How would you treat this hand lesion?

This case discussion, submitted by Dr Robert Teunisse, features a 48-year-old male patient with an elevated, firm and growing lesion on his right hand. There is a previous BCC excision adjacent to this lesion.

What do you think, and what would you do?

Update

Here is the pathology report. The patient was referred to a local melanoma surgeon who did a wide local excision and lymph nodes from elbow and axilla.