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Negative Pigment Network and Shiny White Streaks: A Dermoscopic–Pathological Correlation Study

Pizzichetta, Maria A. MD*; Canzonieri, Vincenzo MD; Soyer, Peter H. MD, FACD; Rubegni, Pietro MD§; Talamini, Renato ScD*; Massone, Cesare MD

The American Journal of Dermatopathology: May 2014 - Volume 36 - Issue 5 - p 433–438
doi: 10.1097/DAD.0000000000000019
Brief Report

Abstract: It has been suggested that both negative pigment network (NPN) and shiny white streaks (SWS) were related to an increase of dermal collagen. To study precisely the dermoscopic–histopathologic correlation of NPN and SWS, we have performed a dermoscopic–pathological correlation study. A total of 25 skin lesions dermoscopically characterized by the presence of NPN and/or SWS, including histopathologically confirmed dermatofibroma (2), Spitz nevus (3), compound nevus (6), dysplastic nevus (7), and melanoma (7), were evaluated for the presence of NPN, SWS, and blue-white veil. The histopathologic features such as orthokeratosis, orthokeratosis plus nests of pigmented melanocytes at the junction, hypergranulosis, hypergranulosis plus nests of pigmented melanocytes at the junction, epidermal invagination plus orthokeratosis, fibrosis, lamellar fibrosis, and elongation and bridging of rete ridges were evaluated. We found a disagreement in 80% of skin lesions between NPN and fibrosis (P = 0.02). For SWS, a significant agreement emerged with hypergranulosis (76%; P = 0.01), and the same occurred with fibrosis (80%; P = 0.01). Moreover, blue-white veil also displayed a significant agreement with hypergranulosis (68%; P = 0.04). Our findings confirm the correlation of SWS with fibrosis, whereas a clear-cut histopathologic substrate of NPN could not be established.

*Division of Medical Oncology C, Preventive Oncology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy;

Division of Pathology, Centro di Riferimento Oncologico, National Cancer institute, Aviano, Italy;

Dermatology Research Centre, the University of Queensland, School of Medicine, Translational Research Institute, Princess Alexandra Hospital, Brisbane, Australia;

§Department of Dermatology, University of Siena, Siena, Italy; and

Department of Dermatology, Medical University of Graz, Graz, Austria.

Reprints: Maria Antonietta Pizzichetta, MD, Division of Medical Oncology C, Preventive Oncology, Centro di Riferimento Oncologico—IRCCS, via Franco Gallini, 2, 33081, Aviano, Italy (e-mail:

P. H. Soyer is recipient of an Australian National Health and Medical Research Council Practitioner Fellowship (APP1020148). The other authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.