If any concern exists, a basic work - up including a CBC with differential and a bone scan is done. For a latent lesion which is causing the patient no trouble, no further work-up is needed at the time of presentation. In any case the lesion should be observed with radiographs at intervals, say 3 - 6 months, to check for any change or growth. After one to two years of observation without any change, the lesion may be safely ignored.
Active lesions demand attention.
They need a focused work-up, and likely a biopsy and treatment as well. In addition to the two new radiographs you just got, I recommend an MRI of the lesion and the surrounding anatomic structures, a whole body technecium bone scan, and basic labs including a CBC with differential and an erythrocyte sedimentation rate. Further work up may be required based o the nature ofthe lesion, the age and health history of the patient, and other factors, but the basic work-up remains the same. Aggressive lesions demand immediate attention, but the biosy must be performed as the last step. Most aggressive lesions are due to malignant primary or metastatic tumor, although a few may be benign.