Careers in Dermatologic Surgery

Dermatologic surgeons have unsurpassed expertise in skin surgery. Their comprehensive knowledge of the basic science, pathology, wound healing, inflammatory processes, and carcinogenesis in the skin puts them in the unique position of knowing how to best use medical resources for skin disease and obtain the best results.

Because most dermatologic surgery is done in the office setting with only local anesthesia, dermatologic surgeons are the premier experts on office surgery. Their safety record for procedures such as tumescent liposuction is unparalleled by other specialties. Dermatologic surgeons are often able to customize their office setting to a high level of efficiency with room turnover superior to most operating room settings, which allows more patients to be examined and more time to operate.

Dermatologic Surgery in the General Dermatology Setting

Many dermatologists perform excisions of both benign and malignant lesions in the office setting. They commonly also implement destructive procedures both with electrosurgical devices and cryosurgery. They may also offer cosmetic procedures such as chemical peels, injectables, or laser treatment. Most dermatology residencies prepare residents for this pathway.

Micrographic Dermatologic Surgeon

Micrographic dermatologic surgery (MDS) requires a focused one-year fellowship in a program approved by the Accreditation Council for Graduate Medical Education (ACGME). Micrographic surgeons (formerly known as Mohs surgeons for the physician who developed the procedure) use a microscopically guided technique for tissue resection of skin cancers. MDS has been shown to have the highest cure rates for most malignant skin tumors, such as basal cell and squamous cell carcinoma. In addition, the technique spares as much healthy tissue as possible by removing the cancer in layers until all margins (superficial and deep) are tumor free. In essence, the job of the micrographic surgeon is to identify the skin tumor, extirpate it, evaluate the presence of residual tumor under the microscope, and reconstruct the defect in a way that maintains form and function.

Micrographic surgeons are experts in management of cutaneous oncology, such as staging and treatment of advanced squamous cell carcinoma, unusual skin tumors, and melanoma. Micrographic surgeons train in the dermatopathologic interpretation of both hematoxylin and eosin and immunoperoxidase staining of skin tumors. They are also specifically trained in reconstructive surgery, utilizing both simple closure methods and complex flaps and grafts in restoration of anatomy. This expertise in both surgery and pathology is unique across medical fields. As such, MDS remains the gold standard for treatment of cutaneous tumors in functionally important and cosmetically sensitive areas.

More about Mohs surgery

Cosmetic Dermatologic Surgeon

ASDS took over the accreditation of the one-year fellowships previously managed by the Cosmetic Surgery Society. This fellowship provides an intensive experience in a wide range of cosmetic skin procedures, which include scar revision, hair restoration / removal, surgical lifting (blepharoplasty, facelift, …), body contouring, vein procedures, resurfacing, treatment of wrinkles and folds and skin rejuvenation. Apart from the facial plastics concentration in otolaryngology, these fellowships are the only fellowships in medicine that provide an in depth, hands-on experience in an aesthetically focused environment.