Practical Dermoscopy
Solitary Blue Plaque: Beyond the Homogeneous Blue Pattern
Placa azul solitaria: más allá del patrón azul homogéneo
A. Alonzo Caldarelli
, P. Johana Barba
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Práctica Privada, La Plata, Argentina
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Alonzo Caldarelli, P.J. Barba" "autores" => array:2 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Alonzo Caldarelli" ] 1 => array:2 [ "nombre" => "P.J." "apellidos" => "Barba" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731023003368?idApp=UINPBA000044" "url" => "/00017310/0000011400000010/v1_202311020433/S0001731023003368/v1_202311020433/es/main.assets" ] ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Practical Dermoscopy</span>" "titulo" => " Solitary Blue Plaque: Beyond the Homogeneous Blue Pattern" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "T904" "paginaFinal" => "T905" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Alonzo Caldarelli, P. Johana Barba" "autores" => array:2 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Alonzo Caldarelli" "email" => array:1 [ 0 => "agostina.ac3@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Johana Barba" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Práctica Privada, La Plata, Argentina" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Placa azul solitaria: más allá del patrón azul homogéneo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 545 "Ancho" => 788 "Tamanyo" => 59870 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Nonpolarized dermoscopy: homogeneous blue pattern.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Report</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 34-year-old woman with no remarkable past medical history presented with a slow-growing asymptomatic lesion on her right buttock that had been present for 20 years. Physical examination revealed a well-defined, round, bluish plaque with a diameter of 15<span class="elsevierStyleHsp" style=""></span>mm (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Polarized light dermoscopy showed global multichromatic pigmentation (blue, red, white), dotted and irregular linear vessels, bright white lines, and structureless bluish-white and reddish areas (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Nonpolarized dermoscopy showed a homogeneous blue pattern (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Histologic examination of a skin biopsy specimen showed a preserved epidermis with superficial parakeratosis and, in the deep reticular dermis, a dense proliferation of round dendritic melanocytes with darkly pigmented melanophages (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Skin biopsy confirmed a diagnosis of cellular blue nevus.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Blue nevi are benign lesions composed of a proliferation of dendritic melanocytes in the dermis. They can be congenital or acquired and present clinically as solitary or multiple papules, nodules, or plaques with a blue, gray-blue, or bluish-brown color.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">1–3</span></a> Onset is typically in childhood, adolescence, or early adulthood. Most lesions are located on the face, scalp, extremities, and buttocks.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Blue nevi can mimic both melanocytic and nonmelanocytic lesions, including melanoma, cutaneous melanoma metastases, Spitz/Reed nevus, and basal cell carcinoma.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The hallmark nonpolarized dermoscopic feature is a homogeneous blue pattern without a pigment network or any other distinctive structures.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">1–3</span></a> Less frequently, this global pattern may also have a diffuse blackish or brown color, or a combination of 2 colors (dichromatic pattern) such as blue-brown, blue-black, or blue-gray.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> Multichromatic pigmentation with a combination of blue, brown, white, black, red, and/or gray is uncommon and has been reported in just 15.8% of blue nevi.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Vascular structures (polymorphous, dotted, comma, irregular linear, and arborizing vessels) are rare local findings. Some case series have shown these features to be significantly associated with the global multichromatic pattern.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Presence of hypopigmented white areas, which histologically correspond to dermal fibrosis, is another uncommon local feature.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Bright white lines, visualized only under polarized light, are not pathognomonic and have not been linked to blue nevus in any of the reports identified.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Observation of a solitary lesion present since childhood in a young patient with no personal or family history of melanoma combined with a homogeneous blue pattern seen on dermoscopy is strongly suggestive of a diagnosis of blue nevus.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> Melanoma, however, cannot be ruled out when dermoscopy shows a bluish lesion with multichromatic pigmentation and other local criteria, such as vessels. In such cases, surgical excision is mandatory.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In conclusion, we have presented a case of cellular blue nevus in which polarized light dermoscopy showed the uncommon global multichromatic pattern and the bright white lines associated with this benign entity. Based on these findings, the differential diagnosis is broad.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of Interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Report" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Diagnosis" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Comment" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of Interest" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 647 "Ancho" => 752 "Tamanyo" => 83547 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Round bluish plaque on the right buttock.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 503 "Ancho" => 752 "Tamanyo" => 30759 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Polarized light dermoscopy showing a global multichromatic pattern with dotted and irregular linear vessels (<elsevierMultimedia ident="202311020435060341"></elsevierMultimedia>), bright white lines (black arrow) and structureless bluish-white and reddish areas (*).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 545 "Ancho" => 788 "Tamanyo" => 59870 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Nonpolarized dermoscopy: homogeneous blue pattern.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 637 "Ancho" => 788 "Tamanyo" => 127393 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Epidermis with no changes, densely pigmented dendritic melanocytes in the reticular dermis (hematoxylin–eosin, original magnification ×10; image courtesy of Dr. Carlos Martín).</p>" ] ] 4 => array:5 [ "identificador" => "202311020435060341" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 24 "Ancho" => 29 "Tamanyo" => 533 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The spectrum of dermatoscopic patterns in blue nevi" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Di Cesare" 1 => "F. Sera" 2 => "A. Gulia" 3 => "G. Coletti" 4 => "T. Micantonio" 5 => "M.C. Fargnoli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2011.08.018" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2012" "volumen" => "67" "paginaInicial" => "199" "paginaFinal" => "205" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22030018" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermoscopic rainbow pattern in blue nevus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T. Uzunçakmak" 1 => "S. Ozkanli" 2 => "A.S. 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