How would you manage this ulcer on the foot?

This week's case discussion, sent in by Dr David Stewart, features a painless, non-healing ulcer on the foot of an 85-year-old man.

The patient blamed new shoes, but the lesion didn't heal when he went back to wearing his previous footwear. The patient is not diabetic and has good foot pulses.

What do you think of the clinical and dermoscopy images, and what would you do in this case?

Update

Here is the pathology result.

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