“My wife nagged me to get this mole looked at”

A CHANGING, irregular, multi-coloured pigmented lesion (especially with itch or bleeding) in a high-risk patient (fair skin, chronic UV exposure, sunburns, many moles) is suspicious for melanoma and must not be reassured away from a photo or a glance. Apply structured assessment — the weighted 7-point checklist (major features: change in size, irregular shape, irregular colour, 2 points each; minor: diameter ≥7 mm, inflammation, oozing, change in sensation, 1 each; a score ≥3 triggers referral) and/or ABCDE — examine in person with dermoscopy and a wider skin/node check, and refer on the melanoma suspected cancer pathway (NICE NG12; the Faster Diagnosis Standard aims for a diagnosis or all-clear within 28 days); do not excise or "watch and wait" in primary care. The examinable hidden agenda is bravado over fear: a workmate died of melanoma, and as sole earner he can’t face being ill, so he minimises — the wife’s concern is the reliable signal. Surface the fear, treat sun-safety guilt without shaming, balance honesty with reassurance, and complete the suspected cancer pathway referral with documentation and follow-up.