What physical examination finding would raise suspicion for basal cell carcinoma?

A pearly ulcerated papule is a classic physical examination finding that is strongly associated with basal cell carcinoma (BCC). BCC is the most common type of skin cancer and often presents as a nodular lesion that has a shiny, pearly appearance. These lesions may also appear ulcerated or have a rolled border. This characteristic appearance is due to the growth of the skin cells and their invasive nature, which can lead to ulceration as the lesion progresses.

In contrast, the other options do not exhibit the typical features associated with BCC. Cherry angiomas, spider angiomas, and pyogenic granulomas are benign vascular lesions and are not indicative of skin malignancy. Cherry angiomas are common benign growths that appear as small, red spots on the skin, while spider angiomas are abnormal clusters of blood vessels causing a 'spider-like' appearance. Pyogenic granulomas are often raised, red lesions that can bleed easily and are typically associated with trauma or irritation rather than malignancy. Thus, a pearly ulcerated papule stands out as a significant indicator of potential basal cell carcinoma.