President's Message

Dear ACMS Members,

As I write this update, it's a brisk, sunny mid-October day in Philadelphia. The city is tense with anticipation as the Philadelphia Phillies play game one of the National League Championship Season, facing the San Francisco Giants. Yesterday evening, the dreaded Yankees (my apologies to our New York members) put on an amazing come-from-behind performance in the 8th inning of their first game to notch up a dramatic victory in their league competition. At this moment, the ultimate outcome of the battle to the World Series is uncertain. However, when our newsletter is emailed this winter, you will have the information that I now lack, and the 2010 baseball season will be a distant memory. Simply stated, the future is indeterminate. In order to know the future, one must, for better or worse, just wait for it to happen. So it is with the evolution of the health care system and the effect of future changes on the practice of Mohs surgery. My feeble attempt to segue from baseball to medicine is meant to underscore my feeling of the unpredictability of where we, as members of the Mohs College are heading, and to mention ways that we are attempting to prepare for the uncertain future with contingencies to face the challenges ahead.

No one can argue that our top priority is the delivery of outstanding and empathetic medical care to our patients with cutaneous oncological disease. However, in order to meet that goal, we all must have practices with a sound economic foundation. In order to ensure the sustainability of our practices, the College has focused on the following endeavors:

WEBSITE
After a thorough vetting of several vendors, the Public Relations Committee, under the leadership of Alysa Herman, has selected Etna Interactive as our web designer (http://www.etnainteractive.com/). The Committee and our staff at the Mohs College are currently working with Etna to produce a website that is user friendly, informative, and able to convey the educational background and advanced training of our Fellowship based members to the general public. The website is being developed as a companion to the current website www.mohscollege.org and will be under the domain name www.skincancermohssurgery.org.

LEGISLATIVE INTERACTION
As health care legislation evolves, our endeavors to communicate with and provide information for key legislators must also expand. The Board will consider the necessary funding source and amount to support productive lobbying activities. Under the leadership of William "Pat" Davey, we will continue to explore the creation of a Grassroots Advocacy network based on the legislative contacts of our members. Although we are a small organization, we must attempt to inform key leaders in government of both the epidemiological changes in skin cancer incidence and of the services we offer to treat affected patients. In this regard, the Board will continue to investigate the possibility of funding high level research studies that demonstrate the cost-effectiveness and efficacy of the Mohs procedure.

RUC
Although the ultimate fate of the RUC is unknown, it is currently the organization that considers and decides the relative valuation of the procedures we perform. Our input and participation in their meetings is crucial in order to maintain fair and appropriate reimbursement for the services we provide. Glenn Goldman has graciously accepted our request to be the first representative from the Mohs College. His voice will be added to that of Brett Coldiron, Dan Siegel, and Scott Collins, who will continue to speak for dermatology's interests at the RUC as they have so ably done in the past.

ORGANIZATIONAL COOPERATION
This year our membership has leadership representation in both the AAD and the ASDS. Ron Moy will be the President of the AAD and Dick Bennett the President of the ASDS. Mutual cooperation will allow sharing of resources to strengthen our ability to interact successfully with legislators and governmental agencies.

Finally, a major thrust of the College is education. Although our fellowship programs are transitioning to ACGME oversight, Suzanne Olbricht and the Fellowship Training Committee will continue to explore ways to ensure quality control of training, facilities and histology techniques as well as devise ways to assist fellows in obtaining maximum benefit from their training experience. Tanya Humphreys and the Scientific Program Committee are developing an outstanding program for the annual meeting in Las Vegas. Perhaps the highlight of the meeting will be a presentation by Fred Mohs Jr., who will discuss the personal and professional life of his father, the founder of the organization that bears his name.

The future is indeed unknown. I have every confidence however, that the talented and thoughtful members of the Mohs College will bring us there with a sound foundation and in a healthy position to care for our patients, advance knowledge and sustain our practices. As I conclude this update, the Yankees are about to lose game two of their playoff series. Perhaps there is cause to hope for an optimistic future for the Phillies as well.

