Sarah was worried about three pea sized lumps on her anterior chest wall. She had noticed them about three weeks before and felt embarrassed about coming with something so trivial. As I examined her, we chatted about the children. She was six months younger than me, with a son six days younger than my daughter (aged 8) and a daughter two years older. Blond and vivacious, Sarah was always a pleasant patient to have on the morning list. Like any intelligent parent, she had her anxieties about her children, and I knew them well.

The lumps she showed me were so small and insignificant that I reassured her confidently, adding my usual advice to “Come back if things change.” Three weeks later, the day the children went back to school after Christmas, Sarah came back. The lumps had grown, and I felt a horrible sense of dread. To “save her worrying” I removed one of the lumps at the end of the morning surgery. As I did so, I found the usual chitchat drying up. The specimen I held in the forceps was unmistakably jet black. I did not need the histologist's report to tell me the diagnosis. Her future swam before me—this was very nasty, she would be dead by Easter. How could I carry on discussing books we had both enjoyed and the tribulations of family life?

In fact Sarah lived until May and died just before her 40th birthday. It was not an easy passing. She already had hepatic involvement, and the subcutaneous nodules spread over the whole of her trunk. Fortunately, before she had too many symptoms from her cerebral metastases, she was overwhelmed by sheer tumour load. At the funeral Sarah's husband defiantly asked many of the friends and family to wear bright clothes, and their daughter played the flute superbly to a packed church.

What did I learn from Sarah, and how has this changed my practice? Eighteen months earlier, she had had a 7 mm mole on her back. Seen by another doctor, she had been asked to come back in two months. The mole disappeared, and she did not return. I had not realised that spontaneous “resolution” is a well recognised feature of primary melanoma.

I still confidently reassure the owners of undisputedly benign lesions, but when there is uncertainty I take steps to reach a definitive diagnosis. With guidance from the local dermatologist, I have bought a digital camera and a dermatoscope, which I am slowly learning to use. I do not tend to review patients with doubtful lesions but instead try to come to a decision there and then whether to refer or to excise so that I do not have patients default. My experience so far is limited, and my threshold for referral is low at present while I build up my knowledge. Above all, I am constantly suspicious and would far rather be safe than sorry.

From a personal point of view, seeing someone my own age dying so quickly and so inevitably made me step back and look at my own family, reminding me that time spent together is very precious.