OSCE — Spitz naevus (spindle and epithelioid cell naevus)

Brief (to candidate)

You will assess a patient with a presentation consistent with Spitz naevus (spindle and epithelioid cell naevus).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Spitz naevus is a benign acquired melanocytic naevus of childhood and adolescence composed of large spindled and epithelioid melanocytes, presenting most often as a rapidly growing pink, hairless, dome-shaped papule. Histology shows spindled/epithelioid melanocytes, Kamino bodies, symmetry, and maturation with depth. The central diagnostic challenge is distinguishing benign Spitz naevus from spitzoid melanoma, with the atypical Spitz tumour occupying a borderline zone. Management is complete surgical excision with clear margins.

Candidate tasks

1. Clarify onset, severity, associated features, and red-flag symptoms.
2. State focused examination priorities.
3. List first-line investigations and any named score/criteria.
4. Give immediate resuscitation steps.
5. Outline definitive management with doses/routes where standard.
6. Name complications and disposition (ward / HDU / theatre / discharge safety-net).
7. Mention one special-population modifier (pregnancy, child, elderly, CKD).

Examiner checklist

Model outline

Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.^[1]