President's Message
Dear Colleagues,
Though summer is in full swing, I find myself looking ahead to our Regional Meeting in Napa this fall and thinking of the great many things to do in the area. Dr. Michel McDonald and the program committee have developed a terrific and engaging lineup of both traditional and novel scientific sessions, including a networking luncheon, TED-style talks, practical pearls, and a Tumor Board including member-submitted cases.
Look for details on the recently launched 2015 Regional Meeting website, at www.mohscollege.org/regionalmeeting. Of particular interest is the Hands-On Skin Flap Workshop for ACMS members, developed by Dr. Deb MacFarlane and modeled after the very successful flaps course for fellows-in-training preceding the Annual Meeting. Along with hands-on instruction, the course features Dr. Nirusha Lachman, an anatomist from Mayo Clinic. More information is included in the newsletter below.
There will also be opportunities to play golf on two PGA-level courses, take a wine and olive oil tasting tour, and more. I encourage you to bring your family, your clubs, and an appetite, and extend your stay in Napa, either before or after the meeting.
Just prior to the Regional Meeting, the Board of Directors will meet to discuss the many activities the College has undertaken in support of its strategic plan. In order to inform our priorities, we will be sending out the next ACMS Member Survey very soon. It is critical that every member completes the survey, since your responses will guide our activities and expenditures over the next couple years.
I look forward to sharing some of the Board decisions and survey highlights at the meeting, in conversation, and in future monthly messages. I want to thank all our Committee and Board members for their thoughtful leadership and willingness to give their time and talent in support of this organization. Many opportunities still exist to contribute and right now I am specifically seeking a member to serve in a new position as our ACMS CLIA Advisory Committee representative. Given the integral role the Mohs laboratory plays in our daily practice, ACMS absolutely needs a thoughtful voice at the table.
I’m also pleased to share that the website for the 2016 Annual Meeting in Orlando is live and includes the Call for Abstracts, which is entirely online for the first time. Dr. Chris Miller is spearheading a fantastic educational program and together with ACMS staff has refined the submission process. Please visit www.mohscollege.org/annualmeeting for details, and read more below.
I would be remiss if I didn’t reiterate that you, our members, are what make the ACMS such a vibrant and essential organization, not just for our patients but also for the future of the specialty. Your voice is important, and it is heard. As always, you are invited to submit a Letter to the President for review and possible publication in this newsletter. I personally read these messages and look forward to hearing from you at president@mohscollege.org.
In service,
John G. Albertini, MD, FACMS
ACMS President, 2015-16
ACMS Happenings
Remember the Alamo! Highlights from the 2015 Annual Meeting
By Eva Hurst, MD, FACMS
Mohs College members gathered in the shadow of the Alamo in San Antonio, Texas from April 30 through May 3 for the 47th annual ACMS meeting. The meeting was held at the Marriott Rivercenter, right on the bustling and beautiful San Antonio Riverwalk, where members could enjoy healthy walks, “not-so-healthy” TexMex, and tasty margaritas!
Dr. Jerry Brewer and colleagues put together a great scientific program, combining long-time favorite oncology and reconstructive sessions with some new information designed to make everyday life easier for us and our patients. Sgt. Kenneth B. Weichert, a fitness trainer and six-time Army Soldier of the Year, led a pre-meeting exercise Boot Camp and spoke on stress management. Special world-class medical guests included Dr. Mark Varvares (head and neck surgery), Dr. Svetomir Markovic (medical oncology), Dr. Christopher Barker (radiation oncology), and Dr. Brian Swick (pathology).
On Thursday, members enjoyed the Tromovitch abstract session, where fellows presented the top research projects of the year. This year, Dr. Andrew Breithaupt and Teresa Soriano’s UCLA crew won the prize with their work on virus RNA sequencing in cutaneous squamous cell carcinomas. A new and popular session titled “Things that Make my Life Easier” was a meeting highlight, with senior practitioners providing tips and tricks for practice efficiency and improving the Mohs experience for patients. Dr. Varvares also gave a session on cost analysis on quality of life issues in high risk cancer patients.