Sincerely,

Len Dzubow, MD, FACMS
ACMS President
PresidentDzubow@mohscollege.org
(484) 621-0082

ACMS 2011 Annual Meeting Update

Go online in early January to view the following Annual Meeting info

http://www.mohscollege.org/annualmeeting/

• Online registration (opening January 13th)
• Hotel info & links to online booking
• Registration: including Early-Bird reduced registration (through February 21st)
• Preliminary programming for the 2011 Annual Meeting

Planning is well underway to offer a star-studded 2011 Annual Meeting

Here are some of the highlights:

Thanks to the hard work of Chair, Dr. Tatyana Humphreys and the rest of the Scientific Program Committee, there will be numerous guest speakers featured at the Annual Meeting:

Thursday

• Frank J. Lexa, MD, MBA, from the University of Pennsylvania Wharton School of Business, will be speaking with Dr. George J. Hruza in the session Health Care Reform

Friday

• Clay J. Cockerell, MD, from UT Southwestern, back by popular demand, will be guest speaking in the session Challenging Dermpath Cases from Dallas and as a panelist on Tumor Board
• Homer A Macapinlac, MD, FACNM, from University of Texas MD Anderson Cancer Center, will be speaking in the session PET/CT & Cutaneous Tumors and as a panelist on Tumor Board

Saturday

• Frederick J. Menick, MD, world renowned expert on nasal reconstruction from Tucson, AZ, will be a guest speaker and panelist in sessions, How Would You Reconstruct It? and The Undesirable Result
• Frederic E. Mohs, Jr. will be our Keynote Speaker featured in Remembering Dr. Frederic Mohs

As with last year's meeting, a broad selection of morning mini-sessions, with smaller room capacity allotments, will be offered to allow for more intimate and in-depth sessions for audience members.

For the general sessions, a few of the old favorites will be back, such as Tumor Board, Coding and Documentation Update, and Reconstruction with the Masters. New timely sessions were added, including, Controversies in Mohs Surgery and Health Care Reform.

This is shaping up to be an Annual Meeting that you won't want to miss!

The abstract submission deadline is just around the corner

The submission deadline is Monday, January 10, 2011 at 11:59 pm PST.

To make your submission visit the ACMS abstract submission website at http://mohscollege2011.abstractcentral.com/ for detailed instructions on how to proceed. Only electronic submissions will be considered for review.

For research abstracts to be considered, research must be underway at the time of submission and completed in advance of the meeting. Industry, institution, and author(s) names must not be used in the title or body of the abstract(s). Importantly, all accepted abstract authors and presenters must disclose commercial conflicts of interest in the application. Failure to do so will result in forfeiture. Use of institution names will disqualify the abstract for consideration, as this compromises blinded review. For more information regarding the ACMS abstract rules and processes, view the 2011 Call for Abstracts online at: http://www.mohscollege.org/annualmeeting/2011/am11-call4abstracts.pdf.

For fellows-in-training: don't forget to apply for the prestigious Tromovitch Award at the time of submission on the ACMS abstract submission site. The award is available only to current fellows-in-training or those who have completed their ACMS approved fellowship within the past year. The recipient(s) of the Tromovitch Award must submit an article suitable for publication in the Journal of Dermatologic Surgery by March 2012. Upon receipt from the Journal of the submitted article, the recipient(s) of the Award will receive complimentary membership dues for his or her first year of membership in the College and free registration at the 2012 Annual Meeting.

We look forward to your contribution.

Highlights From the Literature

Molina BD, Leiro MGC, Pulpon S, Mirabet JF, Yanez LA, Bonet FG et al. Incidence and risk factors for non-melanoma skin cancer after heart transplantation. Transplantation Proceedings 2010; 42 (3001-5).

Most of the published data regarding the development of skin cancer after transplantation come from renal transplant recipients. Not as many studies have been performed in heart transplant (HT) patients, who tend to receive higher doses of immunosuppressive therapy. The authors of this paper sought to determine the incidence of SCC and BCC in heart transplant (HT) patients, and the risk factors for their occurrence, using the Spanish Post-Heart Transplant Tumor Registry, which compiles data on tumors in all adult patients who have undergone HT in Spain. The authors examined data from patients receiving HT between 1984 and December 2003 and followed until December 2004. They evaluated a total of 3393 patients, which is the largest population of HT patients with skin cancers reported to date.

