Blue Hue in the Dermoscopy Setting: Homogeneous Blue Pigmentation, Gray-Blue Area, and/or Whitish Blue Veil?

Abstract

In dermoscopy, the correct recognition of the single parameters is fundamental to achieve great diagnostic accuracy, but the scarce morphologic expression of a parameter may lead to diagnostic errors. We report the case of a 27-year-old white man presenting a pigmented lesion of the back, which was present since puberty. Clinical examination revealed on the back the presence of a flat, gray-blue lesion and at the periphery a small dark-brown papule. An assessment of the lesion by means of dermoscopy was performed. The purpose of this report was to analyze the Blue Hue in dermoscopy with its histopathologic correlates, starting with the discussion of a clinical case.

Grey-Blue Regression in Melanoma In Situ—Evaluation on 111 Cases

“…Dermoscopically, grey-blue areas and the blue-whitish veil are difficult to distinguish, and this causes a low reproducibility in the identification of these features [12–16, 19–23]. Therefore, they are generally considered together and described by the unifying definition of blue structures [24]. …”

Diving into the blue: In vivo microscopic characterization of the dermoscopic blue hue

“…Although it was demonstrated that blue areas and blue-whitish veil correspond to two different histopathologic substrates, 9 in the international dermoscopic terminology they were unified into the definition of ''blue-white structures,'' which include any type of blue and/or white coloration, owing to the poor interobserver reproducibility 4,14 and to the possibility of mistakenly classifying a not clearly classifiable blue pigmentation. 32 In our cases, too, the distinction between blue area and bluewhitish veil showed a poor interobserver reproducibility, obtaining discordant evaluations in 19% of cases. RCM is a new in vivo technique, which permits the visualization of the skin at a limited depth but at a quasihistologic resolution.…”

Management and Dermoscopy of Fast-Growing Nevi in Pregnancy: Case Report and Literature Review

“…7,8 The blue-whitish veil was the only criterion suggesting a nodular highly pigmented melanoma, as previously described. 9 With regard to the whitish streaks described by Argenziano and colleagues, 10 this dermoscopic criterion is also found in pigmented Spitz or/and Reed nevi and in melanoma. Pigmented Spitz nevus is a benign melanocytic lesion sometimes simulating nodular melanoma that may grow quickly, independently of pregnancy, and it was considered in the differential diagnosis.…”