How would you manage this changing lesion on the lip?

This week we revisit a case from Dr Alex Speight, in which a 39-year-old male presents to the practice as a new patient. He saw a doctor elsewhere the previous year for a small lip lesion which isn’t healing. That doctor biopsied the lesion and offered cryotherapy, but the patient declined.

The lesion has since grown, and the patient has visited two other clinicians who did not suggest any treatment. Below is the original biopsy report and current photos of the lesion.

What do you think is going on here? What would you do?

Original biopsy result from last year with different doctor:

Current photos of the lesion:

Update

Here is the pathology result.

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