Dermatologic surgery is a major component of dermatology practice in the USA. The skill set required to perform surgical procedures is developed during the residency period and augmented through surgery-specific fellowships. In recent years, the breadth and scope of surgical procedures provided by dermatologists has increased exponentially. A commensurate expansion in the training requirements of residents and fellows has occurred to meet these demands. Concurrently, evaluation systems to assess competency have been broadened to ensure adequate training and safe delivery of care. However, the provision of surgical training to residents and fellows continues to be met with a number of challenges which are discussed herein.