Dermatologists perform a wide range of surgeries, from quick in-office biopsies to complex skin cancer removals and reconstructions. Most people associate dermatologists with acne treatments or skin checks, but surgical training is a core part of their education. Every board-certified dermatologist completes three years of residency that includes surgical skills, and some go on to complete an additional fellowship year specializing in micrographic surgery and dermatologic oncology.
Skin Biopsies
Biopsies are the most common surgical procedure in a dermatology office. When a spot on your skin looks suspicious or a rash isn’t responding to treatment, a biopsy gives your dermatologist a tissue sample to examine under a microscope. There are three main types, each suited to different situations.
A shave biopsy is the simplest. The dermatologist uses a blade to scoop a thin layer of skin from the surface. It works well for superficial conditions and suspected non-melanoma skin cancers, though deeper features can sometimes be missed if the sample is too shallow. A punch biopsy uses a small cylindrical blade to take a full-thickness core of skin, reaching into deeper layers and even subcutaneous fat. This makes it especially useful for inflammatory skin conditions that extend below the surface, or for sampling a section of a larger pigmented lesion. An excisional biopsy removes an entire lesion along with surrounding tissue. It’s the preferred approach for suspected melanoma because tumor thickness determines staging and treatment decisions, so getting the full depth matters.
Mohs Surgery for Skin Cancer
Mohs micrographic surgery is the gold standard for treating high-risk basal cell carcinomas and squamous cell carcinomas, and it’s increasingly used for melanoma and other rare skin tumors. The procedure has a cure rate of roughly 95%, with recurrence rates of only 1% to 5% depending on the cancer type.
What makes Mohs unique is that the dermatologist serves as both surgeon and pathologist. After removing a thin layer of tissue, the surgeon maps and color-codes the specimen, freezes it, slices it into sections, stains the slides, and examines them under a microscope right there in the office. If cancer cells remain at any edge, the surgeon removes another precisely targeted layer from only the affected area. This cycle repeats until the margins are completely clear. The result is maximum cancer removal with minimal loss of healthy skin, which is especially important on the face, ears, and hands where preserving tissue matters cosmetically and functionally.
The entire process happens in an outpatient setting under local anesthesia, but it can take several hours depending on how many layers need to be removed. You should plan to clear your whole day. Once the cancer is fully removed, the surgeon may close the wound with stitches, use a skin flap or graft for reconstruction, or in some cases allow it to heal on its own. Recovery is generally straightforward: mild discomfort, some redness, and simple wound care at home. Scars can take up to a year to fully flatten and fade.
Excisions of Moles, Cysts, and Other Growths
A large portion of dermatologic surgery involves removing benign growths. Moles that are changing, irritated, or cosmetically bothersome are typically cut out with a scalpel and the wound is closed with stitches. Sebaceous cysts, which are firm lumps beneath the skin filled with keratin, are removed through a similar excision. The goal is to remove the entire cyst wall so it doesn’t recur.
Lipomas, the soft fatty lumps that develop under the skin, are also removed surgically. Most are cut out through a standard incision, and they rarely come back after removal. A technique called minimal excision extraction can reduce scarring. In some cases, liposuction with a needle and syringe is used instead to suction out the fatty tissue through a smaller opening.
Cryosurgery
Cryosurgery uses extreme cold to destroy unwanted tissue. Liquid nitrogen, which boils at minus 196 degrees Celsius, is the most commonly used agent. The dermatologist applies it using a spray, a cotton-tipped applicator, or a probe, depending on the size and location of the lesion. The technique works through a freeze-thaw cycle: tissue is rapidly frozen to a lethal temperature, allowed to slowly thaw, and often frozen again.
Different types of cells require different temperatures to be destroyed. Normal benign cells are typically killed at minus 20 degrees Celsius, while more resilient cancer cells need temperatures between minus 40 and minus 50 degrees. Pigment-producing cells are particularly sensitive and can be damaged at temperatures just below minus 5 degrees, which is why cryosurgery sometimes leaves lighter patches of skin at the treatment site. Dermatologists use cryosurgery for warts, precancerous spots called actinic keratoses, skin tags, and certain superficial skin cancers. When combined with other techniques like curettage (scraping) and electrodesiccation (using electrical current to destroy tissue), cure rates for some skin cancers reach nearly 98%.
Electrosurgery and Curettage
Electrosurgery uses electrical current to cut, destroy, or coagulate tissue. Electrodesiccation, one common form, delivers a spark of current to dry out and destroy superficial growths. Electrocautery uses heat generated by the current to seal blood vessels and stop bleeding during other procedures. These tools are part of nearly every dermatologic surgery suite.
Curettage and electrodesiccation are often performed together. The dermatologist scrapes away abnormal tissue with a sharp, spoon-shaped instrument called a curette, then uses electrical current to destroy any remaining abnormal cells and control bleeding. This combination is a standard treatment for superficial basal cell carcinomas, squamous cell carcinomas in situ, and various benign growths.
Nail Surgery
Dermatologists perform specialized surgery on nails for conditions ranging from chronic ingrown nails to tumors growing beneath the nail plate. Because the nail matrix (the tissue that produces the nail) grows from the back toward the tip, biopsies of this structure are always oriented in the transverse direction. A lengthwise biopsy scar in the matrix would permanently split the nail as it grows out.
For severe or recurring ingrown toenails, dermatologists may perform a partial nail extraction followed by destruction of part of the nail matrix so the problematic edge doesn’t grow back. Cryosurgery has proven more successful than electrocautery for this type of matrixectomy. When tumors or other lesions need to be removed from around the nail, dermatologists use specialized flaps, such as a V-Y rotation advancement flap, to reconstruct the nail fold and surrounding skin.
Reconstruction After Skin Cancer Removal
Removing skin cancer often leaves a wound that needs more than simple stitches to close. Dermatologic surgeons are trained in a range of reconstructive techniques to repair these defects. Skin flaps involve moving adjacent tissue, with its blood supply still attached, to cover the wound. Skin grafts take tissue from another part of the body to fill larger defects. The choice depends on the size, depth, and location of the wound, as well as how much surrounding skin is available to work with.
Reconstruction on the face requires particular precision because even small distortions can affect appearance and function. Dermatologic surgeons who complete Mohs fellowships receive focused training in facial reconstruction, learning to orient scars along natural skin creases and preserve the movement of eyelids, lips, and nostrils. Your follow-up schedule will typically include appointments to remove stitches and monitor healing, along with specific instructions about scar care, activity restrictions, and when you can resume wearing makeup or exercising.
Training Behind These Procedures
Board-certified dermatologists complete four years of medical school, one year of general postgraduate training, and three years of dermatology residency accredited by the ACGME. Surgical skills, including biopsies, excisions, and wound closures, are part of every residency program. Dermatologists who want to specialize further in surgery can pursue a one-year fellowship in micrographic surgery and dermatologic oncology through the American Board of Dermatology, which provides advanced training in Mohs surgery, complex excisions, and facial reconstruction.