This patient has basal cell carcinoma (BCC), the most common type of skin cancer. BCC typically presents as translucent (“pearly”) telangiectatic papules on sun-exposed areas in fair-skinned persons with a history of extensive sun exposure. It is usually asymptomatic and enlarges slowly over time. Although it rarely metastasizes, BCC can cause significant local tissue destruction if not removed in a timely fashion. BCC has a wide variety of morphologies, some of which can be challenging diagnostically.

Angiofibromas (fibrous papules of the nose) are common solitary lesions that are often seen in patients with rosacea. They tend to be flesh colored, lack pearliness or telangiectasias, and are stable in size and appearance over time.

Sebaceous hyperplasia present as small papules found on the face in patients with rosacea. They often have a central umbilication, which is a characteristic feature. They lack the pearliness seen in BCC, have less prominent telangiectasias, and often have a yellowish color.

Squamous cell carcinoma (SCC) may resemble BCC in many aspects; however, SCC tends to be much scalier, lack the pearliness seen in BCC, and have less prominent telangiectasias. It also tends to grow more rapidly than BCC.