Advanced Dermatologic Surgery Post-Graduate Fellowship

The section of Dermatologic Surgery and Cutaneous Oncology within the Department of Dermatology at the Yale School of Medicine sponsors a one-year, ACGME-approved fellowship in Micrographic Surgery and Dermatologic Oncology. Graduates of the program are eligible and prepared to be board certified in the Micrographic Dermatologic Surgery subspecialty.

Founded in 1988 by David Leffell, MD, the Section has grown to become the largest cutaneous surgery program in New England. Close collaborative relationships exist with the sections of plastic surgery, otolaryngology, oculoplastic surgery, medical oncology, and radiation therapy. The Section serves a catchment area of more than 3 million people. The faculty see patients from outside the primary catchment area, including international patients and regional dermatologists, plastic surgeons, head and neck surgeons, and ophthalmologists refer most of the patients we treat. As a university-based academic training program, there is a focus on education and training, clinical excellence, and research. Substantial research databases exist, which include access to clinical images.

Within the training program, fellows have an opportunity to function on an increasingly independent basis. More than 3,000 Mohs micrographic surgery cases are performed on an annual basis. Early-stage melanoma and melanoma in situ are managed with both excision and Mohs surgery, and represent an important opportunity for the fellow to have the broadest exposure in cutaneous oncology. Training in surgical reconstruction is an integral part of the fellowship, as most of the Mohs defects are repaired in the Mohs Unit at the time of cancer removal.

In addition to Mohs surgery, an important component of the fellowship is training in procedural aesthetic dermatology, employing a broad range of lasers, injectables, and other approaches to management of the aging face, scars, and other conditions amenable to procedural intervention.

The surgery is conducted in the Temple Medical Building at 40 Temple Street, Suite 5A. The outpatient surgical facilities, which are under the autonomous direction of the Department of Dermatology, are fully equipped.

The fellowship is open to any physician who has completed a full residency (ABMS-approved) and is at least board-eligible in dermatology. Candidates must have documented superior performance in their residency, especially with respect to patient care. A successful candidate will be intellectually curious beyond that normally expected in a resident. The ability to get along with peers and support staff is a prerequisite for a program that is intensive and depends heavily on close professional relationships. Excellent basic surgical skills are required.

The fellowship is geared towards the dermatologist who is strongly considering a career in academic medicine. We believe that the multidisciplinary approach essential to the success of a cutaneous oncologist physician is pursued best in an academic environment. It is hoped that the fellow will obtain sufficient training in clinical medicine and research techniques so that he or she may contribute to further expansion of knowledge in the field. The breadth of training in surgery, oncology, and pathology are intended to make the fellow a skilled, highly-specialized physician.

Salary will be commensurate with the fellow's PGY status.

The majority of the fellow’s training consists of assisting and performing surgical procedures under direct supervision of program faculty. The fellow is given the opportunity to work with Drs. Leffell, Christensen and Suozzi, performing Mohs surgery and reconstruction 4-5 days per week. In addition, fellows may attend the operating room to observe reconstructions by colleagues in plastic surgery, head and neck, and oculoplastic surgery. All aspects of cutaneous oncology are emphasized during fellowship training, including excising and grossing Mohs stages, tissue mapping, pathology interpretation, wound healing and reconstruction, adjuvant and systemic treatment of advanced malignancies, coordination of multidisciplinary care, and management of skin cancer and melanoma in high-risk patients.

The fellow receives training through the Aesthetic Dermatology Program. Training includes extensive experience with a broad range of lasers and devices. The fellow will learn to treat a variety of conditions, including but not limited to scars, sun-damaged skin, vascular and pigmented birthmarks, rosacea, acne scarring, tattoo removal, hair removal, and others. The fellow also works with injectables, including neuromodulators and a range of soft tissue fillers.

In addition to hands-on training and mentorship in the surgical suite, a didactic lecture series provides additional education on surgical anatomy and complications, advanced reconstruction with local and interpolated flaps, skin grafts, nail surgery (including a practical session in cadaver lab), and lasers and aesthetic dermatology. Dermatologic Surgery Journal Club meets four times a year to review classic and cutting-edge developments in the literature. The Dermatologic Surgery Section Morbidity Conference meets a minimum of twice a year to review challenging cases.

The fellow is expected to have an academic and research interest, and there is ample opportunity to develop teaching skills. In addition to mentoring trainees that rotate through the Mohs Unit, the fellow serves as supervising attending to trainees. Each fellow is mentored in a research project that can meaningfully contribute to the specialty.

Institutional, regional and national conferences are important elements of the training program. Weekly institutional conferences include Dermatology Grand Rounds, Dermatopathology conference, Head and Neck Tumor Board, and Melanoma Tumor Board. The fellow attends and participates in these conferences as appropriate throughout the year. The fellow attends the American College of Mohs Surgery Annual Meeting each year, as well as other regional and national scientific conferences to present research findings.

• American College of Mohs Surgery Annual Meeting
• American Society for Dermatologic Surgery Annual Meeting
• American Academy of Dermatology Annual Meeting