How would you manage this disputed skin cancer on the nose?

This week's case discussion, submitted by Dr David Stewart, focuses more on management than on diagnosis.

A 65-year-old male patient presents with a new lesion on the bridge of his nose.

Clinically, Dr Stewart suspects basal cell carcinoma, so he refers the patient without confirmatory biopsy to a local plastic surgeon for excision. The surgeon performs a pre-op biopsy, which returns with no abnormality found, and opts to observe the lesion for six months. Below, please see the pathology report and the surgeon's letter.

What would you do in this situation?

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