Dermatology is primarily classified as a medical specialty, although it includes a distinct and highly specialized surgical component known as Dermatologic Surgery. The practice involves the study of the integumentary system, including the skin, hair, nails, and adjacent mucous membranes. Dermatologists are medical doctors trained to diagnose and treat over 3,000 different conditions related to these structures. This field encompasses a broad range of patient care, from complex internal medicine issues that manifest on the skin to advanced procedural techniques.
The Medical and Diagnostic Foundation
The core of dermatology lies in its diagnostic and medical capabilities. Dermatologists regularly manage chronic, non-surgical conditions that require long-term medical treatment and systemic therapies. These include inflammatory disorders such as psoriasis, which causes rapid skin cell buildup, and eczema, characterized by inflamed and itchy skin.
The specialty also focuses on the cutaneous manifestations of systemic diseases, which originate in other parts of the body but present symptoms on the skin. Autoimmune diseases, for example, often cause distinct rashes or lesions that a dermatologist must recognize and treat. Management typically involves prescribing topical medications, oral drugs, or advanced biologic therapies that modify the immune response. Accurate diagnosis is achieved through clinical examination and procedures like skin biopsies.
Key Surgical Procedures Performed by Dermatologists
While the specialty is rooted in medicine, a significant part of a dermatologist’s practice involves surgical intervention, particularly for treating skin cancer. The removal of cancerous, precancerous, and benign skin lesions is a routine surgical task. This often involves a standard excision, where the lesion and a surrounding margin of healthy tissue are surgically removed under local anesthesia, followed by wound repair using sutures.
The most specialized surgical technique is Mohs Micrographic Surgery, a precise method for removing high-risk skin cancers like basal cell and squamous cell carcinomas. This procedure is unique because the surgeon acts as both the surgeon and the pathologist, examining 100% of the excised tissue margins while the patient waits. The tissue is removed in thin layers, immediately frozen, stained, and examined under a microscope until no cancer cells remain. This meticulous, layer-by-layer removal maximizes the conservation of healthy tissue, which is important for lesions on the face and other sensitive areas. Dermatologic surgeons also perform reconstructive procedures, using techniques like skin grafts and complex flaps to repair the surgical defect.
Specialized Training and Certification
The pathway to becoming a dermatologist includes four years of medical school, followed by a one-year internship and a three-year residency in dermatology. This residency provides comprehensive training in both medical dermatology and fundamental surgical skills, including basic excisions and biopsies. The procedural aspect of the specialty is further refined through optional, advanced training programs.
A board-certified dermatologist specializing in advanced skin cancer surgery and reconstruction typically completes a one-year fellowship in Micrographic Surgery and Dermatologic Oncology. This fellowship focuses on the advanced application of Mohs surgery and complex wound closure techniques. The training ensures that dermatologic surgeons possess specialized knowledge of skin anatomy and the unique surgical and reconstructive demands of the integumentary system.