Oculoplastics and Mohs surgery?

[NSAspy]

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I'm curious about the "boundary" between derm and oculoplastics when it comes to lesions (basal CA, etc) around the eyelids? Who takes the lead... does it depend on whether the lacrimal apparatus is involved?

Also are oculoplastic ppl generally trained in Mohs? If so, can can they resect lesions (Basal cell etc) beyond the orbit, i.e. nose, cheeks, forehead etc..

 

[rocketbooster]

No, derm does Mohs. OP does some BCC around the eyelid, though. If you are a med student interested in OP, I always thought you're wasting your time applying to ophtho and should be aiming for ENT or plastics instead. Or if you want to do Mohs then derm. ENT does most of the orbital fractures and plastics also steals a lot from OP. OP basically does all the lid retractions if that's up your ally.

 

[ophthope]

I'm curious about the "boundary" between derm and oculoplastics when it comes to lesions (basal CA, etc) around the eyelids? Who takes the lead... does it depend on whether the lacrimal apparatus is involved?

Also are oculoplastic ppl generally trained in Mohs? If so, can can they resect lesions (Basal cell etc) beyond the orbit, i.e. nose, cheeks, forehead etc..

I did a rotation and spent some time with the director of an ASOPRS fellowship. On a couple of cases we had patients come directly from derm - the dermatologist would do these giant MOHS excisions in the midface, and send them directly to oculoplastics to fix the defect. Not in a dump-them-on-oculoplastics way, but in a planned way since they were the ones who are trained in MOHS, and oculoplastics is trained to fix the hole they leave. I don't think any oculoplastics people do MOHS.

No, derm does Mohs. OP does some BCC around the eyelid, though. If you are a med student interested in OP, I always thought you're wasting your time applying to ophtho and should be aiming for ENT or plastics instead. Or if you want to do Mohs then derm. ENT does most of the orbital fractures and plastics also steals a lot from OP. OP basically does all the lid retractions if that's up your ally.

I see your argument, but I think most people interested in Ophthalmology decided they didn't want to do ENT or plastics on purpose. Oculoplastics allows a much milder lifestyle than ENT. Maybe Plastic Surgery could give you a similar lifestyle. You'd also never do any intraocular surgeries, and I definitely know of oculoplastics-trained Ophthalmologists doing a significant number of cataracts.

 

[rocketbooster]

I see your argument, but I think most people interested in Ophthalmology decided they didn't want to do ENT or plastics on purpose. Oculoplastics allows a much milder lifestyle than ENT. Maybe Plastic Surgery could give you a similar lifestyle. You'd also never do any intraocular surgeries, and I definitely know of oculoplastics-trained Ophthalmologists doing a significant number of cataracts.

No private practice ENT has a good lifestyle, not much worse than ophtho. Academic ENT has the bad lifestyle. That's why I'm saying if you know you like facial surgery then you shouldn't apply to ophtho to get to OP, just do ENT or plastics or derm. Much wiser IMO.