Incident light microscopy, bluish-white opaque veil

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Blue-white veil; milky way; whitish veil

Definition
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Reflected light microscopic phenomenon as a consequence of reactive compact hyperkeratosis of the stratum corneum, combined with epidermal hypergranulosis.

General information
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Incident light microscopy: An opaque, milky glass-like veil is formed in the incident light microscopic projection plane. A bluish shimmer is produced by light reflection in the area of underlying melanophagus agglomerates (always without transepidermal pigment exudation) or the melanocyte nests (Tydall phenomenon). Accompanying neovascularizations convey reddish color effects.

Occurrence
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Within the group of pigment cell tumors the characteristic of opaque appearing veil-like structures is found with a specificity of more than 95% in malignant melanomas (sensitivity about 30%). This phenomenon rarely occurs in Spitz nevi, blue nevi or recurrent nevi.

Literature
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  1. Bahmer FA, Fritsch P et al (1990) Terminology in surface microscopy. J Am Acad Dermatol 23: 1159-1162
  2. De Giorgi V (2003) Blue hue in the dermoscopy setting: homogeneous blue pigmentation, gray-blue area, and/or whitish blue veil? Dermatol Surgery 29: 965-967
  3. Kreusch J, Rassner G (1991) Reflected light microscopy of pigmented skin tumors. Thieme, Stuttgart New York
  4. Menzies SW, Crotty KH, Ingvar C, McCarthy WH (1996) An atlas of surface microscopy of pigmented skin lesions. McGraw-Hill, Sydney New York San Francisco
  5. Menzies SW (2001) A method for the diagnosis of primary cutaneous melanoma using surface microscopy. Dermatol Clin 19: 299-305
  6. Pizzichetta MA (2004) Amelanotic/hypomelanotic melanoma: clinical and dermoscopic features. Br J Dermatol 150: 1117-124
  7. Proud W, Braun-Falco O, Bilek P, Landthaler M, Burgdorf WHC, Cognetta AB (2002) Color atlas of dermatoscopy. Blackwell, Berlin Vienna

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Last updated on: 29.10.2020