The significance of crystalline/chrysalis structures in the diagnosis of melanocytic and nonmelanocytic lesions

Abstract

BACKGROUND: Crystalline/chrysalis structures (CS) are white shiny streaks that can only be seen with polarized dermatoscopy. OBJECTIVES: We sought to estimate the prevalence and assess the clinical significance of CS in melanocytic and nonmelanocytic lesions. METHODS: This was a prospective observational study in which dermatoscopic assessment of lesions was recorded in consecutive patients examined during a 6-month period. In addition, a data set of biopsy-proven melanomas was retrospectively analyzed. RESULTS: In all, 11,225 lesions in 881 patients were prospectively examined. Retrospectively, 229 melanomas imaged with polarized dermatoscopy were analyzed. In the prospective data set, a median of 12.7 lesions (range, 1-54) were evaluated per patient. None of clinically diagnosed Clark nevi (n = 9750, 86.8%) demonstrated CS. Overall, CS were observed in 206 (1.8%) lesions, most commonly dermatofibromas and scars among nonbiopsied lesions. A total of 265 (2.4%) lesions were biopsied, including 20 melanomas and 36 nevi. Among biopsied malignant lesions, CS were most commonly observed in basal cell carcinoma (47.6%) and invasive melanomas (84.6%). Melanomas were more likely to have CS than biopsied nevi (odds ratio = 9.7, 95% confidence interval 2.7-34.1). In the retrospective data set, CS were more commonly observed among invasive melanomas (41%) compared with in situ melanomas (17%) (odds ratio = 3.4, 95% confidence interval 1.9-6.3, P < .001). The prevalence of CS correlated with increased melanoma thickness (P = .001). LIMITATIONS: Biopsied lesions represent a small percentage of the total number of lesions evaluated. CONCLUSION: Among biopsied malignant lesions, CS are most commonly observed in basal cell carcinoma and invasive melanomas and rarely seen in nevi. In melanoma, CS may reflect increased tumor thickness and progression. (2) Background: Crystalline/chrysalis structures (CS) are white shiny streaks that can only be seen with polarized dermatoscopy.

The “Rainbow Pattern” and “Crystalline Structures” in a Post-Traumatic Scar

“…In addition, in this study, the presence of these structures was associated with other criteria of dermal invasion, such as: blue-gray veil, milky red globules and polymorphic vessels in melanoma or whitish patch in dermatofibromas or homogeneous blue color in blue nevus. The theory that this phenomenon would be an optical artefact by structures found in the dermis took strength with these studies [10][11][12].…”

“…The birefringent properties of the disorganized collagen would result in a greater dispersion of the polarized light and that is why they would be seen in lesions with abundant dermal fibrosis. Nevertheless, a histopathological correlation has not yet been correctly determined [10].…”

Fibroepithelioma of Pinkus: Case Reports and Review of the Literature

“…Based on the current literature the dermoscopic patterns of FeP can be summarized as follows: (1) polymorphous vessels consisting mainly of fine, focused, short arborizing and dotted vessels, the latter mainly located at the periphery of the lesion (17 cases; 85%); (2) short white streaks (15 cases; 75%), also called chrysalis/crystalline structures, are only visible using polarized dermoscopy [17,18,19,20,21], thus not recognizable in our photographs, which were taken with a nonpolarized light source; (3) additional criteria, including milia-like cysts (7 cases; 35%) and ulceration (9 cases; 45%), have been reported but are not specific of FeP [20], and (4) in cases of pigmented FeP, gray-brown areas and gray-blue dots can also be seen (8 cases; 40%) [5]. …”

A guide for dermatology nurses to assist in the early detection of skin cancer

“…It is important to eliminate air bubbles that can reduce imaging quality. [37] Polarized dermoscopy instead uses two polarizers with orthogonal axes to emit cross-polarized light. Cross-polarizing filters preferentially accept light from the deeper layers of the skin, allowing visualization of structures that may not be visible with non-polarized dermoscopy.…”

“…On the other hand, non-polarized dermoscopy may improve specificity for certain skin neoplasm (e.g., seborrheic keratosis) as more superficial skin structures are more easily identified. [37,38] Toggling between polarized and non-polarized dermoscopy using newer generation, hybrid dermatoscopes facilitates identification of structures that may only be seen with one technique, which has been referred to as the "blink sign". [39] However, nurses need a lesion triaging system that will allow for identification of atypical findings with high sensitivity for skin cancer detection.…”