How To Prepare for a Dermatology Rotation

If you are interested in the field of dermatology, a dermatology rotation will help you decide if it’s a right fit for you and give you a huge advantage when applying to jobs as a PA-C. Here are a few tips that can help you prepare.

Review the common things first

Know the bread and butter of a typical outpatient clinic day. You will see lots of benign lesions (seborrheic keratosis, cherry angiomas), precancerous lesions (actinic keratosis), various skin cancers (basal cell, squamous cell, melanoma), inflammatory conditions (eczema, atopic dermatitis, psoriasis), and more. 

Another good tip is going in your first week and seeing what’s on the schedule, and making a list of common things that you see and review those topics first, as you’ll likely keep seeing them throughout your rotation.

Learn to speak the language

If you want to stand out to your preceptors, learn to speak the language. Learn the common terms to describe lesions. Describing a rash using a primary and secondary morphology term, size, demarcation, color, and distribution can be helpful to picture what the rash looks like before seeing the patient. This further helps you and your preceptor figure out the skin condition. 

• Primary skin lesion: lesions not altered by manipulation/complication or trauma (macule, patch, papule, plaque, nodule, tumor)
• Size
• Demarcation: Is the lesion(s) clearly defined or not?
• Color: hypopigmented (reduced color), depigmented (complete loss of skin color), hyperpigmented (dark color), erythematous (red), pink, dusky, purple
• Secondary skin lesion: from some of manipulation, complication or trauma 
• Distribution: Where is it located?  On the face, generalized, asymmetrical or bilaterally symmetrical.
• A good source: https://dermnetnz.org/topics/terminology/

Learn the different types of procedures

You will almost always do some sort of procedure with each patient in dermatology. Procedures can range from a shave, punch, excisional biopsy to freezing lesions with liquid nitrogen, and even curretteing lesions. Get familiar with certain biopsies and learn the pattern of why certain biopsies are appropriate for certain skin conditions/lesions. It’s always helpful to have a pair of gloves on and get ahead and start setting up for a procedure when you hear what the procedure will be. 

Make the most of your experience

Dermatology offers a lot of hands on experience, including assisting with biopsies, surgeries, and procedures. If your preceptor is looking at a slide looking for signs of a fungal or yeast growth or even scabies, look at the slide as well. If your preceptor is or works with a MOHS surgeon (performs micrographic surgery to treat skin cancers in tissue sparing areas), look at the slides as well and questions about the pathology. 

Clinical Resources

A lot of these textbooks should be available to you through your institution so check with your library first before investing in these textbooks

• Fitzpatrick: An easy read and great photo examples. 
• Habif: A good introduction to dermatology for students. 
• Lookingbill and Marks’ Principles of Dermatology​​: Comparable to Habif, both text books are great introductory books for dermatology and easy to read. 

Apps

• Visualdx: When I was a student my program allowed us free access to this app, and this is my favorite app to use in dermatology. They show concise details about skin conditions and show images of different skin conditions in various skin types. A must! 
• Uptodate: Great algorithms and shares clinical trial data with treatment options. 
• Epocrates: Helpful to see dosages, interactions with drugs and other medications.

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