Endgames Case review

A pedunculated nasal nodule

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j763 (Published 02 March 2017) Cite this as: BMJ 2017;356:j763
  1. Magnus Lynch, specialist registrar in dermatology,
  2. Faisal Ali, surgical fellow in dermatological surgery,
  3. Raj Mallipeddi, consultant dermatologist and dermatological surgeon
  1. Dermatological Surgery and Laser Unit, St John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
  1. Correspondence to R Mallipeddi raj.mallipeddi{at}gstt.nhs.uk

A 92 year old man presented to his primary care doctor complaining of a lesion on his right nostril (fig 1). The lesion had been present for 10 or more years, however recently it had increased in size. His only history was of chronic renal impairment. Examination revealed a 10 mm pink, pearlescent, pedunculated nodule with telangiectasia arising from the right nasal ala.

Fig 1 A pearlescent nodule with telangiectasia arising from the right nasal ala

Questions

  • 1. What is the most likely diagnosis?

  • 2. What is the most appropriate management for patients with this condition?

  • 3. What post-treatment/follow-up instructions are important for the primary care doctor and patient?

1. What is the most likely diagnosis?

Short answer

Basal cell carcinoma.

Discussion

The lesion is a pearly nodule with telangiectasia arising from the right nasal ala. The clinical appearances are characteristic of basal cell carcinoma, which is the most common cutaneous malignancy.1 The main risk factor is ultraviolet light exposure; other risk factors include having fair skin, exposure to radiation, and various genetic syndromes including naevoid basal cell carcinoma (Gorlin) syndrome and xeroderma pigmentosum. A history of slow …

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