Similar to previous reports, the SCC: BCC ratio was 1.62: 1 in this group of patients. Both types of tumors were more common in men, but this difference was statistically significant only for SCC. The incidence of SCC and BCC increased with the length of follow-up and with age. Induction therapy resulted in an increased incidence of both tumors, especially among patients who received OKT3, while anti-thymocyte globulin therapy only increased the incidence of BCC. Interestingly, the use of mycophenolate mofetil and tacrolimus in the first 3 months after HT appeared to be protective against SCC development; azathioprine was a risk factor for SCC and cyclosporine had no effect on SCC development. None of these agents had any effect on BCC development.

Age > 45 years at the time of HT, induction therapy and high sunlight exposure were all significant risk factors for both SCC and BCC in this study population. The authors suggest that SCC development in HT patients appears to be related to the type of immunosuppressive regimen used, and not just the duration or level of immunosuppression. The possible beneficial effect of calcineurin inhibitors after HT has not been previously described. Such a possibility definitely warrants further study as a potential means of decreasing the risk of SCC development in patients undergoing HT.

Désirée Ratner, MD
Columbia University Medical Center

Viewpoints with Rex Amonette, MD

Dr. Rex A. Amonette is a Mohs College founding member, former President and recipient of the College's Distinguished Service Award in 1995 and Frederic E. Mohs Award for Career Achievement in 2006. He is a former president of the American Academy of Dermatology and the International Society of Dermatology. Dr. Amonette is in group practice in Memphis, Tennessee.

1. What sparked your interest in Mohs surgery?

In 1971, while a second year resident at the University of Tennessee, my chairman, Dr. E. William Rosenberg, learned that Dr. Perry Robins was beginning a one year Mohs fellowship program at New York University. He encouraged me to apply, and the following year, I became Dr. Robins' second fellow.

2. Tell us about your current practice.

I practice in the Memphis Dermatology Clinic and as a Clinical Professor for UT. I served as a Mohs Fellowship program director for 25 years, but now have only medical students and residents with me. I continue to work full time.

3. What do you enjoy most about your practice?

I truly love my patients! Also, I am blessed to work with a fantastic staff and eight additional Mohs surgeons, which include my daughter and son-in-law.

4. What do you enjoy least about your practice?

When I am behind and fail to see patients at their appointed time.

5. Clinically, what do you find challenging at this point?

Appropriate stamina to complete difficult and long days.

6. What challenges do you foresee the Mohs College and its members facing in the future?

Possible increasing limitations on utilization of Mohs surgery and decreasing reimbursements.

7. What advice would you give fellows just starting practice?

Be extremely kind and helpful to every patient and attempt to do something special for each one. In turn, they will make sure you are very busy.

8. What do you enjoy doing outside of work (professionally)?

I have been so blessed to be involved in all levels of medicine, including local, state and national organizations. With great pride, I note how far ACMS, AAD, ASDS, ABD and so many more have advanced to make our specialty a leader in all of medicine.

9. What do you enjoy doing outside of work (personally)?

Family, friends, sports and travel. My family members are so interesting and fun that I have constant entertainment. With six grandchildren, all playing multiple sports, I have the opportunity to attend many sporting events each week.

10. What would people be surprised to know about you?

While in high school, I worked as an assistant to a food store butcher. Even then, I was in training to take thin slices!

Jeremy S. Bordeaux, MD, MPH

Mentorship of Junior Academic Mohs Surgeons

Towards mentorship of junior academic Mohs surgeons: "The only constant is change"

There are many reasons why recently trained Mohs surgeons would choose an academic position over private practice. I thought of writing this article to highlight the importance of mentorship in retaining young Mohs surgeons in academics. I have been extremely fortunate to have excellent mentors and I greatly enjoy the daily challenges and rewards my job brings! Because of this, I chose to interview two senior academic Mohs surgeons, Drs. Carl Washington and Tim Johnson, regarding mentorship and retention of young Mohs surgeons in academics.

