The Mohs and Dermatologic Surgery Center Treatment Team
Our Mohs and Dermatologic Surgery Center is part of Brigham and Women’s Hospital (BWH), a teaching hospital of Harvard University. Our three senior attending Mohs surgeons (Drs. Ruiz, Schmults and Waldman) are faculty members of Harvard University. We are privileged to train Harvard Dermatology Residents and Fellows in Micrographic Surgery and Dermatologic Oncology. The residency and fellowship programs operate under the guidelines of the American College of Graduate Medical Education.
Below is information about the physician and nursing team who will take care of you during your visit.
Residents
Our residents are doctors who have completed college, medical school, a year of training in internal medicine or surgery, and are currently completing a three-year training program in dermatology at Harvard University and its affiliated hospitals (including Brigham and Women’s, Beth Israel Deaconess, and Massachusetts General) after which they will become board-certified dermatologists. The Harvard Dermatology Residency program is among the most competitive residency programs in the world and we are thus fortunate to have exceptionally-qualified residents. Residents spend two months in the Mohs Center during the second or third year of residency. By this time, they are already adept at closing open wounds on the skin via suturing. Based on their experience with us, many have elected to pursue Micrographic Surgery and Dermatologic Oncology fellowships.
Fellows
Our fellows are board-certified dermatologists who have recently completed the training above and are now spending two years at BWH, Dana-Farber, and the Boston VA specializing in the care of skin cancer patients. Our fellowship program was established by Dr. Schmults in 2012. It is unique in the nation in that our fellows spend summers completing a Masters Degree in Clinical Effectiveness at the Harvard School of Public Health. Our fellows are not only highly skilled dermatologists, but also scientists who perform clinical research to improve patient care. They are dedicated to continually analyzing and improving patient outcomes. During fellowship, our fellows perform approximately 2,000 skin cancer surgeries.
Our Educational Mission
At Harvard University, Brigham and Women’s Hospital, and the Mohs and Dermatologic Surgery Center, physician education is a cornerstone of our mission. Ongoing education and research at all levels of training and experience allow us to deliver patient care of the highest quality. Our educational environment allows us to continually examine our outcomes and patient satisfaction to improve care.
If you chose us because of our very high patient satisfaction ratings, these ratings are a reflection of our educational environment. Because we train physicians daily, we quickly incorporate recent advances in cancer care. Because we also do research, we contribute to these medical advances by analyzing our
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outcomes, refining what we do, and publishing our findings so that others can benefit. Examples of our publications are below.
This rich and rigorous educational environment results in physicians at all levels of experience striving to continually improve. This in turn leads to outstanding outcomes for our patients, most of whom are taken care of by our residents and fellows, as well as senior physicains. We believe that our educational system gives you, our patients, the best possible outcome.
Differing roles of doctors at each level of training
Our residents and fellows are gradually given more independence over time. Our data shows that patient satisfaction and complication rates are the same regardless of whether residents or fellows performed some aspects of surgery. We are able to train physicians without compromising patient outcomes because we have clearly defined roles and responsibilities that match each doctor’s level of experience as outlined below.
You will have one senior supervising Mohs surgeon (Dr. Ruiz, Dr. Schmults or Dr. Waldman) on your surgery day. She is ultimately responsible for all aspects of your care. She may elect to delegate some parts of your care to others as detailed below but she will supervise and be responsible for that delegated care.
The senior Mohs surgeon will do the following:
Directly supervise the fellow as he/she removes (cuts out, excises) your skin cancer via the Mohs method
Determine whether your excision margins are free of skin cancer by looking at those margins under the microscope her/himself
Approve the plan for your reconstruction (sewing the excision wound closed) by directly examining you and discussing your reconstruction with the fellow or resident who will perform it. Your doctors will discuss the following: type of reconstruction needed, where the sutures will be placed, type of suture material to be used, and specific techniques needed. For routine reconstructions, the senior surgeon will not be in the room with the resident or fellow if that resident or fellow has been fully trained to independently carry out routine reconstructions.
However, the senior surgeon will discuss and approve the key aspects of the procedure with the resident or fellow, is immediately available as needed, and may come in and out of the room to give tips or answer questions.
