Blue-white veil: Irregular, structureless blue pigmentation with an overlying white "ground-glass" haze.
Atypical vascular pattern: Linear-irregular or dotted vessels not clearly arrayed.
Minor Criteria (1 point each)
Irregular streaks: Radial streaming or pseudopods at the periphery.
Irregular pigmentation: Structureless areas of brown/black/gray not centrally located.
Irregular dots/globules: Varying sizes and shapes, distributed asymmetrically.
Regression structures: White scar-like areas and/or blue pepper-like granules.
Section 3
Pearls/Pitfalls
Clinical Pearls
A score of ≥ 3 is highly suspicious for melanoma and mandates excision/biopsy.
Very high sensitivity, but moderate specificity; benign lesions (like dysplastic nevi or Spitz nevi) can occasionally score ≥ 3.
Section 4
Next Steps
Clinical Action
If score ≥ 3, proceed with excisional biopsy (with 1-3mm margins). Avoid punch biopsies or shave biopsies if melanoma is suspected, as this alters Breslow depth staging.
