Roenigk's Dermatologic Surgery: Current Techniques in Procedural Dermatology PDF

Preface

The first edition of this textbook was published in 1988 and at that time, we felt we were helping to define a growing subspecialty in dermatology-dermatologic surgery. We asked a prominent plastic surgeon and an otolaryngologist to write forewords for the book. Both acknowledged the dermatologist's expertise in some surgical procedures but reminded us that collaboration across specialties was important. We continued that theme in the second edition published in 1996. In both editions, we mentioned the experience of Dr. Jacques Joseph who was dismissed from Wolff's Clinic in 1896 for performing a cosmetic procedure. His example serves as a reminder that change is not easy, and agents of change are often ostracized.

Fred Mohs, a general surgeon from MadisonWisconsin, published his first paper on chemosurgery in 1941. At that time, Dr. Mohs was not highly regarded by the surgical community. When I came to Mayo, I heard comments from general surgeons, such as ‘‘we hoped the Mohs procedure would die when Dr. Mohs died!'' It takes time and perseverance, but good ideas with real value normally prevail to become the standard of care. It turns out Dr. Mohs had two good ideas: a better method to completely check the margins of a specimen and, since he used zinc chloride paste to fix the tissue and did not close the wounds, we learned a great deal about second intention wound healing.

General surgeons and other surgical specialties ignored Mohs' procedure because they did not want to read the pathology, and it was not practical to perform this procedure in a traditional operating room. In the late 1960s, some bold dermatologists who were willing to practice outside the normal bounds of dermatology began to expand their skills in surgery. This included novel procedures such as hair transplantation, dermabrasion, and laser, among others. Since dermatologists were learning surgery and are trained during their residency in the clinical and pathology diagnosis of skin cancer, the Mohs procedure was a natural fit. The efficiency of this practice was helped because dermatologists routinely practice in a clinic, not an operating room, and frozen section technology became readily available in the 1970s. As a result, a dermatologist could operate on three or four patients at one time in the clinic using local anesthesia, get a frozen section in about one hour, and read the histology before taking additional tissue. In those days, most wounds were left to heal by second intention. It did not take long before dermatologists realized that they could close surgical defects after Mohs surgery for skin cancer, so the wound healed better and faster. Thus was born oncologic and reconstructive dermatologic surgery, two of the three major areas that make up the body of knowledge of our subspecialty.

Since the first edition of Roenigk's Dermatologic Surgery in 1988 and the second edition in 1996, the reconstructive skills of dermatologic surgeons have expanded considerably. Dermatologic surgeons now repair most of their defects, including many that would have been referred to other surgeons in the past.We do these procedures with better skill because of the number of cases we perform. Based on Medicare data, dermatologists perform more skin lesion excisions, Mohs surgery for skin cancer, primary repairs, and skin flaps than any other medical specialty. Because dermatologic surgeons today routinely perform these procedures on an outpatient basis instead of a hospital operating room, the cost of care has greatly reduced while quality and access have also improved. As a result, the reconstructive surgery section of our book has been greatly expanded in this edition.

All population and demographic studies tell us that skin cancer will continue to increase because of the aging of the baby boomers. At the same time, even more patients are looking for ways to avoid the signs of aging. Combine patient demand with the surgical skills learned through removing cancer along with the dermatologist's appreciation for the appearance of the skin, and the third major area-cosmetic dermatologic surgery-becomes a logical extension of our subspecialty and ever-expanding body of knowledge. This edition of Roenigk's Dermatologic Surgery has added new chapters on technology used for cosmetic procedures, such as lasers and light sources as well as minimally invasive procedures such as soft tissue augmentation, ambulatory phlebectomy, and Botox. We have greatly expanded our cosmetic dermatologic surgery section while also maintaining a balance, since many older procedures still have value, having withstood the test of time.

In the 1970s, several societies were founded to promote education in dermatologic surgery, including the American Society for Dermatologic Surgery and the American College of Mohs Micrographic Surgery and Cutaneous Oncology, among others. A peer-review journal, now named Dermatologic Surgery, was started, which currently enjoys the seventh highest impact factor among 35 peer-reviewed dermatology journals. It became clear that residents must learn dermatologic surgery as part of their dermatology training. The American Board of Dermatology and the Residency Review Committee for Dermatology recognized this change in practice and adopted new program requirements for dermatology training and reorganized the certifying exam in dermatology, adding a section on surgery. It also became clear that fellowship training beyond the residency was an important way for some residents to gain added skills. Most of these fellowships were established by the American College of Mohs Micrographic Surgery and Cutaneous Oncology, but in 2003, the Accreditation Council for Graduate Medical Education approved the adoption of a new subspecialty of dermatology-procedural dermatology.The Residency Review Committee now accredits 35 fellowships in this subspecialty while the American Board of Dermatology is considering a subspecialty-certifying exam in procedural dermatology. Regardless of when a dermatologist was a resident or how much surgery was taught in their training program, it is incumbent on all physicians to maintain their skills and engage in lifelong learning.

Population demographics and the increasing cost of health care have supported the growth of dermatologic surgery over the past 40 years because we provide ready access to cost-effective, high-quality outpatient care for skin disease and the signs of aging, which was heretofore unavailable. Our mission as editors of the Third Edition of Roenigk's Dermatologic Surgery: Current Techniques in Procedural Dermatology has been to provide one source for the most up-to-date yet comprehensive information that broadly describes what is currently accepted as state of the art in dermatologic surgery. Reading this text is an important way for dermatologists who perform surgery to maintain or improve their surgical skills. We hope that the pages of this book become wrinkled and the binding cracked with regular use.