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Criteria for basal cell carcinoma
(According to Menzies)
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To diagnose pigmented cell carcinoma the negative feature of pigment network must be absent AND one or more of the positive features must be present.
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Negative Feature
(Not Present)
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Pigment network
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Positive Features
(at Least One Feature Found)
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Leaf-like areas: brown to gray/blue discrete bulbous extensions forming a leaf-like pattern. They should be distinguished from pseudopods because leaf areas are discrete pigment nests (islands) never arising from a pigment network and usually not arising from an adjacent confluent pigmented area.
Spoke wheel areas: well circumscribed radial projections, usually tan in color
but sometimes blue or gray, meeting at an often darker (dark brown, black or blue) central axis.
Large blue-gray ovoid nests: well circumscribed, confluent or near confluent pigmented ovoid or elongated areas, larger than globules, and not intimately connected to a pigmented tumor body.
Multiple blue-gray globules: multiple globules (not dots) which should
be differentiated from multiple blue-gray dots (melanophages).
Arborizing vessels: telangiectasia with distinct "tree-like" branching.
Ulceration: absence of the epidermis, often associated with congealed blood,
not due to a well-described recent history of trauma.
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Leaf - like areas are brown to gray-blue discrete bulbous extensions forming a leaf - like pattern. They should be distinguished from pseudopods because leaf areas are discrete pigment nests (islands) never arising form a pigment network and ususally not arising form an adjacent confluent pigmented area. |
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Leaf - like areas in a pigmented basal cell carcinoma |
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Spoke wheel areas are well circumscribed radial projections, usually tan in color but sometimes blue or gray, meeting at an often darker (dark brown, black or blue) central axis. |
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Spoke wheel areas in a pigmented basal cell carcinoma |
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Large blue - gray ovoid nests are well circumscribed confluent or near confluent pigmented ovoid or elongated areas, larger than globules, and not intimately connected to a pigmented tumor body |
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Large blue - gray ovoid nests in a pigmented basal cell carcinoma |
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Large blue - gray ovoid nests in a pigmented basal cell carcinoma |
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Multiple blue-gray globules are multiple globules (not dots). While the globules seen here are small they do not have the finer "pepper-like" morphology seen with multiple blue-gray dots (melanophages). |
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Multiple blue-gray globules in a pigmented basal cell carcinom |
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Multiple blue-gray globules in a pigmented basal cell carcinoma |
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Arborizing vessels are telangiectasia with distinct "tree - like" branching |
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Ulceration is the absence of the epidermis often associated with congealed blood. Ulceration in basal cell carcinoma should be distinguished from ulceration due to a well - described recent history of trauma |
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