Fellow

To qualify as a Fellow of ACSCM the following pre-requisites will be required:

All the requirements of Diploma, but at a more substantial level of knowledge and skills.

Unlike Diploma candidates, Fellow candidates are expected to be skilled at dermatopathology and managing rarer cutaneous malignancies. Knowledge of finer details of skin anatomy and physiology is also required at this level.

A log book showing suitable experience in managing a range of skin cancer diagnoses as well as suitable experience in a range of dermatologic surgery techniques. Experience of the equivalent of three years in full time skin cancer surgery will be required on average to meet the log book minimum requirements.

The log book should document an array of skin flap and skin graft techniques. Substantial numbers of procedures to the nose, eyelids, ears, lips, digits and legs must be demonstrated.

Recommended reading

Those achieving Fellowship status will be expected to manage the majority of skin cancers presenting, or referred to them, including lip, eyelid, nose and ear tumours. Practical and written exam. Exam fee = $500 (including GST).

This will involve practical surgical assessment in three forms:

•  performance certified on pigs trotters in the exam room among peers
• evidence of satisfactory completion of techniques on patients, with before, during and after digital photographs acting as evidence
• supervision / preceptorship.

The written exam will comprise :

1. Multi choice exam on skin cancer managment and lesion recognition - 90 minutes. This component is waived for existing certified College diplomats.
2. Short answer questions for three hours  - 24 questions to be answered from a bank - all questions are compulsory.
3. Compulsory multiple choice dermatopathology histology exam - 30 minutes.
4. Compulsory multiple choice dermoscopy exam - including difficult lesions - 30 minutes - This is the same format as that taken by diploma candidates but a higher standard of response is expected.

Click here for list of current ACSCM fellows.

The fellowship is the highest qualification awarded by the Australasian College of Skin Cancer medicine. It is designed for doctors working extensively in skin cancer management, often on a referral basis. A doctor with the Fellowship will be able to manage most skin cancers presenting to them, from diagnosis to treatment and long term follow up. He or she will be able to manage skin cancers proficiently in difficult places like the ears, nose, face and eyelids, and larger tumours on most places of the body by using an array of reconstruction techniques including flaps (both random pattern and axial) and full thickness and partial thickness skin grafts. Some fellows will be very highly skilled in complex repairs and reconstructions of large defects on the nose and eyelids and other difficult parts of the face. Many fellows will have access to local hospital facilities for their surgery.

Knowledge and skills required at the fellowship level

All requirements listed for the diploma level are necessary at the fellowship level. However, the breadth of knowledge and depth of comprehension is expected to be far more substantial than for the diploma level and practical expertise must be considerable.

The following knowledge requirements are expected:

·          Skin anatomy

·          Facial anatomy including the course of the facial nerve, the sensory branches of the trigeminal nerve and the major arteries on the face, and the surgical technique to safely operate in these areas

·          Significant knowledge of histopathology of all the common skin cancers and some of the rarer skin cancers. This should include an understanding of histological stains used and interpreting their significance in reports from the histopathologists

·          Aetiology of skin cancers and effect of sun exposure patterns

·          The clinical presentation, natural history and differential diagnosis of BCC subtypes

·          The clinical presentation, natural history and differential diagnosis of SCC, KA and Bowen’s disease

·          The clinical presentation, natural history and differential diagnosis of melanoma sub types

·          The clinical presentation, natural history and differential diagnosis of common benign skin lesions

·          The clinical presentation, natural history and differential diagnosis of aktinic keratosis

·          Diagnostic criteria management options for dysplastic naevi and dysplastic naevus syndrome

·          Follow-up requirements and management options for  aggressive non-melanoma skin cancers and melanoma

·          Role of sentinel lymph node biopsy

·          Indications, management regimes, side-effects profile and follow-up requirements for non-surgical treatments including diclofenac 3%, imiquimod, 5-fluorouracil, photodynamic therapy and cryotherapy

·          Role of radiation oncology in non-melanoma skin cancer management

·          Dermoscopic features of melanoma,  BCCs and common benign lesions to a higher level than the diploma

·          Indications and contraindications for photographic follow-up of pigmented lesions

·          Surgical management options for benign  (including lipomata and dermal cysts) and malignant skin lesions

