A skin lesion that is pearly, dome-shaped, with central ulceration and telangiectasia is most likely what type of carcinoma?

The characteristics described in the question—pearly, dome-shaped appearance, central ulceration, and the presence of telangiectasia—are classic features of basal cell carcinoma (BCC). BCC is the most common type of skin cancer and is typically associated with sun-exposed areas of the skin, especially in fair-skinned individuals.

Pearly lesions often have a translucent quality and may display tiny blood vessels (telangiectasia) on their surface. The central ulceration observed is a common feature as the tumor grows and can result from the rapid proliferation of cancerous cells that outstrip their blood supply. Given these features, the diagnosis of basal cell carcinoma is strongly supported, as they align closely with the classic presentation of this type of skin cancer.

In contrast to melanoma and squamous cell carcinoma, which can have different appearances and may include features such as asymmetry, irregular borders, varied color, or a scaly surface, basal cell carcinoma is typically more insidious and less aggressive. Adenocarcinoma, which arises from glandular tissue, usually would not present in such a manner on the skin. Thus, the characteristics of the lesion described point clearly towards basal cell carcinoma as the correct answer.