A 66-year-old man presented to the office asking for evaluation of a lesion on his nose. The patient explained that the lesion had been present for over a year, had a history of bleeding and then scabbing over, and had grown slightly in size. Upon visual inspection, the lesion appeared as a smooth pearly pink papule with telangiectatic vessels. The patient had not had any prior treatment for the lesion. His past medical history was significant for sunburns as a child as well as extensive sun exposure as a retired construction worker.

Actinic keratosis can serve as precursors to squamous cell carcinomas, appearing as flat, pink lesions that feel like sandpaper. This patient’s lesion is raised and smooth with visible vessels. A fibrous papule is a benign lesion which usually develops late in adolescence or early adult life on the nose. It can be differentiated from a basal cell carcinoma because it does not have a tendency to grow in size, bleed, or ulcerate. Molluscum contagiosum is a viral infection of the skin that usually occurs in children and presents as round, firm, painless bumps. Unlike this lesion, molluscum tends to occur in groups and usually clears in 12–18 months without treatment. Ultimately, the definitive diagnosis for this patient’s lesion will be histological analysis of a biopsy sample.