Dermatology, the field dedicated to the health and diseases of the skin, hair, and nails, is often perceived as a strictly medical discipline. Dermatology is best described as a hybrid specialty, integrating deep medical knowledge with significant surgical practice. Dermatologists routinely manage complex systemic diseases and perform numerous procedures, ranging from minor office-based surgeries to highly specialized cancer removal techniques.
Dermatology as a Core Medical Discipline
The foundation of dermatology is rooted in medical diagnosis and the non-surgical management of a vast range of conditions. Dermatologists are trained to recognize and treat over 3,000 distinct diseases, many of which are chronic and require long-term medical care. This includes common issues like acne and rosacea, as well as complex inflammatory and autoimmune disorders such as psoriasis, eczema, and lupus affecting the skin.
A large part of a dermatologist’s practice involves interpreting laboratory results, performing detailed patient histories, and managing sophisticated pharmaceutical treatments. These treatments often include prescribing topical medications, oral immunosuppressants, and advanced injectable biologic therapies. The ability to recognize skin manifestations of systemic illness, like liver disease or internal cancers, highlights the specialty’s deep connection to internal medicine.
General Dermatologic Procedures and Surgery
All general dermatologists integrate a variety of surgical and procedural techniques into their daily practice for both diagnostic and therapeutic purposes. Diagnostic procedures frequently involve obtaining a tissue sample through a biopsy, such as a superficial shave biopsy or a deeper punch biopsy, which uses a circular tool to collect a full-thickness specimen. These small, office-based procedures are fundamental for accurately identifying skin cancers, inflammatory conditions, and various rashes.
Therapeutic procedures are routinely performed to treat benign and malignant lesions. Cryosurgery uses liquid nitrogen to freeze and destroy precancerous lesions and benign growths. Electrodesiccation and curettage (ED&C) involves scraping away superficial skin cancers, like basal cell carcinoma, and using an electric current to destroy remaining cells. For deeper or larger lesions, dermatologists perform standard elliptical excisions, cutting out the lesion and closing the wound with sutures. General procedural dermatology also encompasses non-invasive or minimally invasive cosmetic treatments, such as:
- Laser therapies
- Chemical peels
- The injection of fillers
- Neuromodulators
The Specialized Role of Mohs Micrographic Surgery
Mohs Micrographic Surgery (MMS) is the highest level of surgical specialization within dermatology, focusing on the removal of high-risk skin cancers. This technique allows for the complete examination of the excised tissue’s margins while the patient waits. The surgeon acts as both the excisional surgeon and the pathologist, processing and reviewing the tissue slides immediately to ensure all cancer cells are removed before closing the defect.
The procedure involves removing thin layers of tissue, mapping them precisely, and examining them under a microscope to find cancer extensions, which spares the maximum amount of healthy surrounding tissue. This tissue-sparing approach results in cure rates often exceeding 99% for certain primary skin cancers, making it the preferred method for tumors on cosmetically or functionally important areas like the face. Mohs surgeons must complete a competitive, accredited fellowship after residency, demonstrating competence in a high volume of cases and complex reconstructions.
Training and Certification Requirements
The path to becoming a board-certified dermatologist confirms the specialty’s dual identity as both a medical and surgical discipline. After completing medical school, aspiring dermatologists must complete a four-year postgraduate training program. This typically includes one year of general clinical training, such as an internal medicine or transitional year, followed by three years of specialized residency training in dermatology.
The curriculum during the three years of residency provides comprehensive instruction in medical dermatology, dermatopathology, and general dermatologic surgery. Certification is granted by the American Board of Dermatology after passing rigorous exams that test knowledge across the entire scope of practice. For those who wish to focus on the most advanced surgical techniques, an optional one- to two-year fellowship in Micrographic Surgery and Dermatologic Oncology (Mohs) is available to further specialize their procedural skills.