Friday’s highlights for me were the “Merkel Cell Carcinoma Update,” emphasizing a multidisciplinary approach and reviewing the latest literature on this complicated and aggressive tumor, and the afternoon “Transplant Dermatology” session. In the transplant session, Dr. Margaret Mann discussed the practical use of chemowraps, and Dr. Marcy Neuburg reviewed a novel dosing of capecitabine as chemoprevention in her transplant population. Other leading experts discussed PDT, complex patient management, and immunosuppressive medications. Another fun session on Friday was the “2-Minute Pearls,” with topics ranging from reconstruction tricks to pathology interpretation tips.
On Saturday, the “Melanoma Update” session was fantastic. Dr. Tim Johnson gave a thorough review on the latest data regarding sentinel lymph node biopsy and how it is utilized at his institution. Special guest Dr. Svetomir Markovic gave an extremely comprehensive, yet understandable, review of the current best systemic treatments and what is coming down the pipeline. Both speakers reviewed all of the latest literature and studies with a perspective truly helpful for the practicing dermatologic surgeon. Saturday also included what I like to call some “old favorites,” the “How Would you Reconstruct It” and “Tumor Board” sessions.
For those surgical warriors who stayed through Sunday morning, you were rewarded with the always humbling “Diagnostic Quality Control Exam Review” session. Dr. Sumaira Aasi and gang again challenged us with practical, as well as some unusual, examples of things encountered when reviewing Mohs slides. This year was nice because the test was all electronic, and answers and explanation were posted online for review and learning after the meeting. Also on Sunday, members could enjoy the “Masters’ Pearls” and “Case Controversies” sessions, and the opportunity to obtain Maintenance of Certification (MOC) credits.
There was also plenty of opportunity for networking, meeting new folks, and reconnecting with old friends at events like Thursday’s welcome reception, the Women’s Dermatologic Society luncheon, and Saturday’s Fellows-in-Training reception. I also strongly encourage those of you with fellows to send them to the Hands-On Skin Flap Workshop course, which occurs the day before the meeting. My fellow-in-training raved about how great the course was administered.
Hopefully, everyone had a great time in San Antonio! The ACMS hopes to see many of you in Napa at the November Regional Meeting, and definitely mark your calendars for next year’s Annual Meeting in Orlando from April 28 through May 1.
2015 Regional Meeting registration now open
The 2015 ACMS Regional Meeting will be held from November 13-15 at the Silverado Resort and Spa in beautiful Napa, CA. Members are invited to take part in an informative, collaborative and fun educational program. The Scientific Program Committee has sought input from across the College to create a program that builds on the successes of the previous Regional Meetings in San Diego and Charleston.
Visit www.mohscollege.org/regionalmeeting for full details, including:
- Invitation letters from the President and Scientific Program Committee Chair
- Program overview
- Registration and reservations links
- Resort and transportation information
- Details on the pre-conference hands-on skin flap workshop open to all members
- Reasons to extend your stay and explore the Napa Valley
Members will receive a program and registration materials in the mail in the coming weeks, but a snapshot is included below to encourage early registration.
Registration
A capacity limit of 250 meeting attendees has been set, with a waitlist option. Pre-registration opens August 10 and closes October 21 or when meeting capacity is reached. Onsite registration is not available. Registrations will not be accepted after October 21.
The registration fee schedule is as follows:
ACMS Members: $475
Fellow, Associate, Life Member, Associate Applicant, and Fellow-in-Training
Guests of ACMS Members: $150
Guest registration includes breakfast, lunch, and welcome reception. Guest registration does not permit admittance to any of the scientific sessions, except the TED-style talks.
Visit the Registration tab at www.mohscollege.org/regionalmeeting and click the Register Online link near the top of the page for details on how to register online or via fax.
Reservations
Those who register for the Regional Meeting will receive email confirmation of their registration, which will include further information on making room reservations at the Silverado Resort and Spa. Basic information is included below.
- The ACMS secured the reduced guestroom rate of $261/night for resort single/double occupancy. Upgrades to junior suite or one-bedroom suite are available for $301 or $321, respectively. All rates listed here include a $22 resort fee, which covers one glass of house wine per arrival per registered guest, bell gratuities, on-property transportation gratuities, self and valet parking, unlimited personal WiFi access, unlimited local and 800 calls, in-room tea and coffee, tennis, golf bag storage, access to fitness facilities, and admittance to fitness classes).
