The advanced practice registered nurse (APRN) assesses the skin on the face of a 70 year-old patient. The APRN notes a small (7 mm), pink, raised, papule with overlying telangiectasias on the patient's nasojugal fold. The APRN recommends a biopsy of the papule. What diagnosis does the APRN suspect?

Basal cell carcinoma is the most common form of skin cancer and usually develops in sun-exposed areas such as the face, nose, and eyelids, especially in older adults. It typically presents as a small, pearly or pink papule with raised borders and visible telangiectasias on the surface. These lesions grow slowly but can cause significant local tissue destruction if untreated. Early recognition and biopsy are important for diagnosis and definitive treatment. Rationale: A. Sebaceous hyperplasia usually appears as small, soft, yellowish papules with a central umbilication, commonly found on the forehead or cheeks of older adults. These lesions are benign enlargements of sebaceous glands and do not typically present with prominent telangiectasias or suspicious malignant features. Their appearance is usually more waxy and less concerning than basal cell carcinoma. B. Fibrous papules are benign, firm, dome-shaped lesions commonly found on the nose and are usually skin-colored rather than pink with visible telangiectasias. They are generally stable, asymptomatic, and do not have the classic pearly rolled border associated with basal cell carcinoma. Biopsy may be done for confirmation, but the description is more consistent with malignancy. C. Basal cell carcinoma commonly presents as a small pink or pearly papule with overlying telangiectasias and a raised appearance, especially on sun-exposed facial areas such as the nasojugal fold. It often develops in older adults due to cumulative ultraviolet exposure. The lesion’s appearance and location strongly support suspicion for basal cell carcinoma, making biopsy necessary for diagnosis. D. Actinic keratosis usually presents as a rough, scaly, flat or slightly raised lesion rather than a smooth pink papule with telangiectasias. It is considered a precancerous lesion caused by chronic sun exposure and often feels like sandpaper on palpation. The described lesion is more characteristic of basal cell carcinoma than actinic keratosis.