How would you treat this man’s sunexposed arm lesion?

A 66-year-old male presented with a small, asymmetrical, 2 mm blue nodule on the sun-exposed portion of his arm of a few months duration. There is no history of trauma and it does not blanch. 

What would your approach to this lesion be?

A. Shave biopsy
B. A 3 mm punch biopsy 
C. Wide excision with 5 mm margins
D. Wide excision with 1 cm margin
E. Follow conservatively and re-evaluate in 3 to 6 months

(Answer and discussion on next page)

Answer: 3 mm punch biopsy

A 3 mm punch biopsy revealed the lesions to be a benign blue nevus. Blue nodules usually have some degree of dermal depth, which would make a shave biopsy a poor choice for a diagnostic procedure. 

While wide excisions would provide plenty of extra skin for examination, it would be premature to do a “definitive” procedure in the absence of a diagnosis. 

The conservative watching would not be recommended given the recent onset of presentation and given how easy and non-invasive a punch biopsy would be to the patient. ν