Differential Diagnosis for Flesh-like Nodule with Telangiectasia 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-like nodule with telangiectasia, especially on sun-exposed areas like the nose. Its slow growth and local destruction characteristics make it a prime consideration for this clinical presentation.
• 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 telangiectasia. It tends to grow more rapidly than BCC and has a higher potential for metastasis.
  • Keratoacanthoma: This is a low-grade, or sometimes considered benign, tumor that can resemble SCC clinically and histologically but tends to have a more rapid growth phase followed by possible spontaneous resolution. It may present similarly to BCC or SCC on the nose.
  • Sebaceous Hyperplasia: Benign growths of sebaceous glands can appear as yellowish, flesh-like nodules, sometimes with a central depression, and may have associated telangiectasia. They are common on the face, including the nose.
• Do Not Miss diagnoses
  • Merkel Cell Carcinoma: A rare, aggressive skin cancer that can present as a firm, flesh-colored nodule, often on the head and neck, including the nose. It has a high risk of metastasis, making early diagnosis critical.
  • Dermatofibrosarcoma protuberans (DFSP): Although rare, DFSP can present as a nodular lesion and may have telangiectasia. It is a locally aggressive tumor with a potential for metastasis, making it important not to miss.
• Rare diagnoses
  • Trichoepithelioma: A rare, benign tumor of hair follicle origin that can present as a firm, skin-colored nodule. While not typically associated with telangiectasia, its appearance on the nose could lead to consideration in the differential diagnosis.
  • Microcystic Adnexal Carcinoma: A rare, malignant tumor that can appear as a firm, flesh-colored nodule, often on the face. It is known for its local invasiveness and potential for perineural invasion, making it a rare but significant consideration.