When to refer out

As physicians treating skin cancers, our training and experience vary. Regardless, many of us have the need and opportunity to perform varying degrees of skin surgery. The procedures we perform will be based on our training, experiences, and particular areas of expertise, but for even the most experienced practitioner, there are patients whom one should refer out instead of treating. Deciding just which patients to refer out may be difficult and is a skill that is often acquired painfully through experience. It is our hope to provide some guidelines to aid in the decision to refer out so that one may avoid some potential medical, surgical, psychological, or legal headaches. The following might be written from the viewpoint of the Mohs surgeon, but hopefully, there will be insights to be gleaned by anyone treating skin cancers.