You are an FY2 doctor in a general practice. A 62-year-old woman has a pigmented lesion on her left calf. It is 8 mm across and has enlarged over three months. It has irregular pigmentation and is intermittently itchy. Using the weighted 7-point checklist, you score it 6. You explain that this is suspicious for melanoma and needs a suspected cancer pathway (2-week-wait) referral. She is the sole carer for her husband, who has dementia, and declines referral because she wants to wait three months until respite care is arranged. She repeats back the risks of delay accurately, weighs them against her caring duties and clearly communicates her decision.

What is the most appropriate action?