Shiny white structures

From dermoscopedia

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 Editor: Ralph P. Braun

 Author(s): Ralph P. Braun     ·  Katrin Kerl
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Description In this chapter we describe cristalline structuresChristalline structures, are white shiny linear streaks that are seen under polarized dermoscopy, but not under nonpolarized dermoscopy. The white streaks are oriented parallel, and sometimes also orthogonal (perpendicular) to each other. Chrysalis structures can be seen in scars, dermatofibromas, basal cell carcinomas, and also in melanomas and Spitz nevi. These structures correlate histopathologically with altered collagen in the dermis (fibrosis). The birefringent properties of collagen bundles causes rapid randomization of polarized light and this is, why collagen appears bright white and more conspicuous under polarized dermoscopy. and its histopathological correlation
Author(s) Ralph P. Braun · Katrin Kerl
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Bright, white, shiny appearing structuresThis glossary term has not yet been described. that are visible under polarized dermoscopyThe examination of [skin lesions] with a 'dermatoscope'. This traditionally consists of a magnifier (typically x10), a non-polarised light source, a transparent plate and a liquid medium between the instrument and the skin, and allows inspection of skin lesions unobstructed by skin surface reflections. Modern dermatoscopes dispense with the use of liquid medium and instead use polarised light to cancel out skin surface reflections. and can take on different morphologies, including: shiny white streaksWhite lines that appear parallel and perpendicular to each other on polarized dermoscopy, shiny white blotches and strandsWhite structures in the form of circles, oval structures, or large structureless areas that are bright-white longer and less well defined lines oriented parallel or distributed haphazardly, or forming blotches (shiny white clods). Seen only under polarized dermoscopy. (shiny white areasThis glossary term has not yet been described.), and rosettesFour bright white dots or clods arranged together as a square (or a four leaf clover) [1]. Some authors don't make the distinction between them and refer to all of them as "shiny white structuresThis glossary term has not yet been described.".

Shiy white structures schematic 28.jpg
  • Shiny white streaksWhite lines that appear parallel and perpendicular to each other on polarized dermoscopy

Christalline structures are white shiny linear streakslines radial (always at periphery) streaks Reed nevus melanoma recurrent nevus that are seen under polarized dermoscopy, but not under nonpolarized dermoscopy. The white streaks are oriented parallel, and sometimes also orthogonal (perpendicular) to each other. Chrysalis structuresolt term for Chrysalis / Cristalline Structures can be seen in scars, dermatofibromas, basal cell carcinomas, and also in melanomas and Spitz neviThis glossary term has not yet been described.. These structures correlate histopathologically with altered collagen in the dermis (fibrosis). The birefringent properties of collagen bundles cause rapid randomization of polarized lightThis glossary term has not yet been described.. This is the reason collagen appears bright white and more conspicuous under polarized dermoscopy [2].

An example of shiny white lines as they appear in polarized (right image) as opposed to non-polarized dermoscopy (left image):

Npd vs pd blue veils.JPG

  • Shiny white blotches and strandsWhite structures in the form of circles, oval structures, or large structureless areas that are bright-white longer and less well defined lines oriented parallel or distributed haphazardly, or forming blotches (shiny white clods). Seen only under polarized dermoscopy. / Shiny white areasThis glossary term has not yet been described.

These are discrete, white shiny clods (blotches) or larger structureless areas or long thick or thin linesstreaksThis glossary term has not yet been described., randomly distributed or parallel, and not orthogonally oriented (Strands). Like shiny white streaks these structures have been associated with collagen alterations, such as fibrosis, in the underlying stroma [3].

  • RosettesFour bright white dots or clods arranged together as a square (or a four leaf clover)

Rosettes (also known as ‘four-clod dotsDots are small, round structures of less than 0.1 mm in diameter that have a red color when corresponding to blood vessels; however, when due to melanin, their color ranges from black, brown, to blue-gray depending on the depth and concentration of the melanin in the skin (Tyndall effect).’) are defined as four white points, arranged as a four leaf clover. They are not lesion-specific and are described in many tumoral and inflammatory lesions, including: scars, dermatofibromaDermatofibromas are hard solitary slow-growing papules (rounded bumps) that may appear in a variety of colours, usually brownish to tan; they are often elevated or pedunculated. A dermatofibroma is associated with the dimple sign; by applying lateral pressure, there is a central depression of the dermatofibroma., actinic keratosisActinic keratosis (also called solar keratosis and senile keratosis; abbreviated as AK) is a pre-cancerous patch of thick, scaly, or crusty skin., squamous cell carcinomaThis glossary term has not yet been described. and melanomaThis glossary term has not yet been described. and more. Smaller rosettes are mainly caused by polarizing horny material at infundibular level in adnexal openings and larger rosettes mainly by concentric perifollicular fibrosis [4].


Rosettes.jpg


ReferencesThis is material contained in a footnote or bibliography holding further information.
  1. Liebman et al.: White shiny structures: dermoscopic features revealed under polarized light. J Eur Acad Dermatol Venereol 2012;26:1493-7. PMID: 22035217. DOI.
  2. Verzi et al.: The diagnostic value and histologic correlate of distinct patternsThis glossary term has not yet been described. of shiny white streaks for the diagnosisis the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines with variations in the use of logic, analytics, and experience to determine "cause and effect". In systems engineering and computer science, it is typically used to determine the causes of symptoms, mitigations, and solutions of melanoma: A retrospective, case-control study. J. Am. Acad. Dermatol. 2018;78:913-919. PMID: 29138058. DOI.
  3. Navarrete-Dechent et al.: Association of Shiny White Blotches and Strands With Nonpigmented Basal Cell Carcinoma: Evaluation of an Additional Dermoscopic Diagnostic Criterion. JAMA Dermatol 2016;152:546-52. PMID: 26792406. DOI.
  4. Haspeslagh et al.: Rosettes and other white shiny structures in polarized dermoscopy: histological correlate and optical explanation. J Eur Acad Dermatol Venereol 2016;30:311-3. PMID: 25786770. DOI.