The Dermatologic Surgery Rotation

Victor A. Neel, MD, PhD, Director

Tiffany Jow Libby, MD

 

The Dermatologic Surgery Unit occupies approximately 2,500 ft. of floor space on the 10th floor of the APC building at Rhode Island Hospital.  The unit’s emphasis is on Mohs surgery, reconstructive surgery, and cutaneous oncology. Several members of the full-time staff perform other dermatologic surgery procedures, including cosmetic and laser procedures.

The unit receives referrals not only from the dermatologic community, but also from the related surgical specialties of plastic surgery and oculoplastic surgery.  It is one of the busiest academic units in the country with over 1,500 cases performed each year and over 30,000 cases treated by our team since 1989. Complicated cases may be presented to the Interdisciplinary Melanoma and Cutaneous Oncology Clinic for collaboration with surgeons, oncologists, radiation oncologists, and medical dermatologists. Due to the unique nature of this Interdisciplinary Melanoma and Cutaneous Oncology Clinic, cases are referred to us from all over Southern New England. The majority of postoperative wounds are reconstructed in the unit. However, coordinated care with other specialists  such as plastic  or oculoplastic surgeons is easily accomplished on-site at the Rhode Island Hospital campus. The division has a major role in the education of residents and fellows in dermatologic surgery and has active research interests in technical aspects of Mohs surgery, perioperative care, reconstruction, and cutaneous oncology.

The resident is required to take first call for after hours patient inquiries; most calls are related to bleeding, infection, or contact dermatitis and although the calls are rare, they must be taken seriously.  The second and third year residents also rotate in the Mohs surgery unit for a total of 3 months during their training; most residents will directly participate in over 400 cases during training.  Senior residents are allowed hands-on training with taking Mohs layers and suturing closures. There is a senior resident clinic, supervised by several faculty members, for excisions and cosmetic procedures such as laser (pulsed dye and alexandrite), chemical peeling, cosmetic injectable fillers, botulinum toxin, and sclerotherapy.

All procedures are supervised by an attending.  This is especially critical with any advanced surgical or cosmetic procedure.

All procedures are listed in the resident’s surgical log, which is maintained through the ACGME data collection system.  The American Board of Dermatology (ABD) requires that the logs include diagnosis, date, procedure, and whether the resident is first surgeon or assistant.  The surgical logs are reviewed annually and available to the ABD. A formal didactic series of lectures, including interactive technical and surgical labs, discussions with experienced faculty members, journal and book reviews, and invited guest speakers are all integral parts of the surgery curriculum.  Residents are encouraged to participate in research and are offered multiple opportunities to develop their own projects in conjunction with faculty members.

Senior Medical Student Electives

Clinical rotations in dermatologic surgery are available only by special request, and are reserved for students who have completed a clinical dermatology elective and intend to pursue a career in dermatology. However, medical students will have exposure to the unit in the general dermatology elective.