A 53-year-old male school teacher presents for a new patient evaluation at a primary care clinic. He lives in a very rural part of the state with minimal specialist resources. At age 43 he had an abnormal mole removed that turned out to be an early melanoma. On evaluation after excision, the oncologist felt that good margins were achieved around the lesion and no metastases were identified. Which of the following elements of his history confers the most risk of a melanoma in his future? Change in an existing mole. Male sex. Lack of access to routine care with a dermatologist. The patient’s age (greater than 50). History of a prior melanoma that underwent excisional cure before metastasis.