During a routine physical, a 1-cm lesion on the chest is described as raised, flesh-colored with pearly white borders. This finding is most suggestive of which type of skin cancer?

• A. Squamous cell carcinoma
• B. Basal cell carcinoma
• C. Malignant melanoma
• D. Actinic keratosis

Answer: (A)

Pearly, translucent borders on a raised, flesh-colored lesion are classic for basal cell carcinoma. This type of skin cancer arises from the epidermal basal cells and often looks like a smooth, shiny nodule with rolled borders and sometimes visible small blood vessels (telangiectasias). It tends to grow locally rather than metastasize, and ulceration can occur in the center, giving a pearly, “rodent ulcer” feel.

In contrast, squamous cell carcinoma usually presents as a firmer, red or brownish patch or plaque that may scale, crust, or ulcerate and tends to be more likely to invade surrounding tissues. Actinic keratosis appears as rough, sandpaper-like, scaly patches that are precancerous and not typically described as pearly. Malignant melanoma typically shows irregular color variation, asymmetry, irregular borders, and a diameter greater than 6 mm, rather than a smooth pearly border. Thus, the described lesion most strongly aligns with basal cell carcinoma.