Fellowship

Dr. John Hendrix Program Director, Mohs Fellowship

The UVA Micrographic Surgery and Dermatologic Oncology fellowship is accredited by the Accreditation Council for Graduate Medical Education (ACGME) and approved by the American College of Mohs Micrographic Surgery and Cutaneous Oncology (ACMS). Successful completion of the fellowship qualifies you for membership in the ACMS, in addition to accreditation by the ACGME that will be necessary for future board certification in Mohs Surgery. We train one fellow each year.

Four fellowship-trained Mohs surgeons are on the UVA Department of Dermatology faculty (all trained by different programs/directors). The faculty instruct the fellow in all aspects of Mohs micrographic surgery, including the indications, limitations, and applications of the procedure. The fellow will obtain experience in the repair of surgical defects resulting from Mohs surgery, with instruction provided in reconstructive dermatologic surgery, including skin flaps and grafts. In addition to Mohs surgery, the fellow will be instructed in the general principles involved in the management of various cutaneous neoplasms, both common and rare. Our fellowship also provides background for cosmetic and other dermatologic procedures with exposure to the principles of aesthetic repairs as well as direct experience in various cosmetic procedures as desired including the use of Botox, filler, pulse dye laser and IPL. More in depth exposure to other cosmetic procedures can be arranged depending on the fellow’s interest.

There are three offices – the UVA Mohs clinic, and a private practice clinic in two locations. The fellow rotates daily with a different Mohs surgeon. Thursday is an academic day, but a fellow may elect to work with any Mohs surgeon that day (if there is an interesting case) or follow a Mohs patient to the operating room to assist with reconstruction with another surgical discipline.

Mohs surgery is performed daily, generally starting between 7 and 8:30 am depending on the clinic. Follow-up patients and new consults are seen during the late morning or early afternoon while additional Mohs layers are taken, and reconstructions are begun. Other minor surgeries are done in the afternoon. The primary focus of teaching is on Mohs surgery and reconstruction. We perform over 3500 Mohs cases each year, and each fellow will participate in over 1000 of those cases. The fellow will be exposed to all types of cutaneous tumors – predominantly basal and squamous cell carcinoma as well as melanoma- but also rarer malignancies such as atypical fibroxanthoma, dermatofibrosarcoma protuberans, Merkel cell carcinoma, extramammary Paget’s disease, and others.

The fellow’s training also includes extensive training in frozen section histopathology including appropriate laboratory techniques, mapping and processing of tissue specimens, the use of various stains including H&E and toluidine blue, as well as the actual preparation of frozen sections to be microscopically examined during Mohs surgery. The fellow will begin training by learning to cut and stain Mohs slides with proficiency, so when they finish their training they can start and certify their own lab and teach their own laboratory technician. The fellowship training will qualify you to obtain a CLIA certificate for a high complexity laboratory. Our offices employ technicians who have been cutting Mohs sections for over 20 years. We use both Tol-blue and hematoxylin and eosin staining for Mohs. Typically, the fellow will interpret the frozen sections for each case and commit their interpretation on the Mohs map. This is followed by instruction by the attending at the microscope with the fellow reviewing the cases.

We have a strong relationship with the Departments of Plastic and Maxillofacial Surgery, Otolaryngology, Pathology, Radiation Oncology and Ophthalmology. There is an emphasis on using a multidisciplinary approach in the management of difficult cutaneous neoplasms, including appropriate staging and adjuvant care.

Our strengths include: a university as well as a private practice-based academic training program, four fellowship-trained Mohs surgeons from different backgrounds, a busy cutaneous oncology service, both a suburban and rural setting and a close working relationship with other world-class surgical specialists.

Interested applicants should apply on-line at www.sfmatch.org.

Applications are reviewed by a faculty-based committee.

• September 2022 Interview invitations will be sent
• Interviews October 21. 2022 – All interviews will be virtual
• July 1, 2023 Fellowship Begins

There is a reading schedule of books, chapters and papers to cover the core curriculum. This is largely self-directed but discussed as needed. Important articles to read and discuss are mailed out weekly by the program director.

