During a routine skin examination in the dermatology clinic, Sarah, a seasoned nurse, encounters Mr. Rodriguez, a 55-year-old man with a history of excessive sun exposure. Mr. Rodriguez presents with a suspicious skin lesion on his back, which he noticed has changed in size and appearance over the past few months. Concerned about the possibility of skin cancer, Sarah decides to use the ABCDE rule to assess the lesion. Sarah, a gerontological nurse, is evaluating a newly identified skin lesion on Mr. Rodriguez, an 82-year-old man. Using the ABCDE rule, which finding should Sarah recognize as the strongest indicator of potential melanoma in this population?

A. The lesion is firm to the touch but non-tender: Firmness can be suspicious, but tactile quality is less specific than visual ABCDE changes and evolution. B. The lesion measures 5 mm and has not changed in months: Small size and no change lower immediate concern; evolution (change over time) is more worrisome. C. The lesion has symmetrical shape and regular borders: Symmetry and regular borders are reassuring features and lower suspicion compared with asymmetry/irregularity or change. D. The lesion displays multiple colors and has grown in size over the past 2 weeks: Color variation and recent growth (evolution) are high-risk ABCDE features and are the strongest indicators to prioritize urgent dermatologic assessment/biopsy.