FELLOW OF ACCO
Fellow of Australasian College of Cutaneous Oncology (ACCO)
To achieve the award of Fellow of ACCO the following pre-requisites will be required:
· Completed the 5 day Flap and Graft workshop
· Completed the 3 day face and ear workshop
· Completed the Dermoscopy advanced workshop
· Completed the dermatopathology workshop
· All the requirements of Associate Fellowship, but at a more substantial level of knowledge and skills.
· Log book requirements showing experience in skin cancer surgery (see below for details)
· Preceptorship requirement (see below for details)
. 3 hour written short answer style exam of 20 questions (Cost $500)
LOG BOOK
The log book must show suitable experience in managing a range of skin cancer diagnoses as well as suitable experience in a range of skin cancer 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. Some doctors may meet the log book criteria much quicker, keeping in mind the numbers of procedures detailed below.
The log book should document an array of skin flap and skin graft techniques. Substantial numbers of procedures to the nose, cheeks, eyelids, ears, lips, digits and legs must be demonstrated. The log book should include photographic evidence of a range of procedures being undertaken. - Photographs are not required on all logged procedures, - but a selection.
PHOTOS should include before, during and after images. The before photos should include the lesion and identifiable surrounding skin prior to any intervention. Photographs during the procedure should include images of the procedure. The closure technique should be identifiable. Ideally images afterwards should include an image at the sutures out appointment as well as a longer term follow up image.
Those achieving ACCO Fellow level will be expected to manage the majority of skin cancers presenting, or referred to them, including lip, nose and ear tumours. It is expected that a log book will show evidence of:
- flaps on the nose, ears and lips
- wedge resections on the lip and ear
- flaps below the knee
- skin grafts - full or partial thickness
It would be expected that at least 100 flap repairs be performed as well as 15 full thickness or partial thickness skin grafts and 10 wedge resections of the ear and / or lip. At least 50 flap repairs on the face and scalp should be performed, INCLUDING at least 25 on the nose, lips and ears. At least 15 flap repairs should be performed below the knee.
A fellow candidate must be familiar with and experienced in margin control surgery. The log book must identify such experience.
PRECEPTOR PROGRAM
From 2019 there are two option for completing the preceptor Fellow requirement.
1) Attend and observe skin cancer practice with a certified ACCO Fellow or another suitable senior consultant. The recommended duration of the attachment is 4 or 5 days. If you wish to pursue this option, please organise such with the ACCO Fellow or consultant directly and advise ACCO in advance at admin@acco.org.au
2) An ACCO academic will attend your practice for 2 days. You will be asked to plan numerous procedures over those two days including head and neck excisions and reconstructions. consultations and skin checks will also be observed. The two day visit will also include reviewing equipment, surgical theatre set-up, materials, sterilizing, nursing processes, etc. The cost of the 2 day attendance is $3,000 plus any travel and / or accommodation that might be required.
Details of Fellow curriculum:
The ACCO Fellow is the highest qualification awarded by the Australasian College of Cutaneous Oncology. It is designed for doctors working extensively in skin cancer management, often on a referral basis. A doctor with an ACCO Fellow 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 and lips, and larger tumours on most places of the body by using an array of reconstruction techniques including flaps and full thickness and partial thickness skin grafts. Some ACCO 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.
Knowledge and skills required at the Fellow level
All requirements listed for the diploma level are necessary at the Fellow 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 at Fellow level:
· 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 B RAF inhibitors, ipilimumab, PD1 drugs, MEK inhibitors and other agents in the management of metastatic 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, ingenol mebutate, photodynamic therapy and cryotherapy
· Role of radiation oncology in non-melanoma skin cancer management
· Dermoscopic features of melanoma, BCCs, SCCs 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 required at ACCO Fellow level.