Mohs for Melanoma

Thursday, May 25, 2017 • 7:00 pm CT

Target Audience
The target audience for Mohs for Melanoma consists of ACMS Members and current ACMS & ACGME Fellows-in-Training.

Statement of Need
Mohs micrographic surgery (MMS) has long been determined to be appropriate for the treatment of primary and locally recurrent melanoma in situ and lentigo maligna on the head and neck, genitalia and acral sites. Additionally, recent data has determined low rates of local recurrence after MMS for both melanoma in situ and invasive melanoma. Rapid frozen section immunohistochemical stains allows accurate identification and precise excision of subclinical melanoma on the same surgical day, however, adequate training and accomplishment of the surgeon is necessary in order to insure therapeutic success. This webinar aims to address the skills necessary for the Mohs surgeon to learn in order to accurately assess the entire surgical margin by combining frozen section or permanent section pathology of the central debulking excision with complete microscopic margin evaluation of a Mohs layer, using melanoma antigen recognized by T cells (MART)-1 immunohistochemical staining. Variability of practice patterns discussing advantages and disadvantages with respect to width of appropriate margin and examination of the central debulking tissue will also be addressed.

Purchase the recording

• ACMS Members, Associate Applicants, Fellows-in-training: $75
• Non-members: $250

PARTICIPANTS: Access the recording and claim your CME certificate

Learning Objectives
At the end of this activity, the learner will be able to:

1. Describe how the Mohs surgery technique may be utilized for melanoma, namely, identification of tumor margin, excision of appropriate margin, submission of debulking tissue for additional pathologic assessment and staging and interpretation of Mohs sections using MART-1 staining.

2. Recall the importance of examination of central debulking tissue which allows for immediate identification of upstaging and consideration of sentinel lymph node biopsy before reconstruction.

3. Describe clinical circumstances where use of MART-1 may not be as accurate and discuss how best to manage such cases.

Presenter
Fiona O. Zwald, MD, MRCPI, FACMS
Dr. Fiona Zwald received her medical degree from the Royal College of Physicians and Surgeons of Ireland/National University of Ireland in Dublin. After completing a residency in both internal medicine and dermatology in Ireland, Dr. Zwald came to the United States where she again completed a residency in Dermatology at the Emory University School of Medicine. She went on to a clinical research fellowship in the Dermatology branch of the National Institutes of Health (NIH), followed by a fellowship in Mohs micrographic surgery and advanced reconstructive surgery at Vanderbilt University. Currently, Dr. Zwald is Director of Procedural Dermatology, Co-Director of Medstar Georgetown Melanoma and Skin Cancer Center, and Director of Transplant Dermatology at Georgetown University, focusing on the screening and management of patients who have, or who are at risk for, skin cancer – particularly those who are transplant recipients.

Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the sponsorship of the American College of Mohs Surgery (ACMS). The ACMS is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement
The ACMS designates this internet enduring material for a maximum of 1.00 AMA PRA Category 1 Credit(s)^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure of Conflicts of Interest
To comply with the ACCME Standards of Commercial Support on the need for disclosure and monitoring of proprietary and financial interests that may affect the scientific integrity and balance of content delivered in continuing medical education activities under our auspices. The ACMS requires that all CME certified activities be developed free from the control of a commercial interest and be balanced, objective, and scientifically rigorous. Anyone with the ability to affect the content of an educational activity must disclose relevant financial relationships with commercial interests producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

Disclosure of Discussion of Non-FDA Approved Uses for Pharmaceutical Products and/or Medical Devices
The ACMS requires that all faculty presenters identify and disclose any off-label uses for pharmaceutical and medical device products. The ACMS recommends that each physician fully review all the available data on new products or procedures prior to instituting them with patients.

Interest Disclosures
As an organization accredited by the ACCME to sponsor continuing medical education activities, the ACMS is required to disclose any real or apparent conflicts of interest (COI) that any speakers may have related to the content of their presentations. The ACMS requires that all individuals (including spouse/domestic partner) in a position to control/influence content in a program designated for

AMA Physician’s Recognition Award Category 1 credits™ disclose any financial interest/arrangement or affiliation with an ACCME-defined commercial organization that may impact on his/her presentation (i.e. grants, research support, honoraria, member of speakers’ bureau, consultant, major stock shareholder, etc.). In addition, the faculty member must disclose when an unlabeled use of a commercial product or an investigational use not yet approved for any purpose is discussed during the educational activity.

No Interests to Disclose:
Jeremy S. Bordeaux, MD, MPH, FACMS*
Rajiv I. Nijhawan, MD*
Fiona O. Zwald, MD, MRCPI, FACMS*

Interests to Disclose:
None

*Indicates CME & Education Committee Members
**Having a financial relationship with an ACCME-defined commercial organization, or discussing an unlabeled use of a commercial product, may not prevent a faculty member from participating in the planning process. However, the existence of a relevant financial relationship must be disclosed, so that any relevant conflict of interest may be resolved prior to that individual’s participation in the CME activity.

Disclaimer
The views expressed and the techniques presented by the speaker of the ACMS-sponsored educational activity are not necessarily shared or endorsed by the organizations. Anyone with the ability to affect the content of an educational activity must disclose relevant financial relationships with commercial interests producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients, as well as any unapproved or off-label uses of medical devices or pharmaceutical agents that they discuss, describe, or demonstrate during their presentations. Participants should use their independent judgment in applying the information discussed in this webinar in the treatment of patients.