The diagnostic value and histologic correlate of distinct patterns of shiny white streaks for the diagnosis of melanoma: A retrospective, case-control study

J Am Acad Dermatol. 2018 May;78(5):913-919. doi: 10.1016/j.jaad.2017.11.021. Epub 2017 Nov 11.


Background: Shiny white streaks (SWSs) are best visualized with polarized dermoscopy and correlate with dermal fibroplasia histopathologically. SWSs have been described at higher frequencies in melanomas than in benign nevi.

Objective: We assessed the diagnostic value of different patterns of SWSs and their histologic correlate in melanocytic lesions.

Methods: Polarized dermoscopic images of 1507 histopathologically diagnosed melanocytic neoplasms were analyzed for presence and pattern of SWSs. Histology was also reviewed for correlation.

Results: Among 1507 melanocytic neoplasms, SWSs were observed in 31 of 144 melanomas (22%) and 22 of 1363 benign neoplasms (1.6%) (P < .001). The sensitivity and specificity of SWSs for melanoma were 22% and 98%, respectively. Diffuse SWSs exhibited the greatest diagnostic value for melanoma, with sensitivity of 11.8% and specificity of 99.5%. Focal central and peripheral SWSs were comparable in diagnostic significance. The presence of SWSs was highly uncommon in dysplastic nevi, whereas in certain benign subgroups of nevi such as Spitz nevi and atypical genital special site nevi, SWSs were not uncommon. Diffuse SWSs correlated with greater breadth of deep fibroplasia than focal SWSs (P = .009), and SWSs correlated with greater Breslow depth among melanomas (P = .007).

Limitations: This study was retrospective.

Conclusion: Polarized dermoscopy is a valuable diagnostic tool in the identification of SWSs, a feature that is highly specific for melanoma.

Keywords: crystalline/chrysalis structures; dermoscopy; histology; melanoma; nevi; pigmented skin lesions; polarized dermoscopy; shiny white streaks.

MeSH terms

  • Adult
  • Aged
  • Biopsy, Needle
  • Case-Control Studies
  • Dermoscopy / methods*
  • Diagnosis, Differential
  • Dysplastic Nevus Syndrome / diagnosis
  • Dysplastic Nevus Syndrome / pathology
  • Female
  • Humans
  • Immunohistochemistry
  • Male
  • Melanocytes / pathology
  • Melanoma / diagnosis
  • Melanoma / pathology*
  • Middle Aged
  • Neoplasm Invasiveness / pathology
  • Neoplasm Staging
  • Nevus, Epithelioid and Spindle Cell / diagnosis
  • Nevus, Epithelioid and Spindle Cell / pathology
  • Nevus, Pigmented / diagnosis
  • Nevus, Pigmented / pathology*
  • Retrospective Studies
  • Skin Neoplasms / diagnosis
  • Skin Neoplasms / pathology*