- This group rate is available three (3) days before and after the main meeting dates, based on room availability; all overnight accommodations are subject to an additional 14% tax and 14% resort service fee tax (subject to change)
- To receive this discounted rate you must identify yourself as being with American College of Mohs Surgery and must have already registered for the 2015 Regional Meeting
These reduced group rates will be available only through Tuesday, October 21 or until sold out. Reservation requests after the cut-off date will be based on availability at the group rate.
To inquire further about the Regional meeting, contact the ACMS Executive Office at info@mohscollege.org or (414) 347-1103.
2016 Annual Meeting Call for Abstracts
Dear Colleagues:
We cordially invite you to submit an abstract for consideration of an oral or poster presentation at the American College of Mohs Surgery 48th Annual Meeting taking place April 28 – May 1, 2016 at the Rosen Shingle Creek Hotel in Orlando, Florida.
The 2016 Annual Meeting will include two categories of abstracts:
1. Scientific abstracts: Original research that addresses the most urgent needs of our patients and the ACMS. Scientific abstracts with a primary author who is a fellow-in-training or who is in his or her first year of practice after completing a fellowship in Micrographic Surgery & Dermatologic Oncology will be eligible for the Tromovitch Award Competition.
2. Rapid Pearls abstracts (NEW!): Two-minute anecdotal pearls regarding Mohs surgery technique, frozen section pathology, reconstructive surgery, or practice management.
The deadline for abstract submissions is 11:59 pm PST on Wednesday, January 13, 2016.
In addition to abstract submissions, fellows-in-training are invited to submit a case for the Clinicopathologic Case Competition: fellows-in-training may submit clinicopathologic slides and photographs of Mohs cases that have uncommon or rare pathology or that illustrate prototypical diagnostic challenges and keys to diagnosis or tumor detection. Case submissions must be received by the ACMS office by March 1, 2016.
The Scientific Program Committee has broadened abstract submission opportunities with the goals of involving more members in the Annual Meeting and encouraging the highest quality of presentations. To learn more about each of these opportunities:
See details in the Call for Abstracts
If you have any questions about the proposed abstract or the submission process, please contact us at info@mohscollege.org.
Your participation is crucial to ensure the continued success of our specialty’s premier meeting. Please encourage fellows-in-training to submit an abstract for the Tromovitch Award and/or a case for the Clinicopathologic Case Competition.
We look forward to your contribution and hope to see you in Orlando!
Christopher J. Miller, MD, FACMS
2016 Scientific Program Chair
John G. Albertini, MD, FACMS
ACMS President
Call for Nominations to the Clinical Laboratory Improvement Advisory Committee
Dear Mohs College Colleague,
Do you have a special interest in CLIA and laboratory medicine? Are you willing to serve in an advisory capacity to various federal agencies? Please consider applying to serve on the Clinical Laboratory Improvement Advisory Committee (CLIAC).
The Clinical Laboratory Improvement Advisory Committee meets twice per year in Atlanta at the CDC for a total of 4 days per year. The advisor receives a stipend of $250 per day and expenses.
CLIAC provides scientific and technical advice and guidance to the Secretary, Department of Health and Human Services (HHS); the Assistant Secretary for Health, HHS; the Director, Centers for Disease Control and Prevention (CDC); the Commissioner, Food and Drug Administration (FDA); and the Administrator, Centers for Medicare & Medicaid Services (CMS). The advice and guidance pertain to general issues related to improvement in clinical laboratory quality and laboratory medicine.
To apply for nomination, candidates should submit the following items for nomination consideration. The deadline for receipt of materials is September 15, 2015:
- Current curriculum vitae, including complete contact information (name, affiliation, mailing address, telephone number, email address).
- Letter(s) of recommendation from person(s) not employed by the U.S. Department of Health and Human Services.
Candidate suggestions and potential meeting topics may be submitted by email in care of the CLIAC Secretariat at CLIAC@cdc.gov.
Contact person for additional information:
Nancy Anderson
Chief, Laboratory Practice Standards Branch, Division of Laboratory Systems
Center for Surveillance, Epidemiology and Laboratory Services
Office of Public Health Scientific Services
Centers for Disease Control and Prevention
1600 Clifton Road, NE., Mailstop F–11
Atlanta, GA 30329–4018
Telephone: (404) 498–2741
Email: nanderson@cdc.gov
If you are interested, please contact our Washington consultant, Emily Graham (EGraham@HHS.com) for more information and help in applying.
