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November 19, 2013 / molehunter

Is that a blue-white veil?

An issue that comes up quite often with new dermoscopists is the issue of the blue white (or blue grey) veil. When seen in the context of a clear cut melanocytic lesion, as evidenced by reticular network, brown globules or other features, a genuine blue white veil is very specific for melanoma. Its an important sign.

 

However, a similar hue can often be seen on benign lesions.

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This nodule (you can see its elevated from the shadow on the bottom right) is a bit irregular and pigmented. not quite sure what it is, so lets get the ‘scope to it.

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To the experienced dermoscopist, no sooner has the light from this image hit your retina than you make a confident diagnosis of a haemangioma. ‘Lacunae of blood in a fibrous stroma (or lattice) as a global feature’ is a concise and accurate description which seals the diagnosis. But what colours are present?

I can see red, white and an out of focus blue and mauve which might diagnose as a blue white veil. Again, the whitish lattice (the fibrous stroma which enclosed the spaces that make the lacunae (‘little lakes’) of blood could possibly be misinterpreted as the reverse pigment network I mentioned in recent posts.

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Can you see why (A) this really is a haemangioma, and (B) how a beginner might get slightly confused? This is where experience comes in, looking at lots and lots of lesions with an experienced tutor and getting into the habit of using the correct descriptive terms.

key learning point there are global features of a haemangioma here (lacunae of blood in a fibrous stroma) and absent features of melanocytic lesion, therefore a bit of what looks like a blue white veil can be discounted.

homework look up dermoscopy + blue grey (or blue white) veil on Google images and learn the difference.

 

 

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