Dermatologic surgery is a specialized area focusing on diagnosing and treating conditions of the skin, hair, and nails using surgical methods. Dermatologists are medical doctors who complete extensive training, often pursuing additional fellowship training to become highly skilled dermatologic surgeons. This specialization blends medical knowledge of skin pathology with surgical precision, often performed on visible areas where cosmetic outcome is important. Procedures range from obtaining small tissue samples for diagnosis to complex, tissue-sparing cancer removal and elective aesthetic corrections.
Surgical Procedures for Diagnosis
Small surgical interventions are routinely used to secure tissue samples, which is the first step in diagnosing various skin diseases and cancers. These procedures are performed under local anesthesia to gather sufficient material for microscopic examination. The choice of technique depends on the nature and location of the lesion.
A punch biopsy uses a circular instrument, typically 2 to 6 millimeters in diameter, to obtain a full-thickness core sample of the skin. This cylindrical specimen provides a complete cross-section, invaluable for diagnosing conditions extending deep into the dermis or subcutaneous fat. The site is usually closed with stitches.
A shave biopsy uses a sharp blade to remove only the outermost layers of the skin, resulting in a flat specimen. This technique is preferred for superficial, raised lesions like seborrheic keratoses or suspected basal cell carcinomas, and typically does not require sutures. An excisional biopsy involves removing the entire suspicious lesion along with a narrow surrounding margin of normal skin. This method is reserved for small, concerning pigmented lesions suspicious for melanoma, where complete removal during sampling is beneficial.
Excisional Surgery for Skin Cancer
The removal of cancerous tissue is a frequent and complex surgical procedure performed by dermatologists, demanding high precision. Standard treatment for many skin cancers, including early-stage melanomas and uncomplicated non-melanoma cancers, is wide local excision. This procedure involves removing the visible tumor along with a predetermined, surrounding margin of healthy tissue to ensure all cancer cells are cleared (achieving clear margins).
For complex or high-risk tumors, especially those on cosmetically sensitive areas like the face, dermatologists often employ Mohs Micrographic Surgery (MMS). Mohs surgery is a specialized, tissue-sparing technique that allows for the real-time microscopic examination of 100% of the surgical margin. The surgeon removes a thin layer of tissue and immediately maps and freezes it for examination.
If microscopic analysis reveals residual cancer cells, the surgeon returns to the precise location to remove only another thin layer of affected tissue. This layer-by-layer process continues until no cancer cells are detected. Mohs surgery offers cure rates up to 99% for certain primary basal cell carcinomas while preserving the maximum amount of healthy tissue.
Removal of Benign and Non-Malignant Growths
Dermatologists routinely perform excisional surgery to remove common, benign skin growths that may cause discomfort, irritation, or are cosmetically undesirable. These procedures typically involve simple surgical excision and closure with sutures, performed under local anesthesia in an outpatient setting. A common example is the removal of epidermal inclusion cysts, which are benign sacs beneath the skin filled with keratin material.
Surgical excision of a cyst requires removing the entire cyst wall or sac to prevent recurrence, unlike simply draining the contents. Lipomas, which are soft, benign tumors composed of fatty tissue, are also frequently removed when they grow large or become bothersome. Atypical moles (nevi) or large benign moles are often excised completely for preventative measures or cosmetic improvement.
The removal of skin tags and other superficial benign lesions may also be performed surgically, often using simple methods like snipping with surgical scissors or shave excision. Although these removals are less complex than cancer surgery, dermatologists apply reconstructive training to ensure the smallest and most aesthetically pleasing scar possible.
Advanced Aesthetic Surgical Techniques
A subset of dermatologic surgeons focuses on advanced, elective surgical techniques that are primarily aesthetic, often involving invasive correction or tissue repositioning. Hair transplantation is a significant area, involving the meticulous transfer of hair follicles from a donor site to areas of thinning or baldness. Techniques such as Follicular Unit Extraction (FUE) or strip harvesting restore hair density and hairline appearance.
Dermatologists also pioneered tumescent liposuction, a method for removing localized fat deposits. This involves injecting a dilute anesthetic solution into the fatty tissue, which numbs the area and constricts blood vessels to minimize bleeding. This makes fat removal via a small cannula easier and safer, allowing for body contouring with quicker recovery.
Advanced surgical scar revision techniques are also performed, involving the excision of an existing scar followed by meticulous repositioning of the wound edges. These procedures create a thinner, less noticeable line and demonstrate the surgeon’s capacity to perform sophisticated corrections that blend surgical skill with skin aesthetics.