Sincerely,
Dr. Brent Moody
Chair, Public Policy Committee
Updated Surgeon Finder tool on ACMS websites
A revamped version of the Surgeon Finder tool is now live on both www.mohscollege.org and www.skincancermohssurgery.org. This search tool allows members, potential patients and others seeking information on skin cancer treatment to search for an ACMS member in a specified area.
In the previous version of the Surgeon Finder, incomplete search results were occasionally displayed for some users, depending on the type of search performed. This issue has been addressed and other enhancements made to provide a better user experience.
Search types:
- Geographic Search: Search by city and state or ZIP Code
- Name Search: Search by member's last name
When search results are shown, click on the name of the member to see a detailed profile.
Please search for yourself using this feature and let us know via email if you experience any issues. As a reminder, you have control over what information appears in search results. Simply log in to your member profile, which feeds the Surgeon Finder. To check, update or complete your Surgeon Finder profile:
- Go to www.MohsCollege.org
- Mouse over the For ACMS Members tab
- Select Update Surgeon Finder Profile from the dropdown menu; log in with your username and password
You’ll see the following screen, where you can add, edit or remove your address and contact information, including your website address:
Don't forget to complete your profile as fully as possible, as potential patients look for—and make decisions based on—the kinds of credentials and experience displayed in your profile.
The Future of Medicare: The New Alphabet Soup
Bye-bye SGR; say hello to MIPS and APMs
By Todd V. Cartee, MD
On April 16, the house of medicine scored a major victory with the repeal of the Sustainable Growth Rate (SGR) formula. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 also restored surgical global periods which were due to be eliminated by prior Centers for Medicare & Medicaid Services (CMS) mandates. MACRA, however, contains numerous additional policy initiatives that further the long-term goal of shifting from a fee-for-service to a value-driven reimbursement system. To help our membership understand and negotiate these unchartered waters, the ACMS works with Hart Health Strategies (HHS), a boutique healthcare lobbying and consulting firm in Washington, DC, with offices on Capitol Hill. Emily Graham from Hart Health Strategies spoke at our 2015 business meeting to introduce us to the new payment system delineated in MACRA. I interviewed her to expound on these issues and what steps she thinks Mohs surgeons need to be taking:
Hi Emily, could you please tell us about Hart Health Strategies and what services it provides the ACMS?
We have nine members on our team and represent close to 30 different health care organizations, most of which are medical specialty societies. Our primary focus is helping our clients engage in the federal legislative and regulatory process, but we also assist with other quasi-governmental entities that may influence federal initiatives, such as the National Quality Forum and the National Association of Insurance Commissioners. For the ACMS, we provide legislative support on issues that impact the practice of Mohs surgery, and medicine in general. For example, we monitor all newly introduced legislation and provide detailed analysis of relevant bills. We also follow all relevant proposed and final regulations, and provide detailed summaries that help the ACMS understand and respond to the changes. We assist the ACMS with its engagement on federal issues, whether through drafting written correspondence to or direct “shoe-leather” lobbying of Congressional offices and staff. Of course, our engagement is not limited to the above; we are a full-service firm, so we do everything we can to assist the ACMS, and its volunteers, with all aspects of government relations, public policy, and even private payer issues, both at the state and federal level, as requested.
Can you provide a few specific examples of recent activities HHS has conducted for the College?
On June 3-4, the ACMS hosted its third annual legislative conference, or “fly-in,” here in Washington, DC. HHS has continued to help organize the conference. This year, our firm secured a robust lineup which featured speakers from Capitol Hill, including Congressman Phil Roe (R-TN-1), senior Congressional staff from the Senate Finance and House Ways and Means Committees, as well as federal agencies, including CMS. We also coordinated Hill visits for each attendee and put together talking points for the attending members.
We have been investing a lot of effort in combating the narrow network/network adequacy issue with Medicare Advantage (MA) plans, drafting numerous letters to regulatory agencies and other influential bodies that focus on insurer issues, as well as helping design innovative strategies to persuade the MA plans themselves of the importance of keeping Mohs surgeons in their networks.
We have also been actively working with the ACMS to craft responses to problematic Local Coverage Determinations (LCDs), such as the one recently put forth by Novitas Solutions, a Medicare Contractor that covers 12 states. According to Medicare regulations, Novitas is required to contact the relevant specialty society before proceeding with a new or revised LCD, which in this case would be the ACMS, but instead drafted a completely new policy on Mohs surgery without input from the College.
