It is firm with a central depression. It is 0.6 cm in size. What is the SINGLE most likely diagnosis?


#1

A 44 year old man complains of a solitary, shiny, red nodule which has been growing on
his nose for several months. It is firm with a central depression. It is 0.6 cm in size.
What is the SINGLE most likely diagnosis?

A. Basal cell carcinoma
B. Squamous cell carcinoma
C. Molluscum contagiosum
D. Keratoacanthoma
E. Kaposi’s sarcoma
The clues for basal cell carcinoma in the exam are descriptions of a pearly white
umbilicated ulcer with central depression anywhere in the face with rolled edges or
inverted edge. These are hints pointing towards the diagnosis of basal cell carcinoma.
Ulcers presenting above the neck in the PLAB exam are almost inevitably basal cell
carcinoma.

Basal cell carcinoma
Basal cell carcinomas (BCCs) are slow-growing, locally invasive malignant epidermal skin
tumours
Risk factors:

  • Genetic predisposition
  • Exposure to ultraviolet (UV) radiation
    Presentation:
  • The sun-exposed areas of the head and neck are the most commonly involved
    sites
  • Early lesions are often small, translucent or pearly and have raised areas with
    telangiectasia
  • Indurated edge and ulcerated centre