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A mass on the big toe for more than 10 years

Case Identification
Case ID Number: 
Clinical case information
Case presentation: 

This 69 year old male has a mass on the lateral aspect of the great toe for at least 10 years. The mass has now gotten large enough to be troublesome. The lesion is not painful. It is fleshly, and moderately soft.

Radiological findings:: 
The lesion is completely radiolucent. There is no calcification. The density appears to be higher than that of lipid. MRI findings show a well circumscribed mass, T1 dark, T2 intermediate signal intensity. There appears to have a normal tissue plane between the Mass and the adjacent first distal phalanx.
Laboratory results:: 
none ordered
Differential Diagnosis: 
There are a large number of benign soft tissue lesions. Lipoma and variants of lipoma, fibrous lesions, tumors that arise from nerve cells or nerve sheath cells, and tumors of vascular origin are among the possibilities.
Further Work Up Needed:: 
The concerns here are the potential for cancer, which exist despite the very slow growth, and the skin loss that will result from excision. Although local coverage may be possible, a split thickness skin graft should be considered. It does not appear that a local flap or rotational flap will be necessary.
Treatment Options:: 
Excision with local or split thickness skin graft coverage is planned.