Yes, dermatologists are trained physicians who regularly perform surgical procedures. Dermatology is a comprehensive medical specialty that addresses conditions of the skin, hair, and nails, encompassing medical, cosmetic, and surgical treatments. These surgical procedures, often called dermatologic or cutaneous surgery, treat diseases and enhance the appearance of the skin. Most are performed in an outpatient office setting using local anesthesia.
Common Surgical Procedures Performed by Dermatologists
Dermatologists perform minor surgical procedures for both diagnostic and therapeutic purposes. A foundational element of this work is the skin biopsy, which is necessary to confirm a diagnosis, especially for suspected skin cancers or complex rashes. Biopsies typically fall into three categories: shave, punch, and excisional, chosen based on the type and depth of the lesion.
Shave biopsies remove only the superficial layer of the skin, often using a razor-like tool, and usually do not require stitches. Punch biopsies utilize a circular instrument, often four millimeters in diameter, to obtain a deeper core of tissue through the epidermis, dermis, and superficial fat, frequently necessitating a single suture for closure. Excisional biopsies remove the entire lesion along with a small border of surrounding tissue for a complete sample.
Therapeutic procedures routinely performed include the removal of benign growths like cysts, lipomas, and skin tags, as well as the treatment of common skin cancers. For superficial basal cell carcinoma and squamous cell carcinoma, dermatologists frequently use a technique called curettage and electrodessication (ED&C). This involves scraping away the growth with a sharp instrument called a curette, followed by burning the base with an electrosurgical unit to destroy residual cells. Standard excisions, where the entire tumor and a margin of healthy skin are removed with a scalpel and the wound is closed with sutures, are used for various skin cancers and problematic moles.
Specialized Dermatologic Surgery Training
Complex or high-risk surgical cases require a dermatologist to undergo fellowship training beyond their standard three-year residency. This advanced training concentrates heavily on advanced surgical and reconstructive techniques. The most recognized procedure requiring this subspecialty expertise is Mohs micrographic surgery (MMS), a tissue-sparing technique for skin cancer removal.
Mohs surgery is used for cancers that are recurrent, large, have poorly defined borders, or are located on sensitive areas like the face, hands, or genitals. The defining feature of this procedure is that the surgeon acts as both the surgeon and the pathologist. They excise a thin layer of tissue and immediately examine it under a microscope in a dedicated on-site laboratory.
This process is repeated layer by layer until no cancer cells are detected at the margins, achieving cure rates often exceeding 99% for certain primary basal cell carcinomas. Following the complete removal of the tumor, the Mohs surgeon performs complex reconstruction of the resulting surgical defect. This frequently involves advanced techniques like skin flaps or grafts to optimize the functional and aesthetic outcome.
Surgical Aspects of Cosmetic Dermatology
Dermatologists are involved in procedures aimed at aesthetic enhancement. While many popular cosmetic treatments are non-surgical, a subset of procedures performed by dermatologists involves incisions. These methods are often performed to correct or improve outcomes following medical skin surgery or to address age-related changes.
Surgical cosmetic procedures performed by qualified dermatologists include scar revision, which may involve techniques like subcision to release tethered scar tissue, and hair transplantation for addressing pattern hair loss. Some dermatologic surgeons also perform procedures like tumescent liposuction, which involves injecting a large volume of dilute anesthetic solution before fat removal. These procedures are distinct from non-surgical interventions like neurotoxin injections, dermal fillers, or chemical peels, which do not require a scalpel or traditional surgical closure.