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The following is a summary of “Differentiating seborrheic keratosis from melanoma among lesions exhibiting blue-white veil: A retrospective study,” published in the March 2025 issue of Journal of the American Academy of Dermatology by Dana et al.

Distinguishing melanoma (MM) from seborrheic keratosis (SK) with a blue-white veil (BWV) has remained a diagnostic challenge.  

Researchers conducted a retrospective study to identify dermoscopic features that enhanced the differentiation between MMs and SKs exhibiting a BWV.  

They analyzed images from 110 MMs and 121 SKs with a BWV. Among these, 91 MMs and 62 SKs had complete agreement on BWV presence by 3 expert dermoscopists. Independent readers assessed the dermoscopic structures using a web-based data collection tool and the odds ratios measured associations between features and diagnosis, while Fisher’s exact test determined statistical significance.  

The results showed that the presence of milia-like cysts and/or comedo-like openings (MCCO) within the BWV, along with BWV covering the entire lesion, was observed in 56% of SKs and 0% of MMs, while all MMs exhibited at least 1 MMs-specific structure other than BWV or lacked MCCO.  

Investigators concluded that benign lesions showed specific features like BWV with MCCO without MMs-specific markers, which were absent in MM cases. 

Source: jaad.org/article/S0190-9622(24)03118-9/abstract