How to Study Dermatologic Surgery and Mohs in Residency

Dermatologic surgery and Mohs micrographic surgery are integral components of dermatology training, yet mastering these skills takes deliberate effort. To build surgical fluency, residents must combine foundational knowledge, hands-on practice, and strategic use of high-yield resources. This guide provides a structured approach to developing expertise in dermatologic surgery during residency. Understand the Anatomy: A Surgical Foundation Anatomy is the cornerstone of dermatologic surgery. Without a thorough understanding of key anatomical structures, surgical outcomes can suffer, and complications may arise. Residents should prioritize studying the anatomy of the face, scalp, ears, neck, and extremities, as these areas are frequently involved in dermatologic procedures. Focus on learning the vascular supply, nerve pathways, and muscle orientation in commonly treated regions. Pay special attention to critical structures such as the facial nerve branches, superficial temporal artery, and muscles of facial expression. Incorporate cadaver dissection sessions, if available, to reinforce your understanding of three-dimensional anatomy. Master Flaps and Grafts Reconstructive techniques are essential in dermatologic surgery, particularly after tumor removal. Flaps and grafts allow for functional and aesthetic restoration, but their execution requires meticulous planning and comprehension. Begin by studying basic principles such as tension lines, vascularity, and tissue elasticity. Learn the indications, advantages, and limitations of various techniques: Local flaps: Advancement, rotation, transposition, and bilobed flaps. Grafts: Full-thickness and split-thickness skin grafts. Complex closures: Z-plasty and island pedicle flaps. Practice designing flaps on paper or silicone models, and observe their application in the operating room. Surgeons often narrate their thought process during procedures, offering valuable insights into decision-making. Take notes and ask questions