At the business meeting this Spring, you relayed the good news regarding the SGR repeal but also detailed important Medicare payment system changes that were included in that recent legislation. Would you mind summarizing some of the key points we should be aware of?
There will be a transition to the new payment system in 2019. Providers will have a choice between two tracks: 1) the newly defined merit-based incentive payment system (MIPS) or 2) participate in an alternative payment model (APM). MIPS consolidates and replaces the separate existing Medicare value programs; the Electronic Health Record (EHR) Incentive program, also referred to as “meaningful use”, the Physician Quality Reporting System (PQRS), and the value-based payment modifier (VM), all three of which are now in effect and potentially affecting your Medicare reimbursement. CMS will generate a composite performance score under MIPS which includes these three arms and also assesses clinicians’ involvement in clinical practice improvement activities (CPIA). CPIA may include quality improvement programs such as Maintenance of Certification (MOC) and participation in a clinical data registry. Many other programs will likely be designated by the secretary in the future, but the work already done by ACMS in establishing a registry positions you ahead of the curve.
The MIPS track will be the most similar to traditional fee-for-service Medicare, whereas APMs, such as accountable care organizations, patient-centered medical homes, and bundled payments, represent a shift to a value-based model of payment and care delivery. The Secretary of Health and Human Services will tell us what else may qualify as an APM moving forward. For those who chose to participate in an APM, a percentage of their Part B services will need to be attributable to that APM, and that threshold will increase over time.
What can the ACMS do to prepare for this changing Medicare reimbursement landscape?
An APM for diagnosis and treatment of skin cancer would be ideal though not necessary. If the ACMS could develop an APM and get it approved by CMS, that would provide a straightforward mechanism for compliance for the foreseeable future. Regardless, I do not worry that ACMS members would not be successful in compliance. You’ve done an amazing job so far. You are taking on the skin cancer epidemic with a procedure that is 99% effective and overall cost effective. You are functioning in multiple roles: cutaneous oncologist, skin cancer surgeon, pathologist, and reconstructionist. It is unfortunate that some payers do not appreciate the value of this service, but overall, the ACMS is well-positioned to thrive in a value-based reimbursement scheme. The fact that you are already well underway in developing a clinical data registry is a prime example of how you are doing an excellent job staying ahead of the game relative to other sub-specialties.
What should the individual Mohs surgeon be doing to prepare for MIPS?
Right now Mohs surgeons need to make sure they are participating in meaningful use and reporting through the PQRS. They should also get a handle on the value-based payment modifier (VM). The VM will adjust Medicare reimbursements, taking into account both quality and cost. The quality component is derived from PQRS; the current cost measures are not optimal and are based on a physician’s individual impact on a beneficiary’s cost of care relative to his/her total cost of care for the year. Furthermore, Mohs surgeons will likely be compared on cost metrics to all dermatologists. The VM will impact all physicians in 2017 based on this year’s performance [2015].
CMS has been developing a set of reports known as Quality and Resource Use Reports (QRURs) to provide comparative performance information to physicians. Each physician or physician group [defined by TIN] has a confidential QRUR which can be downloaded from the CMS website. I recommend you access your report* and begin to understand it.
*Author’s note: Instructions for obtaining your QRUR (through a predictably convoluted process) can be found at this website: Obtain your 2013 QRUR
For interest’s sake, I have provided a link to a sample QRUR similar to my group’s QRUR: Sample QRUR
Translational Science at the Mohs Meeting
By Sarah Arron, MD, PhD, FACMS
The interaction between skin cancer surgeons and our basic research colleagues can lead to exciting innovations in our field. The recent ACMS Annual Meeting in San Antonio was rich with translational research. I was delighted to present some of the molecular virology of the Merkel cell polyomavirus in the session on Merkel cell carcinoma, and even more delighted by the enthusiastic reception from our members. While much of the work presented was exploratory in nature, these pilot projects give our members a taste of what innovations are on the horizon and keep us on the cutting edge of our field.
In the Masters’ Pearls session, John Carucci shared some of his laboratory’s data on IL-22 induction of SCC cell proliferation, data that may lead to a potential new immunotherapy for SCC.
