A Changing Mole: Assessing and Reassuring
Your Role — Doctor
General Practice
Your 39-year-old patient is very anxious about a mole on their back that a family member said 'looked different'. On examination it has some irregularity and warrants an urgent dermatology referral to exclude melanoma, though it is not definitely cancer. The patient is extremely worried and has a family history of skin cancer. You need to assess, explain the referral honestly without over-alarming, and safety-net.
- •Take a focused history of the mole (changes in size, shape, colour, symptoms) and relevant risk factors including family history and sun exposure.
- •Examine and explain your findings honestly: there are features that need specialist assessment, but it is not a confirmed diagnosis.
- •Explain the urgent referral pathway and why it exists — to check it promptly, which is precautionary, not a sign it is definitely cancer.
- •Address the patient's high anxiety with empathy while giving balanced, honest information.
- •Give clear safety-netting and sun-protection advice, and check understanding.
The Interlocutor
Played by the actor / assessor
You are 39. Your sister noticed a mole on your back looks different, and since your aunt died of skin cancer you are extremely frightened it's melanoma. You've been googling and have convinced yourself it's the worst. You want honest answers but are braced for bad news.
- •Say you're really scared — your aunt died of melanoma and your sister said this mole looks different.
- •Report that the mole seems to have got a bit bigger and darker over a few months and sometimes itches.
- •Ask directly whether it's cancer.
- •Say you've read terrifying things online and are struggling to stay calm.
- •If the doctor is honest, empathetic, and arranges prompt specialist assessment, feel reassured that it's being taken seriously and agree to the referral and sun advice.
Sample Role-play
Hello Ms Romano, I'm Dr Blake. I can see you're worried — let's take a proper look and talk it through together. Can you start by telling me what you've noticed about the mole?
My sister said it looks different. It's on my back so I can't see it well, but she says it's bigger and darker. And my aunt died of melanoma, so I'm terrified.
I can absolutely understand why that combination has frightened you, especially with what happened to your aunt. You did the right thing coming in. Can I ask a few quick questions and then examine it? Has it changed in shape or colour, or does it itch or bleed at all?
It has got a bit bigger and darker over a few months, and it itches sometimes. It hasn't bled.
Thank you — that's helpful. Let me examine it now. … I've had a good look. I want to be honest with you: it does have a few features that mean it should be checked properly by a skin specialist. That does not mean it's cancer — most moles referred like this turn out to be harmless — but it's not something I'd want to just watch.
So it might be cancer. Oh God.
I know that's a frightening thing to hear, and I won't pretend the possibility isn't there — that's exactly why we check. But 'needs checking' is very different from 'is cancer'. The safest thing is to have a specialist look at it quickly, and I'm going to arrange that on an urgent basis so you're not left waiting and worrying.
How quickly? I've been reading awful things online and I can't stop.
The urgent pathway means you'd usually be seen within about two weeks. And a word on the internet — it tends to show worst-case stories, which feeds anxiety rather than facts. If the specialist has any concern, they can simply remove the mole and examine it, which is a quick procedure. Try, if you can, to hold on to the fact that we're acting fast precisely to keep you safe.
Okay. That does help a little. Is there anything I should do in the meantime?
Yes — keep an eye on it, and let us know sooner if it changes quickly, bleeds, or forms a sore that won't heal. Protect your skin from the sun with cover and high-factor sunscreen, and check the rest of your skin too. I'll give you written information and the referral details, and you can call me with any questions.
Thank you. I feel a bit calmer knowing it's being dealt with quickly.
I'm glad. You've done exactly the right thing by getting it checked. We'll get you seen quickly, and please come back sooner if anything worries you before then.
Useful Phrases
Clinical Background
Pigmented lesions with features suggestive of melanoma (change in size, shape, colour, asymmetry, irregular border, diameter, itching or bleeding — the ABCDE criteria and weighted 7-point checklist) warrant urgent (2-week-wave) dermatology referral. Most referred lesions are benign. Definitive diagnosis is by excision biopsy. Balance honesty about the need for assessment with proportionate reassurance, address health anxiety and unhelpful internet use, and give sun-protection and self-monitoring advice.
Common Mistakes to Avoid
- ✕Offering blanket reassurance ('it's nothing to worry about') that is dishonest and may delay diagnosis.
- ✕Over-alarming the already anxious patient by implying cancer is likely.
- ✕Omitting clear safety-netting and sun-protection advice.