Regression structures / Blue white structures

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 Authored by: Ralph P. Braun     ·  Katrin Kerl

 Keywords:   blue white structures · regression · granularity · blue white veil
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Description In this chapter we describe blue white structuresclick here for a definition [[Blue white structures]] network and its histopathological correlation
Author(s) Ralph P. Braun · Katrin Kerl
Owner Ralph Braun→ send e-mail
Status released
Status update May 27, 2017
Status by Ralph P. Braun
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RegressionThis glossary term has not yet been described. structures appear dermoscopically as:

  • white scar-like depigmentationArea of white that is whiter than surrounding normal skin (true scarring). It should not be confused with hypo- or depigmentation due to simple loss of melanin. Shiny white structures and blood vessels are not seen in areas of regression. (lighter than the surrounding skinThis glossary term has not yet been described.)
  • “peppering” (speckled multiple blue-gray granules)

On histopathologyThis glossary term has not yet been described. fully evolved regressionThis glossary term has not yet been described. shows fibrosis and melanosis (infiltrate of melanophages), and sparse lymphocytic infiltrates. The normal undulating DEJ pattern formed by rete ridges and dermal papillae is attenuated to completely Flattened. Regression structures consisting of both scar like depigmentation and peppering (granularityThis glossary term has not yet been described.) should raise suspicion for melanomaThis glossary term has not yet been described.. Regression structures consisting of only peppering can be seen in melanoma, lichen planus like keratosisThis glossary term has not yet been described. and neviThis glossary term has not yet been described.. In lichen planus like keratosis the granularity tends to be coarse and diffusely distributed. In melanocyticThis glossary term has not yet been described. lesions the granularity tends to be finer and focally distributed.

White scar-like depigmentation

corresponds to a white discoloration of the lesion, which is lighter than the surrounding normal skin.On histopathology, this dermoscopic structure correlates with fibrosis.
Scarlike depigmentation peppering 28.jpg

GranularityThis glossary term has not yet been described.

Granularity (also known as “peppering”) is defi ned as accumulation of multiple very small (<0.1 mm), nondescript, blue-grey dotsThis glossary term has not yet been described.. If a large area shows dense, confluent granularity, it is diffi cult to distinguish from blue-white veil, however, clinically, granularity often is seen in macular portions of the lesion, while blue-white veil in palpable areas. Histopathologically, granularity correlates with melanin in the superficialThis glossary term has not yet been described. 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.
Confluent peppering scarlike 27.jpg

Blue-White Veil

Blue-white veil is confluent blue pigmentation with an overlying white “ground-glass” haze. In melanoma, the bluewhite veil does not occupy the entire surface area of the lesion, but rather is present as a focal, ill-defined area. Histopathologically, this dermoscopic structure corresponds to an aggregation of heavily pigmented cells (melanocytes and/or melanophages) or melanin in the dermis (blue colorColor (American English) or colour (Commonwealth English) is the characteristic of human visual perception described through color categories, with names such as red, yellow, purple, or blue.) in combination with compact orthokeratosis . At times, it is difficultThis glossary term has not yet been described. to distinguish between regression structures (namely melanosis) and blue-white veil by dermoscopyDermoscopy is a non invasive diagnostic method. because both structures display blue-white color. However, examining the lesion without dermoscopy can help differentiate between blue-white color due to regression versus due to deep melanocytes. In regression the surface contour will be flat (macular) and in blue-white veil the surface will be raised and palpable. In melanoma the blue-white veil is nonuniform in color and is present focally within the lesion. In contrast, the blue-white veil has a uniform steel-blue color in blue nevi and it occupies the entire surface area of the lesion.

Blue whitish veil 26.jpg