Perfect gems cannot drop from monsters, although a random perfect gem is a reward for destroying Mephisto's Soulstone on the Hellforge, and lower quality gems can be upgraded to perfect using the Horadric Cube or by activating any Gem Shrine found in the wilderness with a flawless gem in inventory. They require one inventory space and cannot be stacked, and they can be sold to any vendor in town for 15,000 gold (35,000 maximum for a Perfect Skull). They add the following modifiers to an item when placed in any socket:
They are involved in the following Horadric Cube formulae:
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