Differential Diagnosis for a 2.5cm Flesh-Colored Nodule with Telangiectasias on the Nose

• Single Most Likely Diagnosis
  • Basal Cell Carcinoma (BCC): This is the most common form of skin cancer and often presents as a flesh-colored nodule with telangiectasias, particularly on sun-exposed areas like the nose. The presence of telangiectasias is a hallmark feature of BCC.
• Other Likely Diagnoses
  • Squamous Cell Carcinoma (SCC): Although less common than BCC, SCC can also present as a nodule on the nose and may have associated telangiectasias. It tends to be more aggressive than BCC.
  • Keratoacanthoma: This is a low-grade, or sometimes considered benign, tumor that can resemble SCC but often has a more rapid growth phase followed by possible involution. It may present similarly to SCC or BCC.
  • Dermatofibroma: A benign skin growth that can appear as a firm, flesh-colored nodule, though telangiectasias are less commonly associated with dermatofibromas compared to BCC.
• Do Not Miss Diagnoses
  • Merkel Cell Carcinoma: A rare and aggressive skin cancer that can present as a flesh-colored nodule. It is crucial to consider this diagnosis due to its potential for rapid growth and metastasis, despite its rarity.
  • Angiosarcoma: A highly malignant tumor of vascular origin that can present with telangiectasias. It is rare but has a poor prognosis, making it essential not to miss.
• Rare Diagnoses
  • Trichoepithelioma: A rare, benign tumor of hair follicle origin that can present as a flesh-colored nodule but is less likely to have prominent telangiectasias.
  • Microcystic Adnexal Carcinoma: A rare, slow-growing tumor that can appear as a firm, flesh-colored nodule but is more commonly associated with the eyelids or other areas of the face rather than the nose.
  • Leiomyosarcoma (cutaneous): A rare malignant tumor of smooth muscle origin that can present as a nodule but is uncommon on the nose and less frequently associated with telangiectasias.