servitup

10+ Year Member
Sep 24, 2006
500
6
Status
Resident [Any Field]
On a dermatology rotation right now and find these Mohs cases to very interesting. It also seems that one could readily integrate Mohs surgery into a busy outpatient OMS practice (as well as use it to feed cosmetics). Does anyone here know of any OMS with training in Mohs surgery? Specifically, I mean someone who does the entirety of the case from the excision to the pathology to the reconstruction.
 
Jul 6, 2010
329
5
Status
Non-Student
On a dermatology rotation right now and find these Mohs cases to very interesting. It also seems that one could readily integrate Mohs surgery into a busy outpatient OMS practice (as well as use it to feed cosmetics). Does anyone here know of any OMS with training in Mohs surgery? Specifically, I mean someone who does the entirety of the case from the excision to the pathology to the reconstruction.
Do a search on SDN over in the derm and prs threads. There is some good stuff over there. I too am interested in this. My dad had a lesion cut off of his nose. A derm did the removal and his own slides. An in house prs (moonlighting basically) did the flap.

It used to be incredibly lucrative and still is for those who have a market share on it. But they both said it is VERY hard to break into. But where I used to live was saturated with docs already.

I'm sure you realize this but it was presented to me as being very complex and the derms have a tight hold on the fellowships. They only train derms. The flaps/recon are done by ent/prs/oms depending on the location.

Let me know what you find out though if you don't get info on this thread. It's cool stuff.
 
OP
S

servitup

10+ Year Member
Sep 24, 2006
500
6
Status
Resident [Any Field]
The place I have been, the surgeon is a fellowship trained dermatologist. He does his own recons with the exception of the eyelid which he sends to an oculoplastic surgeon in town. He will do paramedian forehead flaps, etc. He is talented too. I would let him work on my family.
 

Count Orlok

Octagonecologyst
10+ Year Member
Jan 14, 2008
178
2
Status
Dental Student
It might be beneficial to get a job at a VA (at least part time) when you are out. Those old vets have tons of skin lesions to whack off. You would probably get an excellent experience and then could try to move it out into the private practice setting. You could treat it like an unofficial working fellowship.
 

flapaTron

§ herpen the derp §
5+ Year Member
Jul 18, 2010
445
3
Status
Dental Student
oh man, i see the AMA jumping on this as soon as word gets out :smuggrin:
 

drhobie7

10+ Year Member
Jun 9, 2005
1,367
10
Los Angeles, CA
Status
Resident [Any Field]
Interesting idea. I did an elective in derm surg. The area is highly saturated in so cal. You have dermatologists without moh's fellowships doing moh's procedures. The hardest part (in my opinion) is reading the frozen sections. Frankly, that can be pretty darn tricky. And then there's the issue of getting the skin edge on the slide. To my surprise it was often tough to distinguish a follicle from dysplastic epidermis. It all depends on the angle the skin edge was cut and how it lays on the slide. There are a bunch of weird artifacts that can screw you up and make you think there's a positive margin. It not at all like recognizing SCC on an image in a textbook.
 

schmack

10+ Year Member
Jun 26, 2008
20
0
Status
I don't think I would have any interest in doing that, primarily for the medical-legal aspect of things. If you inadvertently left a positive margin and for whatever reason incorrectly interpreted the slide and the patient had a recurrence, good luck finding an expert witness to testify on your behalf. On the other hand, if you were able to backdoor into fellowship somehow, and prove you have adequate training, then that may be another story. These days it seems as if its more and more difficult to expand your scope without fellowship or more. It's not like the days of old when someone could essentially decide they want to pursue an aspect of OMS and integrate it into their practice by just doing a few cases and expanding gradually (i.e, Joseph Niamtu, etc., etc.). It is interesting stuff though, not sure if I've heard of anyone doing it from OMS...
 

omfsquirrel

10+ Year Member
5+ Year Member
Aug 16, 2007
26
0
The Lands
profile.myspace.com
Status
Resident [Any Field]
We do a boat load of Mohs repairs down here. Most of it at the VA. Derm does the mohs resection then sends em down the hall for the repair. I think we split it with ent or plastics. Like the other guy said... the VA is loaded w/ white guys that need mohs surgery. Evidently working on doing some more at the homeland pretty soon. I'm pretty sure this would be tough to get into outside an institution. Most of the guys doing it are plastics or derm and have a fellowship under their belt. You could buddy up with a derm guy and just do all his repairs. There may be a billing advantage to that out in the real world. It's cool surgery though.
 
OP
S

servitup

10+ Year Member
Sep 24, 2006
500
6
Status
Resident [Any Field]
I think it would be cool to do the whole thing but the flaps, grafts, etc. are neat. There is a billing advantage to splitting up the duties because if the mohs surgeon does the recon he only gets paid half for the recon whereas if the patient walks down the hall to one of us we get paid full price. My understanding is that these guys are all learning the recons in their fellowships but there are a lot of derms doing Mohs excisions after a weekend course or short preceptorship, which is a bit scary.