The presence of shiny white blotches and strands were linked to high diagnostic specificity for nonpigmented basal cell carcinoma (BCC), according to a study published in JAMA Dermatology.1

Shiny white structures (SWSs) are often present in basal cell carcinoma, the most common type of skin cancer, which is often nonpigmented. Investigators sought to determine the diagnostic accuracy of various morphologies of SWSs.

Data were collected from 2375 patients and included 2891 biopsied skin lesions, of which 457 were nonpigmented neoplasms.  SWSs were categorized as blotches, strands, short white lines, and rosettes. The study’s primary endpoint was diagnosis of BCC compared with all other diagnoses combined. Secondary outcome was diagnosis of BCC compared with amelanotic melanoma.

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Out of the 457 neoplasms, 62.8% were BCCs, 23.2% were squamous cell carcinoma, 8.5% were lichen planus-like keratosis, 4.6% were melanomas, and 0.9% were nevi. SWSs occurred in 49% of neoplasms.

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SWS presence was linked with a diagnosis of BCC (odds ratio 2.3; 95% CI, 1.5 – 3.6; P <.001). Blotches and strands  were linked with BCC (6.3; 95% CI, 3.6 – 10.9; P < .001 and 4.9; 95% CI, 2.9 – 8.4); P < .001, respectively). The presence of both blotches and strands had an odds ratio of 6.1 (95% CI, 3.3 – 11.3; P < .001). Shiny white blotches and strands had a diagnostic sensitivity of 30% and a specificity of 91%.


  1. Navarrete-Dechent C, Bajaj S, Marchetti MA, et al. Association of shiny white blotches and strands with nonpigmentented basal cell carcinoma: evaluation of an additional dermoscopic diagnostic criterion [published online ahead of print January 20, 2016]. JAMA Dermatol. doi: 10.1001/jamadermatol.2015.5731.