How would you manage this lesion on the chest?

In this week's case discussion from Dr David Stewart, we look at a 48-year-old man who was seen 12 months ago for a skin check. Two hypertrophic scars are noted on his chest from previous skin lesion excisions, so Dr Stewart advises he try a silicon-based dressing to flatten them. 

However, at his follow-up skin check, the patient reports that the dressings have made the lower scar worse, and Dr Stewart notes a definite change.

Please review the clinical and dermoscopy images below. How would you manage this case?

Update

Here is the pathology result:

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