Curriculum/Schedule

Clinical Curriculum

During the clinical rotations, the fellow obtains hands-on training and instruction in all aspects of Mohs micrographic surgery, including appropriate indications, preoperative evaluation, surgical technique, surgical anatomy, reconstruction and the management of complications.

For each surgical defect, all repair options will be discussed with the fellow in detail until he or she obtains a thorough understanding of the principles of surgical reconstruction.

Multidisciplinary care at the University of Cincinnati (plastic surgery, oculoplastic surgery, ENT‑facial plastic surgery, radiation oncology, internal medicine, surgical oncology and prosthetics) is readily available for the management of complex tumors. The fellow is encouraged to follow and observe patients who require multidisciplinary management after Mohs surgery has been completed.

In addition, the fellow will be exposed to and perform a variety of surgical and cosmetic procedures such as excisional surgery, nail surgery, scar revision, laser surgery (tattoos, vascular lesions, warts, pigmented lesions, hair removal, resurfacing of rhytides and photoaged skin), sclerotherapy, BOTOX injections, chemical peels and dermabrasion.

Alternative forms of skin cancer management (electrosurgery, conventional excision and radiation therapy) will be considered for each patient. In addition, the fellow will receive detailed instruction from the program director and the histotechnician on all aspects of the preparation of frozen sections.

Topics that will be covered include proper transportation of the specimen to the Mohs laboratory, dividing the tissue into thin sections, color coding specimens, different techniques of manipulating epidermal margins so that they lie in the same plane as the undersurface of the specimen, freezing the specimen in tissue-mounting medium, mounting the specimen on the object disc, cutting horizontal frozen sections, tissue staining and coverslipping.

The fellow will learn to prepare, cut and stain frozen sections unassisted. The fellow will be taught how to clean, disassemble and assemble the basic parts of the cryostat.

Anatomy and Physiology

The fellow will receive daily anatomy training from the program director based on surgical cases and will attend an annual lecture by the program director on superficial anatomy of the head and neck. Detailed handouts are provided at this lecture.

The director of human anatomy and physiology at the College of Medicine has also agreed to allow the fellow to perform a superficial head and neck dissection with the first-year medical students.

Dermatopathology

• The fellow will attend all lectures given by our dermatopathologist involving cutaneous oncology.
• The fellow will participate in all dermatopathology unknown sessions involving cutaneous oncology.
• The fellow, under the program director's supervision and instruction, will examine all histopathology slides of the original biopsies of patients undergoing Mohs surgery.
• The fellow, under the program director's supervision and instruction, will examine all Mohs frozen sections and determine the presence and location of residual tumor.
• The fellow will attend a two-hour lecture given by the program director on the histologic appearance of tumors commonly treated with Mohs surgery (e.g., all variants of basal cell carcinoma, squamous cell carcinoma, melanoma, dermatofibrosarcoma, atypical fibroxanthoma, malignant fibrous histiocytoma and microcystic adnexal carcinoma).

Cardiopulmonary Resuscitation

It is expected that all applicants to the fellowship program will have had basic and advanced cardiac life support training. If the fellow has not obtained this training (or it is not up to date), both basic and advanced cardiac life support courses will be required. These courses are offered at the University of Cincinnati Medical Center.

Research

The fellow will be required to prepare at least two papers to be submitted for publication in a peer-reviewed journal.

Conferences/Didactic Education

The fellow will attend monthly one- to two-hour lectures given by the program director to the dermatology residents on the following topics:

• Basic Surgical Instrumentation and Suturing Techniques with hands-on pigs foot lab (July)
• Superficial Head and Neck Anatomy (August)
• Flaps and Grafts with hands-on pigs foot lab (September)
• Mohs Micrographic Surgery (October)
• Laser Surgery with hands-on live patient cases (November)
• The Management of Surgical Complications (December)
• Clinical Pathologic Conference on Malignant Tumors (January)
• Surgical Journal Club (February thru June).

The fellow will be expected to attend the annual meetings of the American Society of Dermatologic Surgery (ASDS) and/or the American College of Mohs Surgery (ACMS).

In addition, the fellow will attend dermatology grand rounds at the University of Cincinnati Medical Center (twice monthly and will present patients at this conference when appropriate), and the weekly conferences offered in the departments of surgery and otolaryngology when relevant topics are discussed.