Can you identify this flesh-colored papule?

This flesh-colored papule is noted on a 34-year-old woman’s nose during a routine skin examination. The patient reports that the “pimple” does not hurt or bleed and had first appeared several months earlier.

What do you suspect?

A. Intradermal nevus.

B. Benign fibrous papule.

C. Neurofibroma.

D. Basal cell carcinoma.

E. Squamous cell carcinoma.

(Answer on next page)

Answer: Basal cell carcinoma

Three factors raised the suspicion of a basal cell carcinoma, D: the lesion’s pearly, or translucent, appearance; its location on a sun-exposed surface of a person older than 30 years; and its presence for more than 3 months. A biopsy of the lesion confirmed the diagnosis of basal cell carcinoma. The lesion was excised.

Squamous cell carcinoma is generally associated with inflammation and crusting. The biopsy ruled out intradermal nevus, neurofibroma, and benign fibrous papule of the nose.