What do you mean by the term 'mentorship'?

Dr. Washington: "Mentorship is key towards helping a junior faculty member build his or her career in procedural dermatology. In the academic environment, the only constant is change! The relationship should be formal with an expectation of a 'product', facilitated by regular meetings between mentor/mentee. The mentor's role is not to do the work, but to help create opportunities and identify individuals with common interests with whom the mentee can collaborate. Both have to be equally committed to the mentor/mentee relationship."

Dr. Johnson: "My driving force as a mentor is that the person I am mentoring becomes better than I am! The key to a great mentor is having a great mentee. It is important to identify the strengths and interests of the mentee, discover what he or she is passionate about, and then channel mentorship in that direction. The focus should be on the career development of the individual."

Where do you see the role of the institution?

Dr. Washington: "If mentorship is the philosophy of the institution, it is likely that the mentor was once in the role of the mentee, therefore he or she can relate better to ongoing concerns. If the mentee succeeds and is happy, this reflects positively on the institution."

Dr. Johnson: "At the University of Michigan, where clinical excellence and patient care is highly valued, it is important that the institution supports and embraces an efficient clinical service. A well run clinical enterprise gives one time to pursue other academic teaching and research interests. It is critically important that the mentee has the protected time to develop their research and other academic interests. The institution must support true protected time and be flexible and willing to create and nurture opportunities for junior faculty. From day one, the mentee must be informed honestly of the requirements for promotion, which are different at each institution. Then they need to be supported in every way to get there."

What are the challenges of young fellowship trained Mohs surgeons who go into academics?

Dr. Washington: "It is very difficult for someone just out of fellowship to step into an academic environment and succeed without simply becoming part of the 'patient mill'. Negotiating protected time with your Chair is vital. A research interest is important but not completely necessary. If you choose to adopt a role of leadership at institutional level or become a clinician educator in the field of cutaneous surgery, that is just as important as developing a career in clinical or translational research. So, one major challenge for young Mohs surgeons in academics is balancing research/leadership interests with time spent seeing patients."

Dr. Johnson: "The major challenge for junior surgical staff is the ongoing competition between research time and clinical time. But I would just say, try to be the best you can for your patients. This takes time and effort, but it is ultimately extremely rewarding on a professional and personal level. Use your clinic as your clinical research arena. Develop systematic prospective research databases to answer clinical questions. Understand levels of evidence and science. The best clinicians must integrate and use rigorous research knowledge to provide optimal care."

Does the mentor have to be a Mohs surgeon?

Dr. Washington: "If you are the solo Mohs surgeon at an institution, then there is no other Mohs surgeon there to mentor you. But one could get advice/mentorship from a senior Faculty member. Or someone outside your Department, e.g. your fellowship director or another academic Mohs surgeon in another institution."

Dr. Johnson: "No, but that helps. Once the individual has recognized his or her area of interest, many possible mentors exist within the academic environment, both inside and outside their institution, in many of the disciplines that encompass cutaneous oncology. Getting out of a Mohs vacuum, developing relationships with other specialists, and pursuing whatever interests you in medicine are really important to fully realize your potential."

Besides personal reasons, why do recently trained Mohs surgeons leave the academic environment?

Dr. Washington: "Lack of mentorship. Junior faculty become frustrated in their attempt to get research off the ground, since the clinical endeavor frequently takes up all available time. The endless conflict between the individuals' academic interests and being productive financially is extremely challenging. So expectations are not met."

Dr. Johnson: "Lack of nurturing and direction from the department leadership and/or lack of long term vision or, to be honest, a demand (which is different than desire) for a large salary by the surgeon. Those who stay long term in academics are usually individuals with an internal compass driven by something much different from salary, because to be successful, the surgeon needs to spend time pursuing academic interests that frankly don't generate much revenue. For those that leave, maybe their expectations were not met or weren't supported or communicated well. You have to give junior surgical faculty a reason to stay and be honest and frank about expectations when you are hiring a young Mohs surgeon for an academic position."

How do you define a successful mentor/mentee relationship?

