The authors present the clinical, mammographic, and pathologic findings in seven patients with radial sclerosing lesions (RSLs) who had a nonpalpable stellate lesion at mammography. Although the radiographic findings were suggestive of RSL in six of seven patients, diagnostic excisional biopsy was recommended for all. One RSL had associated microcalcifications localized in contiguous adenosis. The authors did not find this a useful criterion to differentiate RSL from carcinoma. Similarly, the presence of either a lucent or dense central core was not radiographically diagnostic. Surgical excision of these stellate lesions is therefore required.