In the Tromovitch session, Andrew Breithaupt presented an investigation of human and viral gene signatures in cutaneous SCC. They used RNASeq to demonstrate an antiviral immune response in tumors that was stronger in immunocompetent patients than in immunosuppressed. These data support our current understanding of the potential interplay between viruses, the immune system, and cancer.
Novel imaging modalities were also shared at the meeting. Erik Cabral presented three-dimensional optical imaging of tumor tissue using molecular markers of keratin to demonstrate perineural and endoneural invasion in SCC.
Posters included an example of whole exome sequencing of a primary SCC and its in-transit metastasis, contributed by Abigail Baird and colleagues. They identified mutations in EGFR, mTOR, NOTCH2, and KMT2C. While it is difficult to extrapolate this data to metastatic SCC in general, they were able to justify the use of the EGFR inhibitor cetuximab in this patient. There was also poster from Castle Biosciences presenting data on their melanoma prognostic assay, which uses gene expression profiling to predict outcomes in melanoma.
I look forward to more basic and translational research at the next meeting!
Viewpoints
Reflections from the AMA Resident and Fellows Section Annual Meeting
By Garrett Lowe, MD and Karen L. Connolly, MD
The American Medical Association (AMA) held its annual meeting of the Resident and Fellows Section (RFS) June 4-6 in Chicago, Illinois. During that meeting, Dr. Garrett Lowe (delegate), and Dr. Karen Connolly (alternate delegate) attended as representatives of the ACMS in the RFS to participate in discussions and vote on AMA RFS governance and policy.
First, we would like to say thank you for the opportunity to represent the ACMS at the AMA RFS meeting. During the meeting, we met young AMA leaders within various areas of medicine. During informal and formal discussions, we found that many of our peers in different specialty areas face similar struggles as we foresee for the specialty of Mohs surgery. Additionally, several common challenges faced by residents and fellows were discussed.
Having representation from the ACMS allows us to share with the section some of the needs, challenges, and strengths of our fellowship and our field. During the meeting, a major focus of the RFS was resident and fellow wellness. This issue is relevant to all physicians, and fostering a pattern of wellness and good self-care habits early in our careers will help ensure the longevity of our ability to practice. While our fellowship is typically between 1 to 2 years, practice habits are established that can follow us through our careers. By promoting well-being and recognizing stress and fatigue in fellows, program directors and faculty can encourage healthy lifestyles and maximize productivity for the healthcare team. The ACGME will be hosting a conference in November 2015 specifically focusing on physician well-being and seeking solutions and interventions for the very common issues of physician stress and burnout.
There is extensive evidence showing that people with higher levels of well-being perform better. And it’s not just because tired, anxious, or unfit trainees perform poorly. There are gains to be made at the top as well. Employees with higher levels of well-being actually become more positive, focused, energetic, resilient and resourceful in the way they work. These positive effects have been found to produce significant performance gains on various measures. From productivity to resilience, engagement and effort, higher levels of well-being consistently predict higher levels of performance.
The field of Mohs micrographic surgery and dermatologic oncology continues to grow and mature. The future of the specialty is bright, and will one day lie in the hands of those that we train today. By encouraging and fostering healthy habits in our residents and fellows now, we can hopefully play a small part in helping each of them be his/her best self at home, in the community, and at work.
Survey response requested
The following survey is being shared at the request of an ACMS member in good standing for the purposes of research/data collection, and has been reviewed and approved for distribution by the Executive Committee of the ACMS Board of Directors. Please review and respond. You participation is greatly appreciated.
Survey on practices and preferences for local anesthesia
This survey will be closing soon.
Dear ACMS members,
As a fellow member of the American College of Mohs Surgery, please take this brief survey on certain practices and preferences in the use of local anesthesia. Note that this survey concerns simple local injection anesthesia and nerve blocks, and does not refer to tumescent anesthesia.
The data collected will be used as evidence to show certain specifics of local anesthetic use by dermatologic surgeons, particularly pertaining to epinephrine.
Thank you so much for taking the time to do this.
David A. Gaston, MD, FACMS
Private Practice Mohs Surgeon, Pensacola, FL
Associate Clinical Professor of Dermatology, FL State College of Medicine
ACMS and Mohs in the Media
News anchor Karen Abernathy of WLOX in Biloxi, MS shared her personal account of having Mohs surgery to remove a basal cell carcinoma from the tip of her nose, and how ACMS member Christopher Miller, MD helped ease her fears and get her back in front of the camera.
