Dermatology is the specialized branch of medicine focused on the diagnosis and treatment of conditions affecting the skin, hair, and nails. Dermatologists are medical doctors (MD or DO) who have completed extensive post-graduate training. This training includes four years of medical school, a one-year internship, and a three-year residency program dedicated to dermatology. Their scope of practice is broad, encompassing over 3,000 distinct conditions, ranging from common issues like acne and eczema to complex diseases and skin cancers.
Common Surgical Procedures Performed by Dermatologists
Dermatologists routinely perform a variety of surgical procedures, often in an outpatient setting under local anesthesia. These interventions are typically minor, focusing on diagnosis and the removal of lesions confined to the skin’s surface or upper layers. A frequent diagnostic procedure is the skin biopsy, which involves taking a small sample of skin for microscopic analysis. Biopsy methods include shave biopsies for superficial lesions, punch biopsies for deeper samples, and excisional biopsies to remove the entire lesion.
Dermatologists also manage and remove non-cancerous and pre-cancerous growths. Simple excisions remove moles, cysts, and skin tags, requiring a precise incision and closure with sutures, often in two layers. For pre-cancerous lesions or superficial skin cancers, dermatologists utilize destructive techniques. These include cryosurgery (freezing the tissue with liquid nitrogen) and electrosurgery, such as curettage and electrodesiccation, where the growth is scraped away and the base is cauterized. Performing these procedures is integral to general dermatological practice, providing immediate treatment for many skin concerns.
Specialized Training in Dermatologic Surgery
Beyond standard surgical procedures, some dermatologists pursue advanced training, particularly for managing skin cancer. This advanced training is typically a one- to two-year post-residency fellowship in Micrographic Surgery and Dermatologic Oncology, which is accredited by bodies like the Accreditation Council for Graduate Medical Education (ACGME). The core focus is Mohs Micrographic Surgery (MMS), a tissue-sparing technique for removing certain skin cancers.
During the Mohs procedure, the cancerous tumor is removed layer by layer. Each layer is immediately analyzed under a microscope while the patient waits. This continues until no cancer cells are found at the margins, maximizing the preservation of healthy tissue. Fellowship-trained Mohs surgeons gain extensive experience in complex reconstructive techniques, including advanced skin flaps and grafts, to repair resulting surgical defects. Fellows often complete over a thousand cases, ensuring mastery of excision and subsequent repair. This specialization provides patients with the highest reported cure rates for many common skin cancers.
When Collaboration or Referral is Necessary
While dermatologists are skilled surgeons, complex cases sometimes necessitate collaboration with or referral to other surgical specialists. This is true when a tumor is unusually large, deeply invasive, or located in an area with intricate underlying anatomy. For example, if skin cancer extends into deep structures like muscle, bone, or deep fascia, the expertise of a head and neck surgeon or a general surgeon may be required.
Referral is also common for extensive reconstructive needs outside the typical scope of dermatologic surgery. Lesions near the eye, for instance, often require referral to an oculoplastic surgeon. Those involving the ear or nose may be best handled by an otolaryngologist. Dermatologists prioritize a multidisciplinary approach for complex cases to ensure the best functional and aesthetic outcome. This system of referral ensures that patients receive care from the physician most qualified for that specific aspect of their treatment.