• Robinson – Surgery Of The Skin
• Aasi – Atlas Of Practical Mohs Histopathology
• Morgan – Atlas Of Mohs And Frozen Section
• Baker – Local Flaps In Facial Reconstruction
• Rohrer – Flaps And Grafts In Dermatologic Surgery
• Goldman – Facial Flap Surgery

Attendance at the Annual Meetings of the American College of Mohs Surgery and the American Society of Dermatologic Surgery each year

There is a weekly dermatology grand rounds at UVA on Thursday mornings. There is a multidisciplinary tumor board on Tuesday mornings. There is a journal club monthly.

Fellows are encouraged to attend courses such as Hugh Greenway’s Superficial Anatomy and Cutaneous Surgery Course.

The fellow is expected to complete an in-depth research project by the time he or she finishes the fellowship and to prepare a manuscript suitable for submission to a peer-review journal. Additional research is encouraged. The fellow is expected to present a lecture to the dermatology residents at least once a year on a dermatologic surgery topic. The fellow is expected to submit an abstract for a national or state meeting prior to the completion of their training.

Regular interaction with patients under the guidance and supervision of faculty members who give value, context, and meaning to those interactions. Fellows assume graded and progressive responsibility in patient care, according to demonstrated knowledge, skills, and competencies. Weekly didactic sessions are used to supplement the reading curriculum. These didactic sessions will include lectures or discussions that provide a context for the reading curriculum and highlight important learning objectives.

Formal education to set up and operate a Mohs frozen section laboratory, as well as nearly daily interactions that provide education in the supervision and training of histotechnicians.

Regular opportunities to teach rotating residents and medical students and dermatologic surgery support staff.

An evaluation process helps the fellow to assess his or skills and to identify areas for improvement as early as possible. Supervising faculty routinely provide the fellow with informal feedback based on immediate observation of the fellow’s performance. Fellows also benefit from regularly scheduled, documented formal evaluations, which they can access for review.

faculty member’s training program and fellowship director (their training program)

Program Director
John Hendrix, MD (UVA-Ted Parlette, MD (Fred Mohs, MD (University of Wisconsin- Madison))

Core faculty
Jennifer Tromberg, MD (Arkansas Dermatology– Scott Dinehart, MD (Duke))
Mark Russell, MD (Vanderbilt – Thomas Stasko, MD (Tufts))
Darren Guffey, MD (UVA – Mark Russell, MD)

Current Fellow
Jack Lee, MD (UVA – John Hendrix, MD)

Program Administrator
Brenda Harris blh6n@virginia.edu (link is external).

An overview of salary, benefits and employment eligibility is available under https://med.virginia.edu/gme/program-resources/salary-benefits/

Qualified applicants will have completed a dermatology residency program which meets ACGME requirements by the specified start date. Board eligibility in dermatology is required at the beginning of the fellowship.  ACGME Program Requirements

For additional information, please email the program coordinator Brenda Harris at blh6n@virginia.edu

1. In general, high priority should be given to completing 12 continuous months of full-time training.

2. Any departure from (1), for example time lost for a medical leave of absence, should be documented and fully justified in the trainee evaluation forms filed by the fellowship program director with the Board.

3. It is necessary that 11 months of training are completed in order to qualify for subspecialty certification. Thus, without exception, any absence (inclusive of vacation) resulting in less than 11 months of training during a 12-month program will require an additional period of training to achieve 11 total months.

In 2003, a one-year PGY-5 level fellowship program in Procedural Dermatology achieved accreditation status by the ACGME. Procedural Dermatology builds upon the dermatologic surgery learned in an ACGME-accredited dermatology residency training program (PGY-2 to PGY-4) and provides surgical training beyond the scope expected in residency. In 2014, the ACGME changed the fellowship name to Micrographic Surgery and Dermatologic Oncology (MSDO). At the present time, a certification examination process in Micrographic Surgery and Dermatologic Oncology is being developed.

Micrographic surgery and dermatologic oncology is the subspecialty of dermatology concerned with the study, diagnosis, and surgical treatment of malignancies of the skin and adjacent mucous membranes, cutaneous appendages, hair, nails, and subcutaneous tissue. A particular emphasis is the surgical and medical management of patients with high risk cutaneous malignancies. Micrographic surgery and dermatologic oncology is broadly categorized into the following areas:

Cutaneous oncologic surgery, which incorporates medical, surgical, and dermatopathological knowledge of cutaneous malignancies. An essential technique is Mohs micrographic surgical excision, which is used for certain cancers of