Dr. Washington: "Having the satisfaction of knowing the person I have mentored is an expert in a certain area . . . my 'go to' person! There is no 'value added' to me!"

Dr. Johnson: "It is a strong desire to be selfless! It is knowing that the person I mentored is the best they can be personally and professionally, hopefully better than I am, and that they love what they do and how they do it!"

Fiona Zwald, MD
Emory University

Practice Tips: Prepping for the Media

When it comes to preparing for an interview or a public speaking engagement, even the most seasoned ACMS members look for a few tips from the Executive Office now and again.

For this reason, the ACMS has Practice Marketing Materials available online, which include a Marketing Manual, Advertising Primer, and Media Primer. Log in to the Members Only section to view these complete manuals and read all the information that they have to offer.

Included in the Media Primer online, you'll find information on preparing for being interviewed by the media. An abbreviation of this information is included below.

Being Interviewed by the Media

Reporters always ask the same six journalistic questions: Who, What, Where, When, How, and Why. While the interview is structured as a question and answer session, the most important thing for you to remember is that an interview is merely an opportunity to deliver a particular message. Your task is not to answer all of the reporter's questions, but to get your point across. Too many people try to tell a reporter everything they know about a subject, and their real message gets lost in the clutter.

QUICK TIPS FOR MEDIA INTERVIEWS AND SPEAKING ENGAGEMENTS

1. Speak slowly.
This sounds like obvious advice. The problem is, too few of us actually remember to do it. When you get nervous, the pace of your words tends to speed up. This can have a domino effect; the faster you speak, the more exasperated you get. By being conscious of speaking slowly, you will project more confidence and resist using filler words such as "um" and "like." That said, avoid speaking in a monotone. The goal is to be clear and engaging.

2. Always speak in complete sentences. When asked a question, restate the question as part of the response.
This accomplishes three things:

• It makes you sound more thoughtful.
• It buys you time (a few seconds) to collect your thoughts.
• It reduces the likelihood that you'll be misquoted or have your comments taken out of context.

3. Always look at the reporter when answering questions or your audience when speaking. Don't look directly into the camera, off to the side, or constantly at your notes.
This is important to establish a sense of confidence. It's critical for television but important for print as well since reporters are not only reporting on what you say but how you say it. You want to avoid appearing shifty or untrustworthy. In a speaking engagement, eye contact with the audience is a critical factor to hold interest.

4. Always prepare three central message points and weave these points throughout the interview or speech using slightly different language.
This is important to ensure your audience or a reporter understands the central issues. It also provides an anchor for your delivery. You should prepare these message points in advance and be able to deliver them in a conversational fashion, without referring to notes. Don't memorize exact words, but be familiar with the concepts. The goal here is to move from being entirely scripted to being able to engage in more casual discourse.

5. If a reporter or an audience member makes an inaccurate or inflammatory suggestion during questioning, make a clarification without becoming angry or flustered. Above all, do not lose your composure.
You can begin by saying, "Let me clarify," "let me be very clear" or, "what is actually happening…" From that point, you can bridge to your main message points. If you need to deliver a direct rebuttal, make sure you have facts to back it up. You can begin by saying, "It's very important to understand the facts . . ."

6. If faced with aggressive questions or a demand by the reporter to issue a "yes" or "no" response, proceed cautiously. You CANNOT lie. If the truthful response to a reporter's question would be "yes," but giving a "yes" on the record would cast the organization in a negative light, do not say the word "yes."
Questions on issues that may give rise to this type of questioning:

• Are members of Mohs College better than those who perform Mohs surgery who are not members of the college?
• Why should the CPT codes for Mohs surgery be exempt from the Multiple Surgery Reduction Rule?

Questions such as these must be answered with caution and discretion in order to avoid potential litigation or sanctions by other parties.

7. Prepare a closing remark.
At the end of an interview, reporters often ask, "Is there anything else you would like to add?" Don't say, "I think we've covered everything." This is an opportunity wasted. Instead, deliver a short, two or three sentence statement that captures your central message points. By doing this, you will end the interview on an upbeat note and increase the likelihood that positive messages are reflected in actual coverage.

