Granularity / Peppering
Granularity (also known as “peppering”) is defined as accumulation of multiple very small (<0.1 mm), nondescript, blue-grey dots. If a large area shows dense, confluent granularity, it is difficult to distinguish from blue-white veil, however, clinically, granularity often is seen in macular portions of the lesion, while blue-white veil is seen in palpable areas. Histopathologically, granularity correlates with melanin in the superficial dermis, either as fine melanin particles in melanophages or extracellular “dust-like” particles. When granularity is encountered in nevi it tends to encompass less than 10% of the lesion’s surface area. In contrast, in melanoma the granularity often encompasses more than 50% of the lesion’s surface area.