Don't believe the hype about sunscreen ingredients being harmful. ACMS members Dr. Steven Wang and Dr. Ellen Marmur were interviewed for a Health Magazine story, “What You Must Know About the Chemicals in Your Sunscreen.” The story pointed out that there is significant research from multiple credible bodies that says sunscreens are safe and will reduce skin cancer.
In Memoriam: Patrick Walsh, MD, FACMS
Remembrance by Stanley Miller, MD, FACMS
Patrick Walsh, a Mohs surgeon who trained with Ramsey Mellette, passed away Friday, May 1, 2015, at the age of 61. Pat was born Jan. 28, 1954 as one of eight children. He graduated from Rice University with a BA in biology and psychology; from the University of Texas at Austin with a MA in microbiology; and from the University of Texas Medical Branch, Galveston with a medical degree. Pat then completed a residency in Dermatology, a fellowship in Immunodermatology, and a fellowship in Mohs surgery (with Ramsey) at the University of Colorado School of Medicine.
Pat remained on the faculty at the University of Colorado School Of Medicine until December 2001, achieving the academic rank of Associate Professor with dual appointments in the departments of Dermatology and Internal Medicine/Division of Medical Oncology. Pat then returned to Texas, where he was in private practice in Fort Worth from January 2002 until his passing. He was a Clinical Associate Professor of Dermatology at the University of Texas Southwestern Medical School.
As a friend of Pat’s I must add a few important, human details. First of all, Pat was a real character. He looked, talked, and swore like a truck driver, but he had a degree in immunology and was one of the few Mohs surgeons (especially in those days) to have an NIH RO1 grant. Pat helped to develop a mouse model of immunotherapy for melanoma, a vaccine, about 15 years ago at the University of Colorado that eventually went on into human testing. Pat spoke to our Melanoma and Cutaneous Oncology Group at Johns Hopkins as a guest lecturer.
Usually once per Mohs meeting, I would go with Pat to a dive bar or honkytonk to drink beer and smoke cigars. My favorite memories of him were how he would transform when you asked him an immunology question. All of a sudden, in the midst of beer and rock and roll music, he would begin explaining things to me using multisyllabic words that I could barely understand!
Pat loved to golf, fish and hunt, and he absolutely loved his daughter, Jessica. He was honorable, thoughtful, kind, and generous, and dedicated to his patients and his profession. He will be sorely missed.
THE OCCASIONAL READER
By David P. Clark, MD, FACMS
“The importance of reading, for me, is that it allows you to dream. Reading not only educates, but is relaxing and allows you to feed your imagination - creating beautiful pictures from carefully chosen words.” – Eric Ripert
George Gershwin’s 1935 opera Porgy and Bess proclaimed, “Summertime. And, the living is easy.” Perhaps, “easy living” from June to August was once the case. However, modern summertimes have become crammed full of activities. Vacation experiences, home maintenance, and all manner of youth camps have made any thought that summer might provide a restful break from a busy surgical practice the stuff of ancient myth. Josef Pieper, in his classic book Leisure: The Basis of Culture, suggests true leisure “pierce[s] the canopy” of work that forms over our lives. This kind of leisure is, “stillness, contemplation, receptivity, worship, wonder, mystery, and grace.”
So, what follows are my suggestions intended to entice readers of this column—a loyal following with the widest spectrum of reading tastes— to find some “real” leisure by reading a good book.
FICTION SUGGESTION
“Fiction reveals truth that reality obscures.” – Jessamyn West
STATE OF WONDER by Ann Patchett
My fiction suggestion is a novel from one of America’s most talented living authors. Many readers are aware of her story-telling talents through the award-winning book Bel Canto, or her more recent collection of essays, This is the Story of a Happy Marriage. State of Wonder is her recent novel that contains elements of a who-done-it combined with a classic “journey” story.
An employee of a pharmaceutical company dies unexpectedly in the Amazon. The story's female protagonist, a former student of the deceased, is charged by the company with traveling to the remote site to discern precisely what happened to the dead man--foul play is suspected. She is also asked to clarify exactly how much progress has been made on the drug being developed at the remote site. The protagonist’s journey and ability to sort out the situation are complicated by her significant emotional baggage. As in all epic “journey” stories, the conclusion revolves equally around the protagonist’s dealing with her “flaws” and the solution to the researcher’s death.
