Brief Answer:
Wide local excision.

Detailed Answer:
Hi.
Good evening Sir.
Thanks for your query, an elucidate history and a clear picture.

Considering your age of 67, history of more than 9 months of a swelling as depicted in the picture, no other symptoms other than occasional itching, and the site of left forearm, I would suggest you the following.

I fully agree with you, the clinical and actual picture is mostly suggestive of Basal cell carcinoma.

The best way for the diagnosis in such a lesion is wide local excision and subject the mass for histopathology examination.

There will be 2 benefits:
First, you get rid of the lesion.
Secondly, we get the histo-pathological diagnosis and a curative treatment.

Please go ahead with it without a second thought.

Take care, get surgery done at an appropriate center and please give feedback .
Wishing you a permanent cure.

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Brief Answer:
This is a Histo-pathology diagnosis

Detailed Answer:
First of all I would like to stress is the necessity to get the lesion out and be examined histopathologically to get the correct diagnosis and a curative treatment.

Since you have already waited so long it would be best to consult an Onco-Surgeon at the earliest. To get the diagnosis fast so that a proper treatment will be instituted ASAP.

The proper examination by an Onco-Surgeon will determine about the spread to the local area and to the axilla and other parts. Basal cell cancers are the most common of all the skin cancers hence wrote about it.

Whether this is basal (MC) or spquamous or Melanoma or benign ( noncancerous lesion) , it is confirmed only after the biopsy. This is always a Histo-pathology diagnosis hence we can not say what type it may be.

Please go ahead with OncoSurgeon's consultation and further management.

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Brief Answer:
Least likely to be a Melanoma.

Detailed Answer:
Yes, Sir.
You are absolutely right.
To clarify further I will try to put on some points. Cancer=CA
Cancers develop in the normal tissues of the body which have stopped to obey the body commands, they start behaving on their own, can cause local destruction and can spread to the distant places. Treated in time can help to have normal life span.

Basal cell cancer : they are good as they very rarely spread to the nearby structures like muscles or bones and to distant places. But the recurrence can be seen in some patients even after wide local excision. So follow-up is necessary as in all cases of cancers. Also there is tendency of appearance of basal cell cancers elsewhere on the skin. This is the commonest skin Ca about 80 % of all Ca of skin.

Squamous cell cancers : It occurs from the skin upper layers. It has a bit more tendency to spread locally to the deeper structures than the basal Cancer. Rarely it can spread to other parts of the body ( more tendency than the basal Ca). It is rarer in skin say 20 % of skin cancers.

Melanoma: 2 forms - The benign form is called a mole. The Cancerous form is malignant Melanoma. As the name suggest they occur from the melanin producing cells of the skin which gives color to the skin. Most of the melanomas are black or brown. They grow very fast and the size of the primary lesion has no bearing upon the spread. Even the smallest can have wide spread, that is why they are dreaded.
Yes, by the nice picture you have provided, your does not look to be a melanoma. Yet, I request you to know that there can be surprises on histopathological examination hence the need to take action ASAP. It is great to know that your are visiting a Dermatologist.

I hope this helps you , Sir.

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