How best to manage this tender papule

Weighing up the options for approaching an enlarging lesion at a tricky site

Maureen is an 84-year-old who presents with a three-week history of a rapidly growing, tender lesion on the ring finger of her left hand (see figure 1).

Figure 1. Lesion at presentation.

She is right-handed. She is not aware of any preceding trauma or injury to the site.

Maureen is otherwise reasonably fit and well. She has a history of ischaemic heart disease for which she takes