61.

A 67-year-old woman comes to the physician 1 month after noticing a

nontender nodule on the back of her left hand.
She initially thought it was an insect bite, but it has grown in size over the
past week. It bleeds when she picks at it.
She has no history of serious illness. She lives in a retirement community in
Florida and frequently plays golf and
tennis. Examination of the dorsum of the left hand shows a 2.5-cm lesion.
Photographs of the lesion are shown.
Which of the following is the most appropriate next step in management?
(A) Observation
(B) Topical application of fluorouracil
(C) Sentinel lymph node biopsy
(D) Cryosurgery
(E) Excision of the lesion