45 years old, female. Circular lesion near the left nostril | Figure 1

ReginaldoCastro
Internal Medicine

Patient Details
45 years old, female.
Circular lesion near the left nostril.
Patient used Efurix ointment that burned the lesion.
But after 2 months, the injury grew again.
She said that the lesion can bleed at mechanical stimulation.

What is the probable diagnosis in this case?

Update 1
Due to the clinical aspect and history, the most likely diagnosis is Basal Cell Carcinoma (BCC).
Points that support BCC:

• Typical location: perinasal/nostril region
• Recurrent injury after topical treatment
• Bleeding at the slightest touch
• Suggestive aspect of elevated/rolled edge and altered central area
• Failure of 5-fluorouracil (Efudix) → common in deeper or non-surface BCC

Main differentials, but less likely:

• Squamous cell carcinoma (usually more infiltrated/keratotic)
• Pyogenic granuloma (rapid growth, more friable appearance)
• Contact dermatitis/eczema (it would not explain easy bleeding and recurrence)

Diagnosis
Basal Cell Carcinoma

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