News from the Derm RRC

An update from Dr. R. Stan Taylor, III, Chair of the Derm RRC

The ACGME accreditation process is designed to ensure that Mohs fellowship training programs comply with the growing number of quality standards now facing American medicine. External oversight of medicine is on the increase and the Dermatology Residency Review Committee is working with the ACMS to meet the challenges ahead. An update of ongoing work can be found at: http://www.mohscollege.org/4thqtrdermrrcnews/.

Summarization of Recent Board Minutes

The following is a brief summarization of the ACMS Board of Directors Meeting Minutes from Saturday, November 6, 2010 in Chicago, IL:

Board of Directors: Leonard M. Dzubow, President; Brett M. Coldiron, MD, Vice President; Marc D. Brown, MD, Secretary-Treasurer; Duane C. Whitaker, MD, Immediate Past-President; John G. Albertini, MD; Frederick S. Fish, III, MD; Glenn Goldman, MD; Andrew J. Kaufman, MD, FACP; Gary P. Lask, MD; Ken K. Lee, MD; Gregg M. Menaker, MD; Marcy Neuburg, MD; Suzanne Olbricht, MD

Item I: Membership Dues Increase

With 76% of respondents to the recent membership needs survey saying they would approve of an increase in annual membership dues for lobbying and advocacy purposes, the ACMS Board approved of a $100 annual dues fee increase, to begin in 2011.

Item II: ACMS Logo Usage to be Included in Membership

The Board agreed that ACMS logo usage should be a free member benefit starting in 2011. Members will still need to apply for permission to use the logo with the ACMS through an online logo license submission application process, however, there will no longer be a fee associated with utilizing the logo. Members who have applied for a logo license, submitting a fee after June 1, 2010, will be contacted and reimbursed for their payment amount. Members who have already been granted permission to use the ACMS logo may continue to use the logo so long as that member remains in good standing. To apply for the no-fee logo license usage, fill out the logo agreement online and fax to the College office at: (414) 276-2146.

Item III: Marketing Assessment Tabled

Based on an ambiguous response rate in the membership need survey, the Board has tabled a decision to levy a one-time special assessment for marketing purposes in 2011. The issue will be revisited at a later date.

Item IV: Request to Create a Standard of Care Policy

The Board addressed a request from a California member to create a standard of care policy statement for Mohs procedures. The Board decided to wait and see if Medicare site surveyors to ASCs are frequently imposing arbitrary and unpublished standards on Mohs ASCs or if it was an isolated incident that Medicare tried to compel the California member to abide by so-called regulations that weren't on the books. If the issue becomes pervasive, the Board will reconsider whether the College should have a standard of care policy.

The Occasional Reader

Of the many pleasures associated with my bed, the sensuous delight of reading a good book before sleep may be the indulgence I have enjoyed the longest. I have put away childish habits and no longer read under the sheets with a flashlight; and sadly, my sojourn through late middle age finds me reading far fewer minutes before the exhaustion of surgical practice fells my eyelids. However, I find that when I crack open a good book at the end of a day, I am enveloped by a sense of wellbeing. For at least a few brief moments I can live in the illusion that I still control my life.

But, after at least five discrete attempts at reading my well-drooled upon copy of The Brothers Karamazov, I have exchanged this majestic novel for other more appropriate nighttime reading. In the interest of increasing my colleagues' nighttime pleasures, what follows are my suggestions for nocturnal reading.

For those bedtime readers with the briefest interlude between recumbence and slumber I suggest the genre of "Flash Fiction" or what the publishers now call "short-short stories." These prose efforts, usually less than 1000 words, are the sleekest of stories. Stripped of all but the barest essentials, this is the narrative of glimpses or moments.

Noted author Margaret Atwood has a wonderful collection of short fiction pieces, The Tent. As with many successful novelists, Atwood's shorter work often escapes notice. (See also her collection Murder in the Dark: Short Fictions and Prose Poems) Atwood displays masterful skills in her 36 stories, which are spread over 153 pages. Notable shorts in The Tent include her fictional essay, "Three novels I won't write soon." Atwood gives the reader a succinct masterpiece, a prose demonstrating pithy, discomforting, and insightful commentary that does not require a plethora of words. Her "short-short" titled, "Our cat enters heaven," is wickedly funny. While I don't begrudge the humor in this piece, as a committed "dog person" I lack the imagination to place any cat in paradise.

