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A 45-year-old woman with no significant past medical history is evaluated in the office for an enlarging dark mole on her left arm. The lesion is not painful, but she notes that the borders bleed occasionally. She otherwise denies recent trauma, bug bites, or other rashes. The rest of her review of systems is negative. On exam of the left arm, there is a 12 mm raised lesion with notched borders. The lesion is pinkish in color and has two areas of blue-black discoloration on the lateral aspect. There is no active bleeding seen.

Which of the following is the most appropriate next step in management?

  1. Excisional biopsy
  2. Application of liquid nitrogen
  3. Punch biopsy
  4. Shave biopsy

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1.  Source: "Comparative Analysis of Pre/Post Assessments of Live/Didactic Course Attendees when compared to Mico-Learning/Online Course Users., "Knowledge to Practice, 2017.