The blue-whitish veil is a confluent, gray-blue to whitish-blue, diffuse pigmentation associated with pigment network alterations, dots/globules and/or streaks.

Histopathologic correlates

The histopathologic correlate of the blue-whitish veil is an acanthotic epidermis with compact orthokeratosis and more or less pronounced hypergranulosis usually overlying a large melanin-containing area such as confluent nests of heavily pigmented melanocytes in the upper dermis. This particular constellation of histopathologic findings may be observed in malignant melanomas but also in Spitz/Reed nevi.

Diagnostic significance

The blue-whitish veil, as defined above, is almost exclusively found in malignant melanomas and Spitz/Reed nevi . At least in our judgement, based on its pure dermoscopic appearance, no differentiation between the veil in melanomas and Spitz/Reed nevi is feasible. However, the presence of a blue-whitish veil is a helpful clue for distinguishing melanoma from Clark nevus since, as a rule, no blue-whitish veil is present in the latter.