A 63-year-old patient presents with a lesion on his toe that has doubled in size in the past year. It is non-tender and does not bleed, but his wife says it's getting bigger and darker on one side. The macule is 7mm in diameter. Which of the following is the best next step?

Any pigmented cutaneous lesion that has changed in size or shape or has other features suggestive of Malignant melanoma is a candidate for biopsy. An excisional biopsy with 1-3 mm margin is suggested. Accurate measurement of thickness, if the lesion is melanoma, and constitutes definitive treatment if lesion is benign. For lesions that are large or on anatomic sites where excisional biopsy is not be feasible (such as the face, hands, and feet), an incisional biopsy through the most nodular or darkest area of the lesion is acceptable.