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Melanocytic naevus · Spitz familyICD-10 D22

Pigmented spindle cell naevus of Reed

Reed's naevus; pigmented Spitz naevus; Reed's pigmented spindle cell naevus

The pigmented spindle cell naevus of Reed is a benign melanocytic neoplasm within the Spitz family — sharing molecular features (HRAS, BRAF, ALK, ROS1, NTRK kinase fusions) with classic Spitz naevus, atypical Spitz tumour and Spitzoid melanoma. Clinically it is a strikingly dark brown to black, well-circumscribed, often heavily pigmented papule that develops rapidly over months to years, classically on the lower limbs of young women. Dermoscopy shows a characteristic starburst pattern with symmetric peripheral streaks. Despite its alarming pigmentation and rapid growth — both melanoma "red flags" — Reed's naevus is benign in the great majority of cases. Excisional biopsy with histological assessment is recommended in adults to confirm the diagnosis and exclude pigmented Spitzoid melanoma.

CurrentLast reviewed 26 April 2026

Clinical features

  • Solitary, well-demarcated, dark brown to jet-black, smooth-surfaced papule, usually 3–8 mm diameter.
  • Predilection sites — lower limbs (especially the thigh and calf), buttocks; less often upper limbs and trunk.
  • Rapid development over months — patient may report it appearing or enlarging quickly.
  • Median age 25–35; F:M ~3:1.
  • The clinical features (rapid growth, dark colour) overlap melanoma — a melanoma cannot be excluded clinically.

Dermoscopy

  • Starburst pattern — characteristic; symmetric peripheral streaks / pseudopods radiating from a heavily pigmented central area.
  • Globular pattern — also acceptable; symmetric peripheral globules.
  • Multicomponent / asymmetric / irregular pattern — atypical; concerning for melanoma; excise.
  • Caveat: in adults, even classic starburst pattern lesions deserve excisional biopsy, since pigmented Spitzoid melanoma can closely mimic Reed's naevus.

Histology & molecular

  • Symmetric, well-circumscribed melanocytic proliferation centred on the dermo-epidermal junction.
  • Heavily pigmented spindled and epithelioid melanocytes in nests at the junction; intracytoplasmic and stromal melanin abundant.
  • Pagetoid scatter usually limited; mitoses few; deep maturation present.
  • "Kamino bodies" (eosinophilic globules) — characteristic of the Spitz family.
  • Driver alterations — HRAS mutation, BRAF mutation; or kinase fusions (ALK, ROS1, NTRK1, MAP3K8) — same molecular families as classical Spitz naevus.
  • Differential: classical Spitz naevus (less pigment), atypical Spitz tumour (atypical features), pigmented Spitzoid melanoma (atypia, pagetoid spread, deep mitoses, lack of maturation), pigmented BCC, melanoma.

Management

  • Excisional biopsy with 1–2 mm clinical margin and full histology — recommended in adults given clinical / dermoscopic overlap with pigmented Spitzoid melanoma.
  • Re-excision to clear margins for any equivocal / atypical histological features.
  • In children, photographic and dermoscopic surveillance is acceptable for a clinically and dermoscopically classical lesion (well-circumscribed starburst pattern, age <12); excisional biopsy if any change.
  • Consider molecular profiling (ALK, ROS1, NTRK FISH; CGH array) for histologically equivocal lesions through specialist dermatopathology service.

Prognosis

Excellent — the lesion is benign. The principal clinical issue is the diagnostic overlap with melanoma, and the recommendation to biopsy adults reflects this rather than any clinically significant malignant potential of true Reed's naevus.

References

  1. Reed RJ et al. Common and uncommon melanocytic nevi and borderline melanomas. Semin Oncol; 1975.
  2. Ferrara G et al. Reed's naevus and pigmented Spitz naevus — clinicopathological correlation. Dermatology; 2007.

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