Blue nevus with a starburst pattern on dermoscopy

Area of Science:

• Dermatology
• Dermatopathology
• Oncology

Background:

• Pigmented skin lesions in children can present diagnostic challenges.
• Blue nevi and Reed/Spitz nevi share some clinical and dermoscopic features.
• Accurate diagnosis is crucial for appropriate patient management.

Purpose of the Study:

• To describe a pediatric case with a challenging diagnosis between blue nevus and Reed/Spitz nevus.
• To correlate dermoscopic findings with histological examination in a rare pediatric lesion.
• To emphasize the importance of histological analysis in differentiating similar-appearing melanocytic neoplasms.

Main Methods:

• Clinical presentation of an 11-year-old girl with a blue-gray papule.
• Dermoscopic examination revealing homogeneous pigmentation with starburst pattern.
• Surgical excision and subsequent histopathological analysis of the lesion.

Main Results:

• Dermoscopy showed features suggestive of both blue nevus and Reed/Spitz nevus.
• Histopathology revealed spindle cells with melanin in the dermis, arranged symmetrically.
• Epidermal involvement was absent, and diffuse fibrosis was noted.
• Final diagnosis was confirmed as blue nevus.

Conclusions:

• Histopathological examination is essential for definitive diagnosis of ambiguous pigmented lesions.
• The starburst pattern, while often associated with Reed/Spitz nevi, can be present in other melanocytic lesions.
• This case underscores the importance of integrating clinical, dermoscopic, and histopathological data for accurate diagnosis in pediatric dermatology.