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Perpendicular white lines dermoscopy

Author: Naomi Ashman, Dermoscopist, Torbay Skin, Auckland, New Zealand. DermNet NZ Editor in Chief Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. November 2019.


What are perpendicular white lines?

In dermoscopy, perpendicular white lines are short discrete white lines oriented parallel and orthogonal (perpendicular) to each other and seen only under polarised light [1].  They are also known as polarising white lines, short white lines, shiny white lines, shiny white streaks, chrysalis, chrysalids, and crystalline structures.  Perpendicular white lines are a clue to a specific diagnosis including basal cell carcinoma (BCC) and some melanomas [2].  

What do perpendicular white lines look like through the dermatoscope?

Perpendicular white lines are only seen under polarised light.  They appear as short, shiny white lines and move as the dermoscopy lens is moved at different angles over the lesion.

Perpendicular white lines in BCCs

Perpendicular white lines in melanoma

Polarised and non-polarised light

The following pairs of images demonstrate the differences seen in dermoscopy of perpendicular white lines under polarised and non-polarised light.

Polarised and non-polarised light in BCC

Polarised and non-polarised light in melanoma

In which lesions are perpendicular white lines seen in through the dermatoscope?

Perpendicular white lines can be seen in the following lesions:

  • Pigmented and nonpigmented basal cell carcinoma
  • Melanoma
  • Spitz naevus
  • Dermatofibroma (the polarised white lines are often in radial array rather than perpendicular)
  • Scar tissue
  • Benign lichenoid keratosis.

Perpendicular white lines in a variety of lesions
 

What is the histological explanation of perpendicular white lines?

Perpendicular white lines are thought to correlate histopathologically with altered collagen in the dermis (fibrosis). The birefringent properties of collagen bundles cause rapid randomisation of polarised light. This is the reason collagen appears bright white and is more conspicuous under polarised dermoscopy [3].

They also correlate with dermal invasion in cases of melanoma [4]. However, as our illustrations show, they may also be seen in melanoma in situ.

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Related information

 

References

  1. Kittler H, Marghoob AA, Argenziano G, Carrera C, Curiel-Lewandrowski C, Hofmann-Wellenhof R, Malvehy J, Menzies S, Puig S, Rabinovitz H, Stolz W, Saida T, Soyer HP, Siegel E, Stoecker WV, Scope A, Tanaka M, Thomas L, Tschandl P, Zalaudek I, Halpern A. Standardization of terminology in dermoscopy/dermatoscopy: Results of the third consensus conference of the International Society of Dermoscopy. J Am Acad Dermatol. 2016 Jun;74(6):1093-106. doi: 10.1016/j.jaad.2015.12.038. Epub 2016 Feb 17. PMID: 26896294; PMCID: PMC5551974.
  2. Balagula Y, Braun RP, Rabinovitz HS, et al. The significance of crystalline/chrysalis structures in the diagnosis of melanocytic and nonmelanocytic lesions. J Am Acad Dermatol. 2012;67(2):194, e1–8. [PubMed
  3. Verzi et al.: 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;78:913-919. PMID: 29138058. DOI.
  4. Braun, Ralph P. 'Shiny white structures'. dermoscopedia. 9 June 2019.  Available at: https://dermoscopedia.org/w/index.php?title=Shiny_white_structures&oldid=16548.  Retrieved 22:17, 25 November, 2019.  

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