Micrographic Surgery and Dermatologic Oncology Fellowship
Dear Prospective Fellow,
Our program began ten years ago under the American College of Mohs Surgery oversight and in 2013 transitioned to become an ACGME accredited fellowship in Micrographic Surgery and Dermatologic Oncology. We are proud to be part of the Division of Dermatology of the Florida State University College of Medicine which is a regional based medical campus model with emphasis on care to the elderly, the underserved, and those in rural areas. I believe our program is uniquely suited to training highly skilled and experienced Mohs surgeons and cutaneous oncologists because of several factors.
First is our patient base and volume. We are uniquely situated in the center of the Florida panhandle and see high risk patients from this region, as well as the southern part of Georgia (we are 20 miles from the GA line) and from lower Alabama. There are groups of highly skilled dermatologists in these areas who send us only their highest risk patients. We also receive many referrals from plastic surgeons, general surgeons, primary care and satisfied patients in this region. These individuals often have multiple skin cancers and severe sun damage due to their occupation, age, immunosuppression status or all of the aforementioned. Anyone who visits our practice is impressed with the fact that the majority of our cases are squamous cell carcinoma with a reversal of the normal 3/1 basal cell carcinoma to squamous cell carcinoma ratio. Most Mohs surgeons will acknowledge that squamous cell carcinomas are more challenging due to their inherent risk and the fact that they most often occur on severely sun damaged skin where one sees and has to deal with the field effect and subtle nuances between squamous cell carcinoma and severe actinic keratoses. Learning how to deal with squamous cell carcinoma and the field effect is paramount in becoming a good Mohs surgeon.
The second aspect of our program that makes it very strong is that we have a world class in house dermatopathologist, David Dolson, MD, who each morning comes and conferences with us on our teaching microscope. Before seeing any patient we (the fellow and I) obtain and review the patients’ slides. If there is any question about the diagnosis or it is an instructive case, it goes to our conference. During the course of our Mohs days if we run into anything that is equivocal the fellow or I have the prerogative of bringing the slide physically or electronically to our pathologist. Thus ,we study the subtleties of dermatopathology as it relates to neoplasms in conference as well as in real time.
The same is also true for plastic surgery. We have a high volume of Mohs cases daily and have a very experienced in house board certified plastic surgeon, Meredith McKinney, MD, who helps us with our more challenging cases. Learning plastic surgical techniques from a plastic surgeon seems to be anathema to many Mohs surgeons whose mantra is we can do it as well or better. When it comes down to it we always subscribe to patient choice and what would we do for a family member. We still do a very large number of closures including grafts and flaps but are selective in the interest of the patient and our efficiency as a Mohs unit. On a daily basis the fellow gets to plan and assist in executing multiple complex repairs.
Each afternoon we see and examine high risk individuals from our practice and the surrounding areas. We have been involved from early on with multiple research projects including dermoscopy and seeing and following high risk pigmented lesion individuals. We continue research and innovation with photodynamic therapy in order to decrease the field effect of our severely sun damaged patients. We have also been a leader in the renaissance of superficial radiation therapy which I have been doing since my residency. We have published extensively on skin cancer detection and management and consider ourselves a skin cancer management team, comprised of our Assistant Fellowship Director, Harris Green, MD, as well as aforementioned plastic surgeon, dermatopathologist, and a team of PAs, histotechnicians, nurses and ancillary staff who are true professionals.
This program is designed for individuals who want to handle tough cases and have the unique training that our faculty and patients afford us. Our daily routine is rigorous, but we have a very efficient team effort. We invite you to apply. Prior to interviewing we welcome you to contact any or all of our previous fellows. They will independently be able to relate to you their experience and give you insights as to whether you would be suited for this program.
Armand B. Cognetta, Jr., MD Program Director / Professor FSU College of Medicine Procedural Dermatology Fellowship Program