**Core Concept**
The management of spontaneous nipple discharge, particularly when bloody and unilaterally originating from a single duct, requires a careful evaluation to rule out underlying malignancy, such as ductal carcinoma in situ (DCIS) or invasive breast cancer. The approach involves a combination of imaging studies, ductal excision, and histopathological examination to establish a definitive diagnosis.

**Why the Correct Answer is Right**
In cases of unilateral, bloody nipple discharge, a high index of suspicion for breast cancer is warranted. The patient's age, duration of symptoms, and the presence of blood in the discharge increase the likelihood of an underlying malignant process. Imaging studies, such as mammography and ultrasound, are essential to assess the breast anatomy and identify any suspicious lesions. Ductal excision with histopathological examination is crucial to obtain a tissue diagnosis, which guides further management.

**Why Each Wrong Option is Incorrect**
**Option A:** This statement might be true, as a thorough history and physical examination are essential in evaluating the patient's symptoms and identifying any potential risk factors for breast cancer.
**Option B:** This statement is also true, as imaging studies are critical in assessing the breast anatomy and identifying any suspicious lesions that may require further investigation.
**Option C:** This statement is incorrect because it suggests that a trial of tamoxifen is an appropriate management strategy for a patient with spontaneous, bloody nipple discharge. Tamoxifen is used in the treatment of hormone receptor-positive breast cancer but is not indicated in the management of spontaneous nipple discharge.
**Option D:** This statement is true, as a ductal excision with histopathological examination is essential to establish a definitive diagnosis and guide further management.

**Clinical Pearl / High-Yield Fact**
In cases of spontaneous nipple discharge, particularly when bloody and unilateral, a high index of suspicion for breast cancer is warranted. A thorough history, physical examination, imaging studies, and ductal excision with histopathological examination are essential in establishing a definitive diagnosis and guiding further management.

**Correct Answer:** C.