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Abstract

Spindle cell tumour of Reed is a benign melanocytic 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 typically 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 dermatology doctors.2 The main dermoscopic patterns (when observed under magnification using a dermatoscope) observed are the starburst pattern (50.6% of cases), pattern of dotted vessels (19.3%), globular pattern (17%) and atypical pattern (9.0%).3 Figure 1A illustrates a 7 mmx5 mm symmetrical 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 (figure 2A,B). 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 or growth, or is nodular in nature, in order to rule out atypical Spitzoid tumour or Spitzoid melanoma.3
1
TsoS, etal. BMJ Case Rep 2017. doi:10.1136/bcr-2017-222002
DESCRIPTION
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-
tology doctors.2
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
pattern (9.0%).3
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
(figure 2A,B).
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 ofReed
Simon Tso,1 William Hunt,1 Joanna E Gach1,2
Images in…
To cite: TsoS, HuntW,
GachJE. BMJ Case Rep
Published Online First:
[please include Day Month
Year]. doi:10.1136/bcr-2017-
222002
1Department of Dermatology,
University Hospitals Coventry
and Warwickshire NHS Trust,
Coventry, UK
2Department of Dermatology,
Birmingham Women’s and
Children’s NHS Foundation Trust,
Birmingham, UK
Correspondence to
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.
Patient’s perspective
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.
2TsoS, etal. BMJ Case Rep 2017. doi:10.1136/bcr-2017-222002
Learning points
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
the child.
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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
granted.
REFERENCES
1 Yoradjian A, Enokihara MM, Paschoal FM. Spitz nevus and Reed nevus. An Bras
Dermatol 2012;87:349–59.
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
2017;177:645–55.
ResearchGate has not been able to resolve any citations for this publication.
Article
Full-text available
Spitz and Reed nevi, also called spindle and/or epithelioid cell nevi, are a special group of melanocytic lesions due to their peculiar clinical, dermoscopic and histopathological features. The study of these nevi is of great interest because both their nomenclature and classification are still a matter of discussion. Most importantly, the difficulty to differentiate them from melanoma can lead to inadequate therapies. In this context, dermoscopy, a link between clinical and anatomopathological examinations, appears as a helpful diagnostic tool whose accuracy can reach 93%. "Borderline" lesions are still a great challenge and object of research, including molecular studies. The present study explores the relevant characteristics of these nevi, with emphasis on dermoscopic findings, aiming at understanding their natural history, as well as discussing treatment and patient follow-up.
Article
Spitzoid lesions represent a challenging and controversial group of tumours, in terms of clinical recognition, biologic behavior and management strategies. Although Spitz naevi are considered benign tumours, their clinical and dermoscopic morphologic overlap with spitzoid melanoma renders the management of spitzoid lesions particularly difficult. The controversy deepens because of the existence of tumours that cannot be safely histopathologically diagnosed as naevi or melanomas (atypical Spitz tumours). The dual objective of the present study was to provide an updated classification on dermoscopy of Spitz naevi, and management recommendations of spitzoid looking lesions based on a consensus among experts in the field. After a detailed search of the literature for eligible studies, a data synthesis was performed from 15 studies on dermoscopy of Spitz naevi. Dermoscopically, Spitz naevi are typified by 3 main patterns: starburst pattern (50.6%), a pattern of regularly distributed dotted vessels (19.3%) and globular pattern with reticular depigmentation (17.0%). A consensus-based algorithm for the management of spitzoid lesions is proposed. According to it, dermoscopically asymmetric lesions with spitzoid features (both flat/raised and nodular) should be excised to rule out melanoma. Dermoscopically symmetric spitzoid nodules should also be excised or closely monitored, irrespectively of the age, to rule out atypical Spitz tumours. Dermoscopically symmetric flat spitzoid lesions should be managed according to the age of the patient. Finally, the histopathologic diagnosis of atypical Spitz tumour should warrant wide excision but not a sentinel lymph node biopsy. This article is protected by copyright. All rights reserved.
Article
The Reed naevus or pigmented spindle cell naevus of Reed (PSCN) was previously considered a pigmented variant of the spindle cell-type of Spitz naevus. It is now considered a distinct entity and may overlap with cutaneous melanoma in both clinical and dermatoscopic features. We hypothesised that PSCN is an under-recognised entity in Australia and present a typical case. To test our hypothesis, we performed a clinically based survey of Australian dermatology trainees (Registrars). A further aim of our study was to determine the approach of dermatology trainees in this country to the management of this type of lesion. A web-based survey questionnaire based on the presented case was circulated to trainees of the Australasian College of Dermatologists. Responses, including level of training and initial approach to management, were collated and form the basis of the results presented herein. Of 39 respondents, 13 (33%) diagnosed the lesion as PSCN. The majority (33/39; 84.6%) indicated they would biopsy the lesion, with most of these (91%) preferring excisional biopsy. The results support our hypothesis that PSCN is under-recognised in Australia. The results also show that despite difficulty distinguishing this lesion, management of these lesions by dermatology trainees in Australia is consistent and parallels current recommendations.