Dermatologic Surgery and Cutaneous Oncology

David J. Leffell, MD, Director

The Dermatologic and Laser Surgery Unit focuses on skin conditions amenable to surgical or laser intervention. The keystone of the program is a technique known as Microscopically Controlled Excision (Mohs Technique), applied specifically for recurrent or other high risk skin cancers. It provides the highest cure rate for selected tumors and permits immediate reconstruction for the convenience of the patient. Sophisticated approaches for the management of other complicated or rare skin cancers are also provided.

Special Services:

• Mohs Surgery for non-melanoma skin cancer
• Melanoma evaluation and surgery in conjunction with the Yale Cancer Center Melanoma Unit
• Skin cancer screening
• Laser surgery including:
• Ultrapulse Carbon Dioxide laser - skin resurfacing and rejuvenation
• Pulsed dye laser - for hemangiomas and other vascular growths and warts
• Pigmented lesion laser for age spots and tattoos
• Cosmetic dermatologic surgery including:
• Aging face: techniques for facial rejuvenation including laser and chemical peeling
• Sclerotherapy for varicose and starburst leg veins

Resident Education:

The program is designed to accommodate the differing degrees of resident skills and interests. All residents complete the program with a full understanding of the material covered in the American Society for Dermatologic Surgery guidelines. In the first year, residents learn basic skills from pigs' foot sessions taught by clinical faculty or visiting professors and from text assignments. In addition, didactic information on technique, complications, lasers and related matters is provided by Dr. Leffell and the residents in a seminar format. When a fellow is being trained, the majority of resident didactic teaching is his or her responsibility as this helps develop teaching skills. On a practical basis, first year residents perform basic dermatologic procedures such as biopsies in the private faculty practice at Yale and at the VA. Those interested and skilled will progress to excisional surgery in the first year as well. Each first year resident spends one month rotating on Dermatologic and Laser Surgery where they gain extensive exposure to and hands on experience with excisional surgery, cutaneous oncology, reconstruction, pulsed dye laser, ultrapulse laser, and the Q-switched ruby laser.

Residents perform surgery in the faculty practice commensurate with their skill and interest. In each successive year, more time is spent in the Dermatologic and Laser Surgery Unit and at the VA. By the third year, the resident should understand and be able to perform advanced dermatologic surgery procedures such as flaps and grafts. They should be skilled in Ultrapulse and other laser techniques. During the three years of residency, residents are encouraged to select patients from their own clinic population who require surgery and operate on them as primary surgeons every Friday under supervision by the fellow or Dr. Leffell. About one third to one half of the surgery practice is cosmetic. Chemical peels and laser represent a substantial part of the non-oncologic component of dermatologic surgery and all residents develop hands on experience and didactic knowledge in these areas.