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Menzies' Method for the Diagnosis of Melanoma
[Menzies et al. Arch Dermatol 1996]

For melanoma to be diagnosed a lesion must have neither of both negative features and 1 or more of the 9 positive features.

Negative features (Cannot be present)

• Symmetry of pattern

• Presence of a single color

Positive features (At least one must be present)

• Blue-white veil

• Multiple brown dots

• Pseudopods

• Radial streaming

• Scar-like depigmentation

• Peripheral black dots/globules

• Multiple (5-6) colors

• Multiple blue/gray dots

• Broadened network

Definitions

Symmetry of pattern

Symmetry of pattern is required across all axes through the lesion's center of gravity (center of the lesion). Symmetry of pattern does not require shape symmetry.

Single color

The colors scored are black, gray, blue, dark brown, tan and red. White is not scored as a color.

Blue-white veil

An irregular, structureless area of confluent blue pigmentation with an overlying white "ground-glass" haze. The pigmentation cannot occupy the entire lesion and cannot be associated with red-blue lacunes.

Multiple brown dots

Focal areas of multiple brown (usually dark brown) dots (not globules).

Pseudopods

Bulbous and often kinked projections that are found at the edge of a lesion directly connected to either the tumor body or pigmented network. They can never be seen distributed regularly or symmetrically around the lesion.

Radial streaming

Finger-like extensions at the edge of a lesion that are never distributed regularly or symmetrically around the lesion.

Scar-like depigmentation

Areas of white, distinct, irregular extensions (true scarring), which should not be confused with hypo- or depigmentation due to simple loss of melanin.

Peripheral black dots/globules

Black dots/globules found at or near the edge of the lesion.

Multiple (5-6) colors

The colors scored are black, gray, blue, dark brown, tan and red. White is not scored as a color.

Multiple blue/gray dots

Foci of multiple blue or gray dots (not globules) often described as "pepper-like" in pattern.

Broadened network

A network made up of irregular, thick "cords", often seen focally thicker.

This lesion has symmetry of pattern across all axes through the center of the lesion

While the lesion has symmetry of pattern through one axis (short axis), it lacks symmetry around some other axes (such as the long axis) and therefore this lesion lacks symmetry of pattern.

This lesion has blue-white veil, seen as an irregular, structureless area of confluent blue pigmentation with an overlying white "ground glass" haze, never occupying the entire lesion.

Blue white veil is absent here, since the pigmentation is present in distinct structures (large ovoid nests); therefore, the lesion lacks the structureless component needed to score it as positive for blue white veil.

Multiple brown dots are seen as irregularly distributed focal areas of multiple brown (usually dark brown) dots (not globules).

Multiple brown dots - note again the focal nature and small size (dots).

Pseudopods are found at the edge of lesion directly connected to either the tumor body or the pigmented network. They can never be seen distributed regularly or symmetrically around the lesion. When connected directly to the tumor body, they must have an acute angle to the tumor edge (B and C, not E) or arise from linear or curvilinear extensions (A). When connected to the network (F), the width of the bulbous ending must be greater than the width of any part of the surrounding network (therefore not G) and at least double that of its directly connected network projection (therefore not H).

Multiple blue/gray dots

Broadened network is seen as areas (often focal) of thicker "cords" of the net.

Broadened network While a pseudo-broadened network can be seen on the face, here a true broadened network is found because the holes of the net are not entirely formed by the follicular openings.