Dermatologic Surgery Pearls for Non-Mohs Surgeons

© 2024 HMP Global. All Rights Reserved.

Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of The Dermatologist or HMP Global, their employees, and affiliates. 

In this interview, Dr Travis W. Blalock shares his insights on dermatologic surgery for non-Mohs surgeons, identifying key surgical pearls and offering strategies and techniques for optimizing patient care. 

The Dermatologist: What are some of the key dermatologic surgery pearls for non-Mohs surgeons? 

Dr Blalock: One of the greatest surgical pearls I have learned is recognizing when you should and should not be doing surgery based on the patient assessment or evaluation. Choosing the right patient is important. And then moving on from the perioperative assessment, being aware of how we technically perform the procedure, such as controlling bleeding and tension. How we apply basic and more advanced suturing techniques can have a significant amount of influence and effect on patient outcomes. 

Another surgical pearl might be something as simple as teaching your staff how to assist you with doing surgeries. As we train residents, we teach them the technical components of providing care and doing these procedures, but you only have 2 hands. Hopefully, you can utilize the hands of those around you to help you perform the procedure more efficiently and effectively. 

Beyond that, we can look to safety issues. How do we anesthetize in a way that is safe, effective, and comfortable for patients? How do we make sure that we have the appropriate safety measures for our patients in place when we are doing these procedures? This means having the appropriate utilities and resources to respond to patients who may have reactions to medications or who may be in a situation where we need to respond quickly and effectively. It may also include having staff members who are prepared to reach out to people who can help you if you get into an uncomfortable situation during a procedure. 

Finally, it is important for us to acknowledge the patient experience. If we can get the patient a really good outcome surgically that does not necessarily always equate to the patient having a positive experience. How do we decrease the patient’s anxiety and improve their experience while they are in the office? How do we offer options and create scenarios where we can optimize postoperatve pain control? How do we bandage patients appropriately? How do we counsel them appropriately to take care of their wounds when they leave? We need to understand how to create pearls that are advantageous for our patients after they leave our office. 

The Dermatologist: What are some important considerations regarding wound care and post-operative management, and how do they contribute to optimal patient outcomes? 

Dr Blalock: I certainly think that postoperative care and management should be considered preoperatively. What can this patient tolerate? What resources do they have when they get home? I think if we do not consider these elements, we set ourselves up for some of the negative impacts of surgery, such as dehiscence, infection, and suboptimal patient experience. In my opinion, this is a window of opportunity for us to consider. How do we train our staff members to do this? Do we know ourselves how to do this? From time to time, I look at some of the bandages my staff place and I think, wow, they did such a great job of putting on that bandage and I have not done one quite as well in a while. We must ask ourselves, are we keeping our skill sets up sufficiently enough that if we bring on a new team member we can teach them effectively? This impacts not only the patient’s ultimate outcome, but also their experience. 

Beyond the technical portion of correctly putting on the appropriate bandage, we must figure out how to personalize the bandage for the patient’s unique situation. For example, at my office, if we do surgery on a patient’s face, we will usually put a bandage over the wound for a couple of days, maybe 24 to 48 hours, and we will have them change the bandage at 48 hours. But you can imagine a scenario where a patient simply does not have the ability to change their own bandage. So, from time to time, I will make changes to my standard protocol, having a bandage placed on the wound and the patient not touching the bandage for a week. If the patient cannot change the bandage, I have got to find a way to mitigate that challenge by changing the way I apply the bandage or the way I instruct the patient to take care of their wound. Sometimes the best way to take care of a wound for a patient is to decrease the number of times they must change the bandage, which can be a burden on them. Depending on the situation, it may also decrease the chances for the wound to get infected. 

We need to not only expand our technical skills and abilities to apply postoperative wound care and management, but we also need to think about how we can personalize that wound care and management for the patient who is sitting in front of us. I think there is a great opportunity there for us to consider that from a research perspective, as well as from an educational standpoint. 

The Dermatologist: For dermatologists looking to enhance their surgical skills, what resources would you recommend? 

Dr Blalock: That is a great question, and I think a lot of it comes down to how people learn. As we get out into practice and start practicing dermatology, there is an understanding of what things you need to make yourself more effective and efficient as you are providing care. There are certain aspects of the currently available educational material that probably would not apply to a significant portion of dermatologists, but I think broadly there are some educational opportunities that exist. There are multiple anatomy type courses that are always helpful for dermatologists looking to enhance their surgical skills even if for nothing other than knowing which areas to be mindful of surgically as we approach any dermatologic surgery. 

There are other opportunities available through various groups and organizations, both virtually and in person, which allows you to tailor your education to what you need. As I have gotten into the mid portion of my career, I think some of the best educational opportunities come from spending time with other surgeons. 

We all train at different programs and those programs have different surgeons and dermatologists who, on any given day, teach pearls that improve your ability to provide care to patients. But the reality is really about diversity of training. We do not have one textbook or one person who is able to teach you absolutely everything, so we must find avenues to learn a diversity of ways to respond to surgical situations or deploy certain pearls we have discovered as we provide care. I have learned so much during surgical pearls symposia because they provide short and compact nuggets of information. Even changing one thing based on what you learned can improve your ability to provide care quicker and more efficiently for your patients.