Basal cell carcinoma — RACGP Fellowship MCQ

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HardDermatologyBasal cell carcinomaRACGP Fellowship

A 67-year-old man has a slowly enlarging pearly papule on the nose with telangiectasia and intermittent bleeding. Dermoscopy shows arborising vessels. He is immunocompetent. What is the most likely diagnosis?

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Correct answer: A — Basal cell carcinoma

The correct answer is A: Basal cell carcinoma. The clinical presentation—pearly papule with telangiectasia, slow growth on sun-exposed skin (nose), intermittent bleeding—combined with dermoscopic findings of arborising vessels is pathognomonic for nodular BCC. Arborizing vessels are the most frequent dermoscopic finding (60.7% of BCCs), particularly in nodular subtypes, and represent the hallmark vascular pattern. A. Seborrhoeic keratosis lacks telangiectasia and presents with keratin-filled cysts and stuck-on appearance. C. Keratoacanthoma grows rapidly (weeks), not slowly, and lacks arborizing vessels. D. Pyogenic granuloma presents as a red/purple vascular nodule without pearly appearance and shows dotted or globular vessels, not arborizing pattern. E. Molluscum contagiosum presents as multiple umbilicated papules without telangiectasia.

Reference: Royal Australian College of General Practitioners (RACGP). 'A pearly papule with telangiectasia.' Australian Journal of General Practice, June 2020. https://www1.racgp.org.au/getattachment/c49ce6e6-537e-4c8c-acda-f969f91314a3/Pearly-papule-with-telangiectasia.aspx