Cohorts: Tiffany Libby MPH'25, MD: Building the Future of Dermatologic Surgery at Brown

Tiffany Libby is an assistant professor of dermatology and a Mohs micrographic surgeon and cosmetic/laser surgeon with Brown University Health. She is also the founding program director of Brown’s Mohs Surgery and Dermatologic Oncology fellowship. Her clinical and research work spans skin cancer surgery, reconstruction, cosmetic dermatology, medical education, and emerging technologies including artificial intelligence. Publications like Reader’s Digest, U.S. News & World Report, Forbes, Cosmopolitan, and more regularly seek her expertise on skin cancer prevention and evidence-based skincare.

What first brought you to Brown?

I’m originally from Monmouth County, NJ, and completed a seven-year accelerated MD program at Rutgers New Jersey Medical School. My training in Newark gave me substantial hands-on experience and early autonomy, something I now try to give the residents and fellows I teach.  

I completed my dermatology residency and dual fellowships in Mohs surgery and cosmetics at Albert Einstein College of Medicine in the Bronx. Mohs surgery is a specialized technique for treating skin cancer in which the surgeon removes the tumor in stages and examines 100 percent of the surgical margin in real time. Once the cancer is completely removed, we reconstruct the defect, often during the same visit.

My husband and I had our first two kids while we lived in New York, and we thought about where we wanted to be long term. At that same time, my former attending told me about how Brown was recruiting and thought I would be a great fit. 

What really struck me the most about Brown, though, was the people. The department felt collaborative, entrepreneurial, and genuinely invested in helping faculty build something. I love the faculty and everyone I work with, and the residents bring an energy and curiosity that make teaching enjoyable. Brown gave me the opportunity not only to practice dermatologic surgery, but to help grow our program, train fellows, and shape the direction of our surgical division.

What does a typical day look like for you?

One of my favorite things is that no two days are ever the same. My dual-fellowship training allows me to move between skin cancer surgery, reconstruction, and cosmetic dermatology. I also direct our Mohs fellowship program, which trains the next generation of dermatologic surgeons.  

Some days are heavier on surgery and others on cosmetic procedures. Mohs surgery is particularly rewarding because the care is so immediate and complete: a patient comes in with a tumor, we remove it, confirm that the margins are clear, and reconstruct the area. 

As an academic referral center, we get some of the most complex skin cancers in the region. We’re often working alongside radiation oncology, head and neck surgery, medical oncology, dermatopathology, and other specialties on challenging cases. On the cosmetic side, we use injectables, lasers, and energy-based devices to address concerns ranging from scars and vascular lesions to pigmentation and age-related skin changes. 

We also do a lot of teaching for residents and fellows, which is woven in throughout our day. We’re always learning just as much from them as they’re learning from us, and the constant exchange of ideas is what is fun about being in academics.

How did you become interested in dermatology and what makes your work important?

I was a medical student who was interested in almost everything. I loved surgery, emergency medicine, obstetrics—almost every rotation made me consider a different career. Dermatology ultimately appealed to me because it rewards that kind of curiosity. It is extraordinarily broad: medicine, surgery, pathology, immunology, oncology, infectious disease, and aesthetics all intersect within one specialty. It is a field built for lifelong learners.

Every patient has skin, so you’re carrying people across every stage of life, from infants to pregnant patients to older adults to people facing complex medical diseases. It’s a field where you get to combine medicine, surgery, and pathology, while working with specialties like immunology and oncology—all within one field. In dermatologic surgery, we also have the privilege of taking a patient from cancer diagnosis through definitive treatment and reconstruction. That combination of intellectual breadth, technical precision, and longitudinal patient care is what continues to draw me to the field.

With summer in full swing, you've been featured in articles about the importance of skincare, sunscreen, and related topics. Are there  skincare tips or advice you wish more people knew about?

One of the things I’m always discussing with my patients is how important sun protection is not just for preventing skin cancer, but also preventing UV-related damage to collagen and premature skin aging.. Sunscreen is important, but it is only one part of sun protection.   Most people don’t apply enough or reapply as often as needed. I generally recommend a broad-spectrum SPF 30 or higher—often SPF 50 for prolonged outdoor activity—along with water resistance when appropriate.

It’s important to remember that sunscreen isn't a sun block. Real-world studies have shown that we’re actually under-applying that sunscreen, often at half the amount needed to get that full protection. There’re also other protective measures like hats and UV-protective clothing. If you’ve had skin cancer, there’s a vitamin B3 called nicotinamide, which, when taken in 500 milligrams twice a day, can cut down your future risk of developing non-melanoma skin cancer by 23 percent. It’s not necessarily one sunburn that leads to skin cancer; it’s all about the cumulative exposure. Five or more blistering sunburns will nearly double your risk of melanoma.

We’re also seeing a renewed tanning culture that I feel is propagated by the media, but people don’t realize how much damage they’re causing to their skin and what that can look like in the future.

Do you have any ongoing research or other projects?

One area we’re particularly interested in is how emerging technologies, especially artificial intelligence, can improve health care while being implemented responsibly. I don't think AI will replace physicians, but it can augment what we do. Used well, it has the potential to reduce administrative burden, streamline documentation, support clinical decision-making, and give physicians more time with patients. 

A lot of our research focuses on the intersection of this technology and patient care. We completed a systematic review and meta-analysis examining AI applications in Mohs and dermatologic surgery, including where these tools show the most promise and where important evidence gaps remain.

 We’ve also studied the patient experience and how technology and communication can help improve our informed consent. One project examined the readability of surgical consent forms across specialties and helped inform efforts to make patient-facing materials clearer and more accessible within our own hospital system.

We have also studied bias in generative AI, including whether AI-generated images accurately represent the demographics of patients and physicians across surgical specialties. The discrepancies can be striking. Those findings reinforce that AI systems are only as trustworthy as the data, validation, and oversight behind them.  There’s still a lot of work that needs to be done here, and it would be helpful to develop an ethical framework to help inform how to implement these tools.

What do you enjoy doing when you’re not working?

I have three kids—5, 7, and 10—so life outside the hospital is busy in the best way. We spend a lot of time outdoors, traveling, and exploring new places together. This summer we took the kids to Florence and Sardinia, which was a great mix of history, food, beaches, and the usual adventure of traveling internationally with three children. Closer to home, we’ve really embraced New England life, weekends at the beach, trips around the region, tennis for me, and inevitably plenty of time on the sidelines of kids’ sports. I’ve somehow learned more about soccer than I ever expected to, but mostly I love having a life outside medicine that feels active, fun, and very family-centered.