A Physician Assistant (PA) is a licensed medical professional who practices medicine, typically under the supervision or collaboration of a physician. PAs are trained and authorized to perform minor surgical procedures and biopsies in the office setting, including mole removal. This capability is rooted in their broad medical education and specialized training. The specific procedures a PA can perform depend on their experience, practice setting, and governing state laws.
The PA’s Role in Minor Skin Procedures
PAs complete a rigorous master’s degree program, including over 2,000 hours of clinical rotations in specialties like general surgery and primary care. This training provides PAs with the sterile technique and surgical skills needed for minor in-office procedures. Dermatology-focused PAs (DermPAs) receive additional training and continuing education from their collaborating dermatologist.
A PA’s authority to remove a mole stems from their license to practice collaboratively with a supervising physician. State laws dictate this relationship, but PAs are generally authorized to perform biopsies and excisions under the scope of the physician’s practice. Mole removal is a low-risk procedure PAs are trained to handle, which increases access to care and allows supervising physicians to focus on complex cases.
Common Mole Removal Techniques Used by PAs
PAs use several established techniques for removing or sampling moles, depending on the mole’s appearance, size, and suspicion for malignancy. For raised moles, shave removal uses a scalpel to shave the lesion flush with the surrounding skin. This technique is often used for cosmetic removal or superficial biopsies.
For flat or deeper lesions, a PA may perform a punch biopsy, using a sharp, circular instrument to remove a small plug of tissue. This small defect may require one or two stitches for closure. If a mole is highly suspicious or requires complete removal, a PA performs a simple excision, cutting out the entire lesion and a small amount of surrounding normal skin. This procedure requires the PA to close the resulting wound with sutures, creating a linear scar. PAs also commonly perform cryotherapy, which involves freezing small, benign lesions with liquid nitrogen.
Recognizing When a Specialist is Needed
PAs are proficient in minor mole removal but recognize the limits of their practice and refer patients to a dermatologist or surgeon for complicated cases. Referral is warranted if a mole exhibits concerning features, such as multiple colors, uneven borders, or rapid change in size, suggesting melanoma. These suspicious lesions require a more extensive surgical approach than a standard in-office procedure.
Referral is also necessary for very large or deep moles, or those located on areas requiring complex aesthetic reconstruction, such as the face. Lesions requiring specialized techniques like Mohs micrographic surgery are performed by a fellowship-trained surgeon. Mohs surgery involves layer-by-layer removal and immediate microscopic examination. The PA ensures patient safety by recognizing when the lesion’s complexity necessitates specialized expertise.
For flat or slightly deeper lesions, a PA may perform a punch biopsy, using a sharp, circular instrument to remove a small, cylindrical plug of tissue. This small defect may require a stitch or two for closure. When a mole is highly suspicious or requires complete removal with clear margins, a PA will perform a simple excision, cutting out the entire lesion and a small amount of surrounding normal skin. This procedure is more invasive and requires the PA to close the resulting wound with sutures, creating a linear scar. PAs also commonly perform cryotherapy, which involves freezing small, benign lesions with liquid nitrogen.
Recognizing When a Specialist is Needed
While PAs are proficient in minor mole removal, they are trained to recognize the limits of their practice setting and will refer patients to a dermatologist or surgeon for more complicated cases. A referral is typically warranted if a mole exhibits concerning features, such as multiple colors, uneven borders, or rapid change in size, which may suggest melanoma. These suspicious lesions often require a more extensive and precise surgical approach than is suitable for a standard in-office procedure.
Referral is also necessary for very large or deep moles, or those located on areas where aesthetic reconstruction is complex, such as the face. Lesions requiring specialized techniques like Mohs micrographic surgery, which involves layer-by-layer removal and immediate microscopic examination, are performed by a fellowship-trained surgeon. The PA acts as a discerning gatekeeper, ensuring patient safety by recognizing when the complexity of the lesion necessitates the specialized expertise of a dermatologist or plastic surgeon.