A 69-year-old man complained that a small spot on his nose intermittently bled, although he denied seeing any growth.
Key point: Physical examination disclosed very small papules with a single spot of dried blood at one side. Almost no benign disorder affecting nasal skin should bleed. A small shave biopsy revealed basal cell carcinoma.
Treatment: After discussion of various options, the patient elected to undergo Mohs micrographic surgery. Although the subtle lesion was only 1.5 mm in greatest diameter, the final defect demonstrated that the area the tumor invaded into was almost 1 cm wide.
Note: The other most common entity leading to a small nasal lesion is the fibrous papule of the nose. The latter virtually never spontaneously bleeds.