A 60-year-old man presents with a pearly, translucent nodule with telangiectatic vessels over the nasal alar region. Central ulceration with a rolled everted edge is noted. There is no lymphadenopathy. Which histological subtype is most common?

• A Nodulo-ulcerative (rodent ulcer) BCC ✓
• B Superficial spreading BCC
• C Morphoeaform (sclerosing) BCC
• D Pigmented BCC

Explanation

Nodulo-ulcerative basal cell carcinoma is the most common subtype, presenting as a pearly, translucent papule or nodule with rolled (not everted) edges, surface telangiectasia, and central ulceration — classically referred to as the 'rodent ulcer' because of its slow destructive progression. It arises from the basal cells of the epidermis and has the best prognosis among non-melanoma skin cancers due to its rarity of metastasis. The nasal region, inner canthus, and periorbital areas are common sites. Mohs micrographic surgery is the treatment with highest cure rates.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.