Murad Alam - Evidence-Based Procedural Dermatology

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Since the first edition of this text, much has changed. The methodologic quality of the literature in dermatologic surgery has continued to improve [1, 2]. Journals are encouraging, and authors are accepting, the importance of well-designed studies that are also written up in accordance with appropriate reporting guidelines, like those maintained by Equator [3].

For therapeutic and interventional studies, the importance of carefully selected outcome measures is increasingly apparent. As the Cochrane Collaboration and others have found, research waste can result when the results of small studies cannot be pooled because the outcome measures used are too disparate to reconcile [4, 5]. This problem may ultimately be rectified by the development of core outcome sets, or minimum groups of agreed-upon outcomes that would be employed by all investigators studying a particular disease or condition. In dermatologic surgery, the IMPROVED group is a US-based collaboration working on relevant core outcome sets for the treatment of skin cancers and cosmetic conditions.

High-quality patient-level data may also soon be forthcoming from the many qualified clinical data registries being created by professional specialty societies in the United States. While the presumptive primary incentive for such registries is to facilitate practitioners ability to report required quality metrics to the federal government, the data collected will also be a fruitful resource for a range of clinical questions. Registries in dermatology, such as DataDerm at the American Academy of Dermatology, are currently maturing but within 5 years may be being mined by interested researchers. In dermatologic surgery, the American College of Mohs Surgery has initiated the MohsAIQ Registry, and the American Society for Dermatologic Surgery (ASDS) has planned a registry to track adverse events specifically.

Funds for clinical and comparative effectiveness research in dermatologic surgery are still sparse. A notable bright spot is the ASDS new Brandt grant program, which specifically supports multicenter clinical research in dermatologic surgery. Investigators are learning to work across centers in ways that are cost- and time-efficient.

The first edition ofEvidence-Based Procedural Dermatologywas named after the ACGME-approved advanced fellowship in dermatologic surgery started in 2003. More recently, this fellowship has been modified to exclude most cosmetic procedures and has been renamed Micrographic Surgery and Cutaneous Oncology (MSDO). A new fellowship program, Cosmetic Dermatologic Surgery, has arisen under the auspices of ASDS to fill the training gap in advanced cosmetic and laser procedures. Collectively, there are now about 100 fellowship positions in dermatologic surgery each year, with approximately 1 in 4 US dermatology residents choosing to obtain advanced dermatologic surgery training. Perhaps even more importantly, dermatologic surgery is permeating residency training in dermatology, with young dermatologists better trained in the surgical management of relevant conditions. The techniques pioneered by dermatologic surgeons have also entered other specialties, including plastic surgery, head and neck surgery, ophthalmology, vascular surgery, medical and surgical oncology, and many others. As a consequence, this text is more relevant than ever. The growing cadre of specialists in dermatologic surgery need current, authoritative, and comprehensive information that weighs the benefits and limitations of various treatment approaches for conditions of concern.

We have opted to stay with the moniker Procedural Dermatology, which concisely conveys the breadth of our charge. But the second edition is much expanded from the first. More topics are addressed, and more outstanding chapter authors are included. I am deeply grateful to the many gifted, busy, and generous dermatologic surgeons who have written this book.