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08 FYi • Careers


SKIN DEEP


Is dermatology the specialty for you?


I


T HAS been predicted that by the year 2024 skin cancer rates among 60 to 79-year-olds will rise by a third in the UK – this on top of statistics suggesting that people in the same age group are today five times more likely to be diagnosed with malignant melanoma than their parents were, thanks to an increase in sunny foreign holidays and the use of sunbeds. Just these figures alone attest to the growing


profile of dermatology as a medical specialty and the need for competent practitioners in the coming decades. But that’s not to say that competition for dermatology NTNs (National Training Numbers) isn’t stiff and the training demanding.


Overview Dermatologists manage diseases of the skin, hair and nails. These are extremely common and account for around 15 per cent of GP consultations. The number of possible dermatological diagnoses has been estimated at 3,000 and includes inflammatory, inherited, environmental, occupational or malignant skin disorders. The specialty requires an in-depth


knowledge of skin physiology and pharmacology,


internal medicine and other specialties including immunology, pathology and genetics. It is mainly an out-patient specialty although some patients need hospital admission and dermatologists are often on the wards seeing patients in other departments. Some skin conditions are chronic and


intractable but many are curable and most are at least treatable. Dermatology is said to have the largest formulary in the hospital ranging from ancient tar preparations to the latest immunomodulatory drugs. Most dermatologists are also skin surgeons


and responsible for treating approximately three-quarters of all skin cancers, identifying lesions that require excision for histological confirmation and providing further treatment. A growing number of other subspecialties are also emerging in dermatology including dermatopathology, hair and nail disorders, paediatric dermatology, cutaneous allergy, immunodermatology, photodermatology, cosmetic dermatology and genetic skin disease. Personal qualities required in dermatology


include reliability, self-motivation, punctuality, flexibility and an ability to work well in a team. Dermatologists must also possess good communication and interpersonal skills because of the considerable psychological impact of some skin conditions.


A typical day for a dermatologist might


involve an outpatient clinic, followed by ward visits and a surgical list. Dermatologists work with other consultant dermatologists and nurse consultants and due to a high volume of skin cancer work there may be close liaisons with histopathology, plastic, ENT and maxillofacial surgery colleagues and clinical and medical oncology. Weekend on-call duties are generally less demanding than in other medical specialties.


Training Entry into specialty training for dermatology requires two years of foundation training and then a further two years in core medical training or the acute care common stem (ACCS). Trainees must have passed the full MRCP (UK) for entry to ST3. The programme is highly competitive and


some experience in dermatology at ST1 or ST2 level or as a locum specialty registrar is certainly beneficial. Most trainees will also try to get involved in some research or audits to improve their chances. Specialist training takes four years (specialty registrar) with the award of a certificate of completion of training (CCT), after which a doctor can apply for a job as a consultant dermatologist. Because dermatology is a well-structured outpatient based specialty with a relatively low


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