Reed nevus
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Reed nevus (Eng. Reed nevus) is a particular type of benign melanocytic nevus that is characterized by intense pigmentation and rapid growth in the initial phase of development. This lesion was first described by dermatopathologist Richard J. Reed and is classified among variants of pigmented nevi derived from melanocytes – the cells that produce melanin. Clinically, Reed nevus usually appears as a dark, almost black papule or patch with well-demarcated borders. It most often occurs in children and young adults, particularly on the lower extremities. Due to its intense coloration and characteristic dermatoscopic structure, this lesion may resemble melanoma, which is why correct dermatological diagnosis is of key importance.
Reed nevus – what is it?
Reed nevus is a variant of a heavily pigmented melanocytic nevus belonging to the group of Spitz nevi. In the dermatological literature it is often described as the pigmented variant of Spitz nevus, differing, however, in certain clinical and histopathological features. The lesion arises as a result of local proliferation of melanocytes within the epidermis and the superficial layers of the dermis.
Typical clinical features of Reed nevus include:
- dark coloration – from dark brown to almost black,
- small size – usually from a few millimeters to about 1 cm,
- symmetrical shape, most often round or oval,
- well-demarcated borders,
- smooth surface or a slightly elevated papule.
This nevus most commonly appears in:
- children,
- adolescents,
- young adults.
The most common locations are:
- lower extremities, particularly the thighs and lower legs,
- less commonly the trunk,
- rarely the upper limbs.
On dermatoscopic examination Reed nevus shows a characteristic starburst pattern. It consists of radially arranged streaks of pigment radiating from the central part of the lesion. This structure results from the proliferative activity of melanocytes and their distribution in the epidermis.
Histopathologically the lesion is composed of:
- heavily pigmented melanocytes,
- spindle-shaped cells,
- nests of cells located mainly in the epidermis.
Although Reed nevus is a benign lesion, its rapid growth and intense pigmentation mean that it often requires careful dermatological and dermatoscopic assessment, and in some cases also surgical removal for histopathological verification.
Reed nevus and melanoma
One of the most important diagnostic problems related to the Reed nevus is its differentiation from malignant melanoma (melanoma malignum). Due to its very dark pigmentation and dynamic development, this lesion can clinically resemble the early stage of melanoma, which raises justified concerns among both patients and physicians.
The most important differences between Reed nevus and melanoma include:
| Feature | Reed nevus | Melanoma |
|---|---|---|
| Symmetry | usually symmetrical | often asymmetrical |
| Borders | well-defined | irregular |
| Color | uniformly dark | multicolored |
| Growth | rapid but limited | progressive and infiltrative |
| Dermatoscopy | radiating pattern | atypical structures |
In dermatoscopic examination, melanoma may show, among other features:
- an irregular pigment network,
- asymmetrical distribution of structures,
- a variety of colors (black, brown, gray, red),
- irregular areas of regression
By contrast, the classic Reed nevus typically presents a uniform radiating arrangement of pigmented streaks, which is one of the most characteristic diagnostic features.
In clinical practice, several methods are used to assess suspicious nevi:
1. Dermatoscopy
A non-invasive diagnostic method that allows assessment of skin structures not visible to the naked eye. It enables differentiation of many benign nevi from malignant lesions.
2. Videodermatoscopy
An advanced form of dermatoscopy that allows documentation of lesions and comparison over time.
3. Histopathological examination
If diagnostic doubts arise, the lesion is surgically removed and subjected to microscopic analysis. This is the gold standard in melanoma diagnosis.
It is worth emphasizing that the Reed nevus:
- is not a neoplastic lesion,
- does not represent a transitional stage of melanoma,
- does not by itself increase the risk of developing melanoma.
However, any rapidly appearing or changing pigmented lesion should be evaluated by a dermatologist. Particular attention should be paid to signs such as:
- a sudden change in the size or shape of the nevus,
- the appearance of irregular borders,
- bleeding or ulceration,
- marked asymmetry of the lesion.
In such situations, urgent dermatological evaluation is necessary, because early detection of melanoma significantly increases the effectiveness of treatment.
Reed nevus – diagnosis and removal
Diagnosis of a Reed nevus is based primarily on a thorough dermatological examination and dermoscopic evaluation of the lesion. Because of its intense pigmentation and rapid growth in the initial phase of development, this nevus can be clinically difficult to distinguish from melanoma, and therefore often requires detailed specialist assessment. The primary aim of diagnostics is to confirm the benign nature of the lesion and to exclude a malignant skin tumor.
The most important methods used in diagnostics include:
- dermoscopy, which allows assessment of pigmentary structures not visible to the naked eye; the typical appearance for a Reed nevus is a radial arrangement of pigment streaks (the so-called starburst pattern),
- videodermoscopy, enabling documentation of lesions and their monitoring over time,
- histopathological examination, performed after surgical removal of the lesion in cases of diagnostic uncertainty.
In clinical practice, the decision to remove a Reed nevus depends on several factors, such as the dermoscopic pattern, the lesion’s growth dynamics, the patient’s age, and the nevus location. In children and young people, observation with dermatologic follow-up is possible when the dermoscopic pattern is typical. However, if the nevus shows atypical features or undergoes rapid changes, complete removal is most often recommended.
The standard treatment method is surgical excision of the lesion with a small margin of healthy tissue, which allows for a thorough histopathological examination. This method is considered diagnostically the safest because it permits an unequivocal assessment of the cellular structure of the lesion.
For benign pigmented nevi, other methods of removing skin lesions are also used, such as:
- dermatologic laser therapy,
- dermatologic surgical procedures,
- methods of electrocoagulation or skin ablation.
It should be emphasized, however, that for pigmented lesions of uncertain character, surgical removal of the lesion with histopathological assessment is preferred, because destructive methods do not allow full tissue analysis. For this reason, any suspicious or rapidly changing pigmented lesion should be evaluated by a dermatologist, who will select the appropriate diagnostic and treatment method.
