what course of action is best for my skin lesion?

For about 2 yrs I have had a skin blemish on the middle of my nose. It is about 5 x 7 mm in size and consists of a slightly thickened area which has a large pore/dip in the middle. It is normal skin colour, does not itch or bleed, is not pearly, has no visible capillaries  and does not appear to be growing. I have tried to treat it with retin A gel(unsuccesfully) and I saw a practioner in dermatology who said it was a sebaceous hyperplasia and gave it a short spray of liquid nitrogen but when the scab came off it was still there. I was worried it may be a bcc and saw a dermatologist for a 2nd opinion - he said to give it a few months to settle and if I was still concerned he would do a 3mm punch biopsy. The original practitioner I saw said she would not consider a punch biopsy in that area due to scarring but that if I was really concerned she would perform a shave biopsy, although she did not feel it was necessary to biopsy at all. But I have read that shave biopsies are only suitable for a noticeably raised lesion with a very definite border. My lesion is only minimally raised and about a third of the edge isn't raised at all (I'm unsure if it was or not before the liquid nitrogen)I have doubts about whether a shave biopsy would give enough skin to test without them gouging beneath my skin level, presumably leaving a big pock mark in the process. I don't know what to do for the best...do nothing or have a biopsy and if so which kind. Which kind would leave the most minimal scar - as it is right in the middle of my face? Are there any treatments that I could have which could confirm if it is benign or not - ie a course of roaccutane or electrodessication may solve the problem if its benign or could laser treat the area regardless of whether its a s.hyperplasia or a bcc? I would like to avoid a biopsy if a can. My relevant history is I am a female with pale skin in my 40's, I have had 2 solar keratosis - not in the area of my current blemish and I did have a brief period of facial flushing/pre-roseacea which was treated successfully with antibiotics and has not returned. I have very oily skin on my nose and fordyces spots on the inside of my lips. I think the skin on the end of my nose has very, very slightly thickened/coarsened over the past year and the pores are large, especially near this blemish.Another complication is that in approx the last 2 months I have developed a small (about 2x2 mm)raised bump which is very slightly pink very close to the original lesion. It does not itch or bleed but now I am a bit worried about that too. It does not have a central pore or dip.Any ideas on what best to do with this? Do you think it has a connection to the original lesion? Please advise on what best to do... what kind of biopsy is most appropriate, if one is needed at all, what kind of scarring can I expect, and is there any way I could treat both blemishes by a process of elimination rather than biopsy if possible ? Many thanks!

[Alan Rockoff, MD]

I would rely on the clinical judgment of your dermatologist.  Obviously two different ones didn't think this is a skin cancer.  (The "pore/dip" does speak against skin cancer.)  There may in fact be nothing useful to do to remove this--options for safe treatment of nasal bridge lesions are limited because of the risk of scarring.  So the best thing may be to leave it alone.

Shave biopsies are fine for potential basal cell skin cancers.  If your dermatologist does have any concerns along that line, shave or curette (scrape) biopsy would indeed be the way to go.

Best.

Dr. Rockoff