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Description In this chapter we describe the dermoscopy term structureless areas and their histopathological correlation including regular blotches, irregular blotches
Author(s) Katrin Kerl · Oriol Yélamos · Ralph P. Braun
Responsible author Ralph Braun→ send e-mail
Status unknown
Status update August 1, 2019
Status by Ralph P. Braun

Areas within a lesion that are devoid of any network or other structures, such as globules or regression structures (i.e., scars, peppering, granularity, or blue-white veil over flat areas), are called “structureless areas”. Their size should be at least 10% of the lesions's total surface area. Structureless areas can be hypopigmented, hyperpigmented or regularly pigmented.

Hyperpigmented structureless areas

A blotch is defined as an area with a size that is at least 10% of the lesion’s surface area and is heavily pigmented. In a blotch the melanin pigment is often present throughout the skin, including the stratum corneum, epidermis, and the dermis [1]. The dark pigment in a blotch visually obscures the ability to discern any underlying structures [2]. Blotches can be regular or irregular.

Regular hyperpigmented structureless areas

Peripheral reticuler central hyperpigmentation schematic.jpg

Regular blotches are defined as those that display symmetry, regular borders,homogenous dark hue, and are located within the center of the lesion. A pigment network often surrounds a regular blotch. Regular blotches are associated with nevi.

Regular blotch.jpg

Regular blotches can be seen in “activated” nevi and are attributed to heavy melanin concentrations in the stratum corneum. Because the pigment is concentrated in the stratum corneum, it can easily be stripped off using a tape-stripping procedure, thereby revealing underlying structures.

Irregular hyperpigmented structureless areas

Atypical blotch 37.jpg

Irregular blotches are defined as those that are asymmetric, have irregular contours, are located off center, and/or display multiple dark hues (i.e., heterogenous dark hues). Irregular blotches are associated with melanoma or dysplastic nevus.

Irregular blotch.jpg
Irregular blotch histopathology.jpg

Hypopigmented sctructureless areas

Hypopigmented structureless areas have a lighter pigment compared with the rest of the lesion; however, they manifest the same or slightly more pigment compared with the surrounding normal skin (N.B.: structureless areas that are hyperpigmented are called blotches). Focal structureless areas within a lesion are a common finding in nevi.

Nevus central hypopigmentation.jpg

In contrast, focal tan to light brown structureless areas at the periphery of a melanocytic lesion is commonly associated with melanoma. Peripherally located structureless areas in melanoma tend to have a light brown to fawn color and tend to end abruptly at the edge of a lesion. Histologically, these areas are characterized by flattening of the DEJ (loss of the undulating pattern of rete ridges and dermal papillae) and scattering of atypical melanocytes in suprabasal epidermal layers (i.e., pagetoid cells).

Melanoma displaying tan structuresless area

  1. Yadav et al.: Histopathologic correlates of structures seen on dermoscopy (epiluminescence microscopy). Am J Dermatopathol 1993;15:297-305. PMID: 8214386.
  2. Kittler et al.: Standardization of terminology in dermoscopy/dermatoscopy: Results of the third consensus conference of the International Society of Dermoscopy. J. Am. Acad. Dermatol. 2016;74:1093-106. PMID: 26896294. DOI.
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