 1 November 2017
Figure 1 (A) A 7 mm x 5 mm deeply pigmented spindle
cell tumour of Reed on the right knee. (B) A deeply
pigmented plaque with a starburst pattern.
Figure 2 (A) A regressing Reed naevus. (B) A pale
plaque. Without observing the natural evolution of the
Reed naevus, the white and blue veil sign in (B) alone
could be misinterpreted as melanoma.
Our initial thoughts were to have the skin lump
removed from a parent’s perspective as it was
causing my daughter unnecessary stress and my
concern was, she became conscious of it, that was
unbalancing her in a negative emotional way. On
our ﬁrst visit we had a specialist team look and
examine her which was fantastically reassuring
as a parent. Because of the attention and care we
received, we chose to withhold any excision and
review and monitor it. Over the course of the last
12 months, we saw a real submission of the skin
lump and were very relieved we did not take the
option at surgery.
2TsoS, etal. BMJ Case Rep 2017. doi:10.1136/bcr-2017-222002
►The diagnosis of a Reed naevus should only be made
by dermatologists experienced in skin oncology, and
we recommend that primary care physicians and
non-dermatologists should always refer suspicious or
evolving moles to dermatologists for assessment.
►Clinical diagnosis and expectant management has its place
for the management of a benign Reed naevus in limited
circumstances (ie, morphologically symmetrical and macular
lesions in small children) and our management is in line with
international consensus guidelines and parental preference of
monitoring the lesion.
►The editorial reviewer of our case report recommended
that for purposes of published cases a skin biopsy is very
important to support the diagnosis and rule out atypia,
features of uncertain malignant potential or melanoma.
In absence of skin biopsy, the reviewer
suggests a much longer clinical follow-up to
ensure the stability of the lesion and health of
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or growth, or is nodular in nature, in order to rule out atyp-
ical Spitzoid tumour or Spitzoid melanoma.3
Acknowledgements We would like to thank the reviewer for the constructive
feedback on our submission.
Contributors All authors were involved in the care of the patient. ST prepared
the initial draft of the manuscript. WH and JG revised the draft and contributed to
its important intellectual content. All authors provided ﬁnal approval of the version
published and agreed to be accountable for all aspects of the work.
Competing interests None declared.
Patient consent Guardian consent obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article)
2017. All rights reserved. No commercial use is permitted unless otherwise expressly
1 Yoradjian A, Enokihara MM, Paschoal FM. Spitz nevus and Reed nevus. An Bras
2 Webber SA, Siller G, Soyer HP. Pigmented spindle cell naevus of Reed: a controversial
diagnostic entity in Australia. Australas J Dermatol 2011;52:104–8.
3 Lallas A, Apalla Z, Ioannides D, et al. Update on dermoscopy of Spitz/Reed naevi
and management guidelines by the International Dermoscopy Society. Br J Dermatol