Providers as Patients: A PA's Biopsy Story

We're all patients at some point, and that's where real empathy comes from. Stepping into the patient's shoes, even for something routine, changes how you practice. I recently went through a biopsy of my own, and it gave me a whole new appreciation for what my patients feel when they're in my chair.

I'm not a particularly moley person, but I've always had one mole on each foot. Over the past year I started to think they were getting a little larger, and one began to darken. Those are classic signs of possible dysplasia, or atypical changes, in a pigmented lesion. When I first showed them to my supervising physician about a year ago, she thought they were fine. When I showed her again recently, her opinion had changed, which was what I expected. If I saw those moles on a patient, I'd want to take them off too.

You have to be careful with moles on the feet, because the skin there (volar skin) is a little different and the features you look for shift slightly. In dermatology we use a dermatoscope, basically a magnifying glass with a light. It's very helpful, but if you're already suspicious with the naked eye, the dermatoscope should mostly confirm your decision to biopsy.

There are two main types of biopsy, and both start with numbing the area with lidocaine, usually with epinephrine. A shave biopsy uses a flexible razor blade to shave underneath the lesion, often for raised moles or to sample possible skin cancers. A punch biopsy is like a cookie cutter that removes a plug of skin down to the subcutaneous fat and needs stitches. It captures the epidermis and dermis for a deeper sample, and punches come in sizes from 2mm to 8mm. Punches are used for anything suspected to be melanoma or atypical when you can remove the whole lesion. Standards vary by practice, but those are my rough guidelines.

Given the size and dark pigment of my moles, punch biopsies were the best option. I had about a week to dread the shot, and honestly it hurt just as much as I expected. There are so many nerves in your hands and feet that a shot there is killer, and lidocaine burns. Then it's strange when your feet go numb. We did the biopsies at lunch on a Thursday and luckily I had Friday off.

By Friday morning it felt like a chunk had been taken out of both feet, and I hobbled around all weekend. A week later, one site got infected even though I kept them covered constantly, and both feet were still sore, probably not helped by working all week. The whole thing made me deeply thankful for my feet and gave me real empathy for what my patients go through.

Being the patient is one of the best teachers a provider can have. It's a good reminder to lead with honesty and empathy, because your patients are nervous and tender and just want to feel cared for. If a spot on your skin is changing, don't wait to get it looked at, and if you're a future PA, hold onto these moments of being the patient when it's your turn to help.