Other possibilities in the "short-short" category include: 100 Great Science Fiction Short Short Stories. Ed. Isaac Asimov. New York: Avon, 1985 and New Sudden Fiction: Short-Short Stories from America and Beyond. Eds. Robert Shapard and James Thomas, New York: Norton, 2007.

Some readers now passing forty, still exhibit a dogged determination to acquire the humanities education they didn't get while acing Organic Chemistry and Anatomy. Typically, this group has a literary bucket list, a folded newspaper clipping from the New York Times listing the 100 books all truly educated people should have read. For this group I counsel patience. Take a deep breath and get a grip -- reading at bedtime needs to be thought of more like a massage than a colonoscopy.

Rather than start with War and Peace, an effort that might occupy the bedtime hours of the weary Mohs surgeon until retirement, I suggest a collection of short stories from these same "master authors." Author Brett Lott has collected, now in two volumes, classic short stories, a series called Eyes to See. Both volumes have classic stories told by older masters like Tolstoy and Dickens as well as newer literary experts such as John Updike and Flannery O'Connor. Many of these short stories are difficult to find in print and represent some of the best fiction writing in the English language. Reading older masters reminds me that stories about human beings, especially good stories well told, are independent of time and culture. The insights, dilemmas, character development, and human foibles still ring true, as fresh and imaginative today as when they were written.

Some nighttime readers may persist in the quest to read novels in bed. For this group of traditionalists I would suggest the novella. Novellas are a fictional literary form longer than a short story but shorter than the classic novel. In the past, magazines often published these stories in a serial format. Hemingway's The Old Man and the Sea and Steinbeck's Of Mice and Men are 20th century examples of this form but Dickens' A Christmas Carol also qualifies as a novella. You will not, however, find a "Novella" category at Barnes and Noble. Instead, the form is lumped with the novels. They are, however, easily recognized by the thinness of the volume -- between 100 and 200 pages. These fictional efforts have more characters and a thicker narrative development than the short story but significantly less than, say, Anna Karenina or Jonathan Franzen's recent novel Freedom.

The Cellist of Sarajevo is the first novel of Steven Galloway and an excellent novella/novel candidate for the nighttime reader. Galloway has employed an interesting structure for the work. The narrative is closely linked to a timeline in which a cellist braved ongoing shelling, sat in the center of a bombed out Sarajevo street, and performed daily at noon for 22 days in order to honor the dead. However, the chapters are relatively independent stories, unrelated narratives concerning four characters caught up in the Sarajevo siege. In the manner of a braided essay or a collage fiction, Galloway combines traditional fictional development with the modern use of story element juxtaposition to impart meaning. This was a novella I read quickly at the rate of a chapter a night but found myself remembering and considering for many weeks -- one of my criteria for a "good read" recommendation.

If you don't read for pleasure at night, I strongly recommend it -- it doesn't really count as a vice and you'll sleep better. Consider this a prescription for the doctor: Rx. Good Fiction. Sig: Take 20 pages hs. Refill: As needed.

David P. Clark, MD

ACMS Classifieds

Surgeons

Histotechs

Call for Articles

If you are one of the many ACMS members who have enjoyed the articles in the ACMS Membership Bulletin and have an interesting story to tell, the newsletter committee is looking for more articles of the same caliber. Please send a brief summary to the ACMS office for consideration. Email your article summary to: info@mohscollege.org. All materials submitted become property of ACMS.

Note to ACMS Membership Bulletin Readers:

Reference to any specific commercial product, process, or service by trade name, trademark, manufacturer, or otherwise throughout this e-newsletter, does not necessarily constitute or imply its endorsement, recommendation, or favoring by the American College of Mohs Surgery. The views and opinions of authors expressed do not necessarily state or reflect those of the American College of Mohs Surgery, and shall not be used for advertising or product endorsement purpose.