The novel reads quickly, with excellent descriptions of place and interrogation of characters. None of the characters becomes a stereotype, and the author weaves a group of fascinating sub-plots. Those with intimate knowledge of pharmaceutical companies may need to suspend their beliefs in a few spots. However, the author has been able to engage many of the industry’s problems and ethical issues without appearing to preach.
The novel’s characters are far from perfect, and motives remain murky or at least conflicted. Unlike traditional detective fiction, stories that start with a dead body and proceed via physical clues to a solution, this novel plumbs psychological clues for clarity. This interest in motivation and hidden desires makes State of Wonder far more like the complex Inspector Wexford novels of Ruth Rendell than the formulaic stories of Dame Agatha Christie. Patchett writes unique books, and this one should hold your attention.
POETRY SUGGESTION
“The poet's job is to put into words those feelings we all have that are so deep, so important, and yet so difficult to name, to tell the truth in such a beautiful way, that people cannot live without it.” – Jane Kenyon
DRAWN TO THE LIGHT: Poems on Rembrandt’s Religious Paintings by Marilyn Chandler McEntyre
Readers of this column know that from time to time I recommend books of poetry. I freely admit I am an amateur in this area. But, rather than the modern meaning of amateur—an unpaid and wholly inept practitioner—I prefer an older definition deriving from the French word amour. I am a lover of poetry.
This small, older book by Marilyn McEntyre combines art and poetry. Excellent reproductions of the Rembrandt paintings accompany these wonderful and vivid poems. McEntyre’s poetry is solid, particular, and beautiful. Hers are not abstract musings, but rather the thoughts of an intelligent and imaginative observer.
Poetry has been defined as “painting with words.” Drawn to the Light offers the reader the opportunity to thicken the imagination with a helping of beauty from two masters: Rembrandt’s paintings and McEntyre’s words. The heart will understand long before the reader’s head will realize the superb word-craft of this talented poet.
The book is available on Kindle. However, in a reverse of the usual state of affairs, excellent hardback book copies are available on the used market at a significant discount. Worth the effort.
NON-FICTION SUGGESTION
“These are the times of fast foods and slow digestion, big men and small character, steep profits and shallow relationships. The paradox of our time in history is that we have taller buildings but shorter tempers, wider Freeways, but narrower viewpoints. “ – Bob Moorehead
THE ROAD TO CHARACTER by David Brooks
David Brooks is a well-known New York Times columnist. Brook’s previous books have been biting satires concerning current culture. (See: Bobos in Paradise) However, as readers of his bi-weekly op-ed columns know, Brooks has more recently moved toward reflecting on the deeper shifts in our society’s practices that leave us ill-prepared to deal with our complex ethical problems. This is a deeply engaging and thoughtful book concerning personal virtue development; particularly the virtues constituting character.
While teaching a course concerning character in public life at Yale, the author recognized contemporary society has difficulty accurately defining precisely what character is. Rather than falling back upon the usual “I know it when I see it” cliché, Brooks has employed an unusual literary structure to illustrate his discussion. In the introduction and first sixteen pages, the author briefly outlines his thesis. First, the virtues that enhance our resumes and contribute to external success are different than the virtues discussed at your funeral. These “eulogy” virtues are deeper values of the heart, the old-fashioned virtues of kindness, honesty, bravery, and faithfulness. The second argument suggests that modern culture has so blurred the meanings of the words used to define virtue and character, we have lost the language to discuss them in a “bullet point” fashion. Stories must be used if meaningful debate concerning our moral ecology is to occur.
The remainder of the book uses the lives of specific individuals as exemplars. Brooks’ choices are eclectic. Johnny Unitas, George C. Marshall, George Elliot, and Augustine are just a few of the characters the author investigates to explicate the virtues forming the infrastructure of character. To Brooks’ credit, he does not sanitize his exemplars. For example, he discusses Dwight David Eisenhower’s self-control failures—anger, in particular—even as he points out the former President’s formidable accomplishments because of his life-long commitment to self-control.
The Road to Character is a enjoyable book to read, one that educated me about portions of American history and individuals I did not know well. Plus, Brooks is a master writer. Even if you are not a fan of his New York Times column, I think you will find much here to stimulate thinking and the imagination.
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