How would you manage these three lesions on the mid-back?

In this week's case discussion, submitted by Dr David Stewart, we look at a 49-year-old male with a strong family history of melanoma (father, uncle, brother). The patient has had multiple excision biopsies in the past.

He presents for a routine skin check and states that he has never liked the look of the "Orion's belt" of three moles on his mid-back. 

Please see clinical and dermoscopic images below. Which of these three lesions would you excise, and why?

Clinical image:

Left lesion dermoscopic image:

Middle lesion dermoscopic image:

Right lesion dermoscopic image:

Update

In this case, the patient requested removal of all three lesions, stating that skin doctors always seem concerned about them. Digital imaging showed no change in any of the lesions over 5 years.

The lesions were shave biopsied and the pathology result is below.

In this case, would you have considered removal, and if so, how? Further, how much weight do you put on lack of change on digital images when there are concerning features on dermoscopy?

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