Find and shade orthogonally contiguous regions of cells ("tumors") and orthogonal lines ("incisions") on the board.
Margin numbers refer to the number of tumor cells in that row or column.
Incisions are groups of edge-to-edge orthogonal line segments within a cell joined end to end to form a longer line. Any given incision cell can either be a vertical line, a horizontal line, or a cross (as two incisions overlap).
Unshaded pearls clue where an incision ends; as such, there may be at most two per incision. Crossings are already placed on the board. Crossings overwrite unshaded pearls, meaning a crossing cell may be the end of some incision, but such would not be clued.
A tumor must be a rectangle with exactly one extra shaded cell attached. This shaded cell must be diagonally adjacent to exactly one shaded cell in the rest of the tumor. Two tumors may not be royagonally adjacent.
Every non-tumor cell should have an incision somewhere on it.
A tumor's size without the jut must be MxN where M and N do not differ by more than 1.