Milky red globules / areas

From dermoscopedia

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 Editor: Ralph P. Braun

 Author(s): Ralph P. Braun
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Description Describes dermoscopy of milky red globules / areas
Author(s) Ralph P. Braun
Responsible author Ralph Braun→ send e-mail
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Status update June 29, 2017
Status by Ralph P. Braun


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Milky red globules[1] are, as their name suggests, globules with a milky reddish coloring. These vascular structures may be observed within or near areas with a milky red color [2].

Milky red globules schematics.jpg




Differential diagnosis
Although milky red globules are not seen frequently, when present, they are highly suggestive of invasive melanoma [3]. They may be valuable in the recognition of thicker amelanotic/hypomelanotic melanoma (AHM), which often do not have many noticeable or identifying features. In AHM, milky red globules/red areas were reported in 31% of thin melanomas (1mm) and in 93.3% of thick melanomas (1mm), as compared with 17.3% and 9.1% of amelanotic /hypomelanotic benign melanocytic lesions and amelanotic/hypomelanotic non-melanocytic lesions, respectively. In another study, 4.7% of melanomas with vascular structures on dermoscopy contained milky red globules/areas, correlating with a PPV of 77.8%; only 0.5% of nonmelanoma lesions had these structures. Vascular blush, also known as erythematous blush, pink veil, or milky red areas, represents a red or pink region that corresponds to an area with increased vascularity. Thus, vascular blush can be seen in lesions, such as dermatofibromas, vascular tumors, such as pyogenic granulomas, inflammatory lesions, and both melanoma and nonmelanoma skin cancers. Although vascular blush can be seen in nevi, it tends to be more common and conspicuous in melanoma.




References:

  1. An Atlas of Dermoscopy, Second Edition. Marghoob A. et al. CRC Press; 2012.
  2. Argenziano et al.: Vascular structures in skin tumors: a dermoscopy study. Arch Dermatol 2004;140:1485-9. PMID: 15611426. DOI.
  3. Braun et al.: Dermoscopy: what's new?. Clin. Dermatol. 2009;27:26-34. PMID: 19095151. DOI.