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Criteria for basal cell carcinoma
(According to Menzies)

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.

 

Negative Feature
(Not Present)

Pigment network

 

Positive Features
(at Least One Feature Found)

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.

 
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.

 
Leaf - like areas in a pigmented basal cell carcinoma

 
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.

 
Spoke wheel areas in a pigmented basal cell carcinoma

 
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

 
Large blue - gray ovoid nests in a pigmented basal cell carcinoma

 
Large blue - gray ovoid nests in a pigmented basal cell carcinoma

 
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).

 
Multiple blue-gray globules in a pigmented basal cell carcinom

 
Multiple blue-gray globules in a pigmented basal cell carcinoma

 
Arborizing vessels are telangiectasia with distinct "tree - like" branching

 
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