A 72-year-old patient has a 1 cm pearly, firm nodule on the nose with fine telangiectasias. Which of the following is the most likely diagnosis?

• A. Basal cell carcinoma
• B. Squamous cell carcinoma
• C. Seborrheic keratosis
• D. Actinic keratosis

Answer: (A)

The main idea here is recognizing the classic presentation of basal cell carcinoma. A pearly, firm nodule on the nose of an older adult, especially with fine telangiectasias on the surface, is textbook for basal cell carcinoma. This skin cancer most often appears on sun-exposed areas like the nose and tends to grow slowly, forming a smooth, translucent or pearly bump with visible blood vessels.

Why this fits better than the others: squamous cell carcinoma can also occur on sun-exposed skin but usually presents as a rough, scaly, crusted, or ulcerated lesion rather than a smooth, pearly nodule with telangiectasias. Seborrheic keratosis is typically a benign, waxy, “stuck-on” plaque that has a more uniform pigmented appearance and lacks those fine surface vessels. Actinic keratosis appears as rough, scaly patches that are usually flat rather than nodular. The combination of a small, shiny, vascular-natured nodule on the nose in an elderly patient is most characteristic for basal cell carcinoma.