·          Excision margins

·          Biopsy techniques (punch and shave) with indications for each

·          Curettage and cautery techniques with their indications

·          Curettage and cryotherapy techniques with their indications

·          Surgical closure using skin grafting and skin flaps

·          Properties of essential surgical equipment, instruments, suture material and blades

·          Contributing causes and management of common skin surgery complications

·          Management of perineural invasion and residual /recurrent tumours

Knowledge of the rarer skin malignancies such as atypical fibroxanthoma, merkel cell tumour and sebaceous carcinoma is needed at a higher level, including the clinical manifestation, management and prognosis of these tumours is t required at fellowship.

In addition to these knowledge based requirements, the diploma candidate needs to have practical expertise in the following surgical procedures:

·          Curettage techniques

·          Partial thickness skin grafts

·          Full thickness skin grafts

·          Skin flaps possibly including axial flaps like interpolation flaps, and myocutaneous flaps.

Competence in performing the ten core flaps required for the Diploma level and evidence of regular use of these flaps is needed.

1.       Single advancement

2.       Twin advancement

3.       A - T

4.       Rhomboid

5.       Rotation

6.       O - Z / S

7.       Simple transposition

8.       Bilobed

9.       V - Y island advancement

10.    ROM

The Fellowship exam process

First the candidate must sit the certificate exam in a 90 minute time frame. A score of 85 or more is required to proceed further.  This exam component is waived for candidates who already have a certificate or diploma and scored over 85 at that time.

The candidate must then sit a 120 minute short answer written exam. The 20 questions for this exam will have been chosen from a large bank of questions. The exam comprises 4 pages with 5 questions per page. To successfully pass, candidates need to answer all 5 of the questions on each page. More detailed knowledge is required in these answers than at the Diplomat level.

After this there is a 30 minute multiple choice examination in dermoscopy comprising matching dermoscopic images to a list of possible diagnoses. The level of dermoscopic expertise required for this exam is far greater than that required for the certificate and diploma exam.  

After this there is a further 30 minute multiple choice examination where 8 histolopathological pictures have to be matched to eight skin cancer diagnoses. These ALL have to be correct to pass.

Finally the candidate is asked to simulate 2 surgical tasks on pigs’ trotters in front of the examiners. The candidate is presented with a simulation of a certain cancer on a certain part of the anatomy and he/she is expected to excise this with the correct margins. He/she will be asked to close the defect with an appropriate flap of their choice for each clinical scenario and is expected to be able to perform any of the 10 core flaps detailed in the diploma level exam.

Experience Needed

It is expected that a fellow will have been working for equivalent of 3 years in full time skin cancer medicine. The censor and the board reserve the right to make the decision on what may be equivalent to 3 years full time in EACH individual circumstance.

A log book or equivalent will be needed to show evidence of having performed simple and complex flap repairs and especially flap repairs in certain places like the face, scalp, nose, ears and below the knee. Evidence will also be needed of having performed Full thickness or partial thickness skin grafts.

It is expected that a log book will show evidence of

1.         flaps in general

2.         flaps on the nose, ears

3.         flaps on the face

4.         wedge resections on the lip or ear

5.         flaps below the knee

6.         skin grafts - full or partial thickness.

It would be expected that at least 300 flap repairs be performed as well as 30 full thickness or partial thickness skin grafts and 25 wedge resections of the ear and lip. At least 100 flap repairs on the face and scalp should be performed, INCLUDING at least 50 on the nose and ears. At least 30 flap repairs should be performed below the knee.

Workshops

The Australasian College of Skin Cancer Medicine does not require candidates to attend any College educational event. The College does not believe that fellowship candidates should have to attend workshops or seminars that they may not need.

However, prospective candidates may wish to attend workshops designed to cover the core knowledge base required at the diploma level.  ACSCM does not run workshops targeted for prospective diplomats.  However, there are courses targeted at this level, including workshops run by Assistant Professor Dixon in Geelong and Health Workforce Queensland. More advanced dermoscopy workshops are available through SACSA, Healthcert and UQ.

Preceptorship

It is a requirement to do 1 week preceptor ship with another fellow or any suitable skin cancer specialist as approved by the board.