A 70 year old female presents with a lesion on cheek with pearly raised border & telangiectasia on surface of lesion.Diagnosis is:
First, I need to recall common skin lesions in older adults. The pearly border and telangiectasia are classic signs of a basal cell carcinoma (BCC). BCCs often present with a rolled, pearly border, telangiectasias, and sometimes a central ulcer. They are the most common type of skin cancer, especially in fair-skinned individuals.
Other options could include squamous cell carcinoma (SCC), which might have a scaly surface and less pearly appearance. Actinic keratosis is a precursor lesion, usually rough and scaly, not pearly. Seborrheic keratosis is another possibility but typically has a waxy, stuck-on appearance without the pearly border.
The key here is the combination of pearly border and telangiectasia. BCC is the most likely diagnosis. The clinical pearl here is that BCCs are the most common skin cancers and have specific clinical features. The correct answer should be BCC.
**Core Concept**
The clinical presentation of a pearly raised border and telangiectasia on the face is classic for **basal cell carcinoma (BCC)**, the most common type of skin cancer. These features reflect the histopathological architecture of BCC, including peripheral palisading of basaloid cells and vascular proliferation leading to telangiectasia.
**Why the Correct Answer is Right**
Basal cell carcinoma typically presents as a **pearly, translucent nodule with rolled borders** and **telangiectatic vessels** on the surface. The lesion often appears on sun-exposed areas like the face. Histologically, BCCs are composed of basaloid cells arranged in nests or cords, with peripheral palisading. The telangiectasia results from neovascularization in the tumor stroma, contributing to the "pearly" appearance due to mucin deposition.
**Why Each Wrong Option is Incorrect**
**Option A:** *Squamous cell carcinoma* presents with a scaly, crusted, or ulcerated lesion, often with a firm, keratinous plug, not a pearly border.
**Option B:** *Actinic keratosis* is a precancerous lesion with a rough, scaly texture on sun-damaged skin, lacking the pearly or telangiectatic features.
**Option C:** *Seborrheic keratosis* has a waxy, "stuck-on" appearance with a flat or slightly raised surface, devoid of telangiectasia.
**Clinical Pearl / High-Yield Fact**
Remember the **"Egg on a plate"** sign for BCC: a pearly, translucent lesion with a central ulcer and rolled border. This is a high-yield exam fact for differentiating BCC from other skin cancers. Avoid confusing BCC with SCC, which often has a more aggressive, keratin-filled appearance.
**Correct Answer: C. Basal cell carcinoma**