FRONTIERS IN DERMATOLOGIC SURGERY
In this issue, we hope to explore the history of dermatologic
surgery and also delve into new discoveries in the field. In
the 1930s, Frederick Mohs introduced chemosurgery to
dermatology and expanded the way in which dermatologists
treated skin cancers. Although Mohs micrographic
surgery has become an indispensable treatment modality
for skin cancer, enhancements have been made in the
medical management of advanced skin cancers. Dermatologists
have further expanded their skill set in surgery to
encompass cosmetic surgery with injectables, peels, laser
surgery, tumescent liposuction, hair transplant surgery,
and beyond. Many of the advancements in dermatologic
surgery have come within the past decade. We have seen
the emergence of fractionated laser technology and a burgeoning
field of noninvasive body contouring, which has
revolutionized our ability to offer nonsurgical options to our
patients. We have also witnessed clever applications of old
technologies and materials to treat difficult, recalcitrant conditions.
As the field continues to grow, dermatologic surgeons
are expanding their skill set, and the horizon looks
bright for dermatologic surgery. We have sought to compile
an exciting array of articles from thought leaders in the field
that highlight the past, present, and future of dermatologic
Bill Hanke opens the issue reviewing key moments in the
history of dermatologic surgery. Next, Kelley Redbord and
Bill were able to assemble a unique well-illustrated biography
of the late Samuel Stegman. Bill has access to all of Dr Stegman’s
papers, and thus, he was able to compile a fascinating
article on one of the specialties’ pioneering dermatologic surgeons.
The past and future of soft tissue fillers is then reviewed
by Rick Glogau. Doru Alexandrescu and Vic Ross
follow with a discussion of the manifold current and future
uses of lasers in cutaneous medicine and surgery. Cutaneous
vascular lesions have long been treated with lasers and light
sources but complete removal of many vascular lesions and
malformations remains a difficult task. The future for the
treatment of such lesions is reviewed by Kristen Kelly and
colleagues. The use of fractionation in delivery of laser energy
has brought about rapid and dramatic conceptual and practical
changes in how we can deliver care, and Nazanin Saedi
and colleagues review fractional laser use in the treatment of
esthetic and medical disorders. One of the most exciting observations
in recent years has been the dramatic effectiveness
of ablative fractional resurfacing in the treatment of traumatic
scars and contractures in wounded warriors. These studies
have been carried out at the Naval Medical Center in San
Diego and are described by Nathan Uebelhoer, Vic Ross, and
Body contouring and sculpting is one of the great areas of
most intense current interest in esthetic medicine and dermatology.
Noninvasive fat removal, an important aspect of
this field, is discussed by Ray Jalian and Matthew Avram.
Arielle Kauvar treats us to a discussion of a new approach to
the treatment of melasma using low-fluence Q-switched neodymium-
doped yttrium aluminium garnet lasers to target
melanosomes. Low-level laser therapy has long been used
with some success in Asia and other parts of the world and is
now finding broad application for a variety of pigmented and
textural problems. The treatment of hyperpigmentation in
skin of color is very challenging, and this topic is nicely
reviewed in-depth by Sailesh Konda, Aanand Geria, and Rebat
Halder. Lastly, there is a short discussion of the cutting
edge in cutaneous oncology treatments by Kim Chong and
We sincerely hope that you find this issue informative and
The history of surgery in dermatology (“dermatologic surgery”) is rich with significant developments
and advances by multiple individuals. Only a few of these pioneers can be highlighted
in this report because of space limitations. My apologies to colleagues and friends who have
not been included or mentioned in this article. The Timeline: Major milestones in the history of
dermatologic surgery in this article tells some of the story. The biographic pieces on 15
outstanding physicians add additional detail and perspective. Many major developments have
occurred since 2000, but they are beyond the scope of this article.
Semin Cutan Med Surg 31:52-59 © 2012 Elsevier Inc. All rights reserved.
The Stegman Papers is a biography of Dr. Samuel J. Stegman. The papers were collected by Dr.
Stegman during his lifetime as a dermatologic surgeon and leader. The manuscript includes a time
line of Dr. Stegman’s life and listing of his accomplishments, including significant publications.
Semin Cutan Med Surg 31:60-77 © 2012 Elsevier Inc. All rights reserved.
Modern medical use of injectable soft-tissue augmentation fillers has evolved from the
introduction of bovine collage implants to an array of synthesized materials in the current
domestic and foreign markets. The concept of augmentation has moved from simple lines,
scars, and wrinkles to revolumizing the aging face. A brief overview of the past, present,
and future injectable fillers is presented.
Semin Cutan Med Surg 31:78-87 © 2012 Elsevier Inc. All rights reserved.
The simultaneous advances in engineering, medicine, and molecular biology have accelerated
the pace of introductions of new light-based technologies in dermatology. In this
review, the authors examine recent advances in laser surgery as well as peer into the future
of energy-based cutaneous medicine. The future landscape of dermatology will almost
undoubtedly include (1) noninvasive imaging technologies and (2) improved “destructive”
modalities based on real-time feedback from the skin surface.
Semin Cutan Med Surg 31:88-97 © 2012 Elsevier Inc. All rights reserved.
Dermatologists encounter a wide range of cutaneous vascular lesions, including infantile
hemangiomas, port-wine stain birthmarks, arteriovenous malformations, venous malformations,
Kaposi sarcomas, angiosarcomas, and angiofibromas. Current treatment modalities to
reduce these lesions include topical and/or intralesional steroids, laser therapy, surgical
resection, and endovascular therapy. However, each method has limitations owing to recurrence,
comorbidities, toxicity, or lesion location. Photodynamic therapy, antiangiogenic therapy,
and evolving methods of sclerotherapy are promising areas of development that may mitigate
limitations of current treatments and offer exciting options for patients and their physicians.
Semin Cutan Med Surg 31:98-104 © 2012 Elsevier Inc. All rights reserved.