Dermatologist Salary Guide 2026: Medical Derm, Mohs Surgery, Cosmetic & Academic Pay

Dermatology consistently ranks among the highest-compensated and most competitive medical specialties to enter — residency match rates are among the lowest in medicine, and compensation reflects that supply constraint. In 2026, the income range within dermatology is wide: an employed academic dermatologist earns $280,000–$400,000 while an experienced Mohs surgeon with a productive cosmetic practice can exceed $1,000,000 in total annual income. The key variables are Mohs fellowship training, cosmetic revenue integration, laser equipment ownership, and whether the dermatologist employs PA or NP extenders to multiply clinic capacity. This guide covers current salary benchmarks by setting and subspecialty, with detail on the cosmetic and procedural revenue streams that create dermatology's highest-earning practices.

Dermatologist salary by setting

• Private practice (medical dermatology, insurance-based): $380,000–$580,000; general dermatology seeing acne, psoriasis, eczema, skin cancer screenings, biopsies, and lesion removals; high patient volume; employed NP/PA extenders significantly multiply revenue by allowing the physician to focus on complex and procedural cases
• Private practice (cosmetic-integrated): $450,000–$800,000+; medical dermatology plus cosmetic procedures — botulinum toxin, HA fillers, laser resurfacing, body contouring, chemical peels, PRP, biostimulators (Sculptra, Radiesse); cosmetic revenue is direct-pay with no insurance billing; experienced cosmetic dermatologists in affluent markets can earn $500,000–$1,000,000+ in cosmetic revenue alone
• Mohs surgery (fellowship-trained): $400,000–$700,000+; skin cancer excision with immediate intraoperative margin analysis; procedurally intensive; Mohs surgeons with high case volume and cosmetic repair capabilities are among the highest-paid dermatologists; Mohs fellowship is ACGME-accredited (1-year) and highly competitive
• Dermatopathologist: $350,000–$500,000; pathology interpretation of skin biopsy specimens; can be practiced remotely (digital pathology); some dermatologists hold dual board certification in derm and dermatopathology; laboratory ownership adds technical component revenue
• Employed dermatologist (health system / large group): $310,000–$450,000; salary + RVU productivity bonus; health system captures cosmetic revenue or caps cosmetic practice time; employed model growing as health systems recruit dermatologists for access improvement; lower ceiling but more predictable income
• Pediatric dermatologist: $300,000–$430,000; pediatric hospital and academic center programs; atopic dermatitis, vascular anomalies, genetic skin disorders, pediatric skin cancer; lower income than adult derm but severe subspecialty shortage
• Academic dermatology: $280,000–$400,000; lowest-paying setting; medical school faculty with teaching, residency training, and research responsibilities; NIH grant supplementation for active investigators; higher specialization in complex inflammatory or rare skin diseases
• Teledermatology: $240,000–$370,000; asynchronous store-and-forward image review; synchronous video visit platforms; growing segment for access expansion in shortage areas; lower income ceiling than in-person practice due to procedural limitation but high efficiency

Cosmetic dermatology revenue

Cosmetic procedures are the primary income differentiator between top-earning dermatologists and their peers at the same clinical volume:

• Botulinum toxin (Botox, Dysport, Xeomin): $300–$800 per treatment area; rapid procedure (5–15 minutes); high margin with in-office buy-and-bill or direct patient purchase; an experienced derm performing 20–30 botulinum sessions/week generates $150,000–$400,000/year in cosmetic revenue from neuromodulators alone
• Hyaluronic acid fillers (Juvederm, Restylane, RHA): $600–$1,500/syringe; more time-intensive than botulinum; high patient satisfaction; ongoing series of treatments creates patient retention
• Biostimulators (Sculptra, Radiesse): $1,200–$2,800/session; growing segment; collagen-stimulating rather than volume-filling; typically requires multiple sessions
• Laser procedures: $500–$4,000 per session depending on modality (CO2 fractional resurfacing, IPL/photofacial, pulsed dye for vascular, Q-switched for pigment, laser hair removal); practices that own their laser equipment (capital cost $50,000–$300,000 per device) generate much higher cosmetic revenue than those that rent or refer out
• Body contouring (CoolSculpting, Kybella, Emsculpt): $1,000–$4,000/treatment; direct-pay; growing segment in cosmetic practices with dedicated body contouring rooms
• Medical-grade skincare dispensing: In-office pharmaceutical skincare sales (SkinMedica, ZO Skin Health, Obagi, Alastin); ancillary revenue with modest margin; creates patient loyalty and ongoing product revenue

Mohs surgery income

Mohs micrographic surgery is the highest-income dermatology subspecialty for procedurally-oriented physicians:

• Technical mechanics: Mohs surgeons excise skin cancers in successive layers, processing and reading each margin immediately; the procedure is billed per stage (CPT 17311 for first stage, 17312 for subsequent stages); complex cases requiring multiple stages and reconstruction (flaps, grafts) generate the highest per-case revenue
• Average case revenue: A straightforward 2-stage Mohs case with primary closure generates $1,200–$2,000; a 4-stage case with complex flap reconstruction generates $3,000–$6,000+; high-volume Mohs surgeons performing 6–12 cases/day can generate $500,000–$750,000/year in professional fees
• Cosmetic repair add-on: Mohs surgeons with strong reconstructive and cosmetic dermatology skills can capture cosmetic procedure revenue from patients who present for Mohs work; the combination of Mohs + cosmetic repair + post-procedure filler/toxin represents the highest total income model in outpatient dermatology

PA and NP supervision as an income multiplier

Many dermatology practices employ PA or NP extenders to increase clinic capacity while the supervising physician focuses on higher-acuity and procedural cases:

• Revenue multiplication model: A dermatologist supervising 2–3 NP/PA providers sees their clinic revenue multiply; the PA/NP sees routine visits (acne, eczema, screening exams) at $90–$150/visit while the supervising physician's personal time is reserved for Mohs, complex biopsies, cosmetic procedures, and patient escalations
• Supervision income: In states that require physician supervision for PA practice, the supervising physician may receive a supervision stipend ($2,000–$6,000/month) in addition to capturing a margin on the NP/PA's clinical revenue through shared overhead and billing arrangements
• Telehealth extension: Some practices use PA/NP telehealth for follow-up visits and low-acuity concerns, further multiplying the physician's reach

Geographic variation in dermatology compensation

• Florida / Texas / California / New York: $380,000–$800,000+; high cosmetic demand in affluent metro areas; large aging population with skin cancer burden; Mohs volume high in Sun Belt (UV exposure, older demographics)
• Midwest / Mountain West: $330,000–$580,000; somewhat lower cosmetic demand in smaller metros; medical dermatology focused; solid Mohs volume in Sun Belt-adjacent states (AZ, NV, CO)
• Rural / underserved markets: $300,000–$500,000; teledermatology expanding access; in-person dermatology practices in rural areas can command premium for the only local dermatologist; some rural areas have zero dermatologists within 60+ miles

What we see at Ava Health

Dermatology recruiting is highly competitive — there are far more open dermatology positions than there are board-eligible candidates, and physician-owned practices routinely offer sign-on bonuses, ownership tracks, and cosmetic revenue-sharing to attract qualified dermatologists. Mohs-fellowship-trained candidates are among the most actively recruited physicians in our network; practices compete aggressively on ownership equity, non-compete terms (or their absence), and the quality of Mohs infrastructure when recruiting Mohs surgeons. For dermatologists evaluating their first private practice position, the revenue-sharing model for cosmetic procedures — whether it's a split, a flat cosmetic add-on, or full cosmetic ownership — is often more financially significant than the base salary in the first 5 years of practice.

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