The resident may do the following:
Explain how your surgery will be performed and answer your questions throughout the day (with input from senior surgeon as needed)
Remove benign and malignant lesions via standard (non-Mohs) excision
Reconstruct your wound with supervision as needed (see above)
We have the following specific educational activities which enhance our educational environment:
Daily case by case discussion of proper skin cancer excision and reconstructive techniques prior to and during patient care
Weekly case conferences as needed during which complex cancer cases are reviewed by the physician team
Weekly meetings of our clinical research team to review ongoing projects aimed at improving patient care
Monthly staff meetings where nurses, doctors, and administrative staff review patient satisfaction survey results and implement improvements based on patient feedback
Monthly journal clubs to review and discuss relevant new studies in the medical literature Examples of the many publications which have resulted from our educational environment and ongoing analysis of patient outcomes (doctors at all levels of training authored this work):
Heightened infection-control practices are associated with significantly lower infection rates in office-based Mohs surgery. Journal of Dermatologic Surgery, 2010
The Z-Advancement Flap for Reconstruction of Lateral Nasal Tip and Medial Alar Defects.
Dermatologic Surgery, 2014.
Outcomes of Patients with Multiple Cutaneous Squamous Cell Carcinomas: A Single-Institution Cohort Study. Journal of the American Academy of Dermatology, 2015
Sequential Curettage, 5-Fluorouracil, and Photodynamic Therapy for Field Cancerization of the Scalp and Face in Solid Organ Transplant Recipients. Journal of Dermatologic Surgery, 2016
Multiple Mohs Micrographic Surgery is the most common reason for divergence from appropriate use criteria. Journal of the American Academy of Dermatology, 2016
An evaluation of high-stage cutaneous squamous cell carcinoma outcomes by gender. British Journal of Dermatology, 2016
The positive impact of radiologic imaging on high-stage cutaneous squamous cell carcinoma management. Journal of the American Academy of Dermatology, 2017
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Our Senior Supervising Surgeons
Attending A, MD is Director of the Mohs and Dermatologic Surgery Center at Dana- Farber/Brigham and Women’s Cancer Center and is an Associate Professor of
Dermatology at Harvard Medical School. She completed her undergraduate and medical degrees at X University and and dermatology residency at Y. She is a fellowship-trained Mohs surgeon. She received a Master degree in X subject at Y University. She has served on the board of directors of the X and Y committees.
Our Fellows
Fellow A, MD is a Board Certified dermatologist currently completing both a fellowship in Micrographic Surgery and Dermatologic Oncology at the Brigham and Women’s Hospital and a Masters of Public Health at the Harvard School of Public Health. Before joining the medical field, she had a prior career in X field. She earned her undergraduate degree at X university. She then attended medical school at Y University and completed her dermatology residency at Z University.
Our Residents
Resident A, MD is a Harvard dermatology resident. He grew up in X city, USA. He received his undergraduate degree from X University and completed medical school at Y University. His interests within dermatology include medical education, consult dermatology and dermatopathology. Outside of work, he enjoys running, cycling, trying new food and traveling.
Resident B, MD studied and worked in X field before becoming a physician. After receiving undergraduate and graduate degrees in X field, she worked for three years in research and development capacities at a Y company. As a Harvard dermatology resident, she has focused on device and technology innovation to help patients requiring Mohs surgery. She plans on pursuing further sub- specialized fellowship to practice as a full-time Mohs surgeon.
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Our Histology Technicians (who process your skin for microscopic evaluation)
Our
Administrative Team
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Nurse B, LPN went to X University School of Practical Nursing. She joined the Mohs team in the summer of 2017. She has been in Dermatology for 15 years.
Histotech A joined the Mohs and Dermatologic Surgery Center in 2008 as a Senior Histologist. She is a member of the National Society for
Histotechnology and American Society of Mohs Histotechnologists (ASMH). She has participated in many research projects over a 30 year career including our study of immunohistochemistry staining for melanoma.
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Practice Coordinator X joined the Mohs team in the fall of 2009 and receives a steady stream of accolades from patients who cite her
knowledge, promptness, and kindness in scheduling them for surgery and handling their logistical needs.
Practice Assistant II joined the Mohs team in the spring of 2017 bringing his enthusiasm and kindness to seamlessly coordinate your visit and ensure that your questions are answered.
