Blue-black rule: a simple dermoscopic clue to recognize pigmented nodular melanoma

Abstract

Using a method based on the BB feature or one of the standard melanoma criteria, only 9·4% of positive pigmented nodular lesions were found to be benign and only 6·8% of negative lesions were found to be melanoma histopathologically.

Peripheral stellate telangiectasias: a clinical-dermoscopic clue for diganosing cutaneous melanoma metastases

“…1,2 Importantly, structureless blue, blue-white and blue-brown areas as typically seen in CMM or fast growing thick primary melanoma, may be also the only dermoscopic features of blue nevi. 3,4 However, unlike blue nevi, which once developed are highly stable lesions, advanced melanoma and CMM are characterized by rapid growth; this is further supported by our findings, as in all 3 patients CMM developed within the course of few weeks and revealed progressive growth. Consequently, it has become a rule that the diagnosis of a blue nevus should be always confirmed by a "convincing" subjective history of an unchanged, stable lesion.…”

Diagnostic spectrum of nodular melanoma

“…The milky red areas are areas with more than one pink shade, probably corresponding to areas with increased vascular volume and represent an increased vascular volume that reflects a neoangiogenesis (2). The combination of blue and black areas involving at least 10% of the surface of the lesion was studied by Argenziano et al and seems to have an important role in the dermoscopic diagnosis of nodular melanoma (21). Starting with 283 dermoscopic images of benign and malignant lesions, the standard criterion for melanoma was compared with the presence of blueblack areas (BB).…”

“…Starting with 283 dermoscopic images of benign and malignant lesions, the standard criterion for melanoma was compared with the presence of blueblack areas (BB). It was noted that combined use of the two criteria is correlated with a higher positive predictive value for malignity (90.6%) and with 93.2% of negative predictive value for nodular melanoma (21). Many characteristics included in the standard criteria for melanoma cannot be expressed in nodular melanoma because they refer to epidermal and upper dermal component such as atypical pigment network, irregular pigmentation, atypical brown globules, brown areas lacking structures, regression (21).…”

“…In previous studies a blue-white veil and atypical vessels were often predictive of melanoma. When the standard criteria are absent the diagnostic relevance of the bluewhite veil and atypical vessels is limited because these two characteristics can be present in both benign and malignant lesions (21). The addition of the BB criterion seems to have overcome this limit: the combination of blue and black indicates that the pigment is not only present in the medio-deep dermis (blue color) as seen in hemangiomas and blue nevi, but is also present in atypical melanocytes of the epidermis (black color).…”

Modern non-invasive diagnostic techniques in the detection of early cutaneous melanoma

“…Argenziano et al developed the "blue-black rule", which indicates that the presence of a combination of blue and black color within the lesion, is a simple dermoscopic clue to recognize pigmented nodular melanoma with a 84.6% sensitivity and a 80.5% specificity. 20 The frequency of atypical blood vessels is approximately 70%. Ulceration is present in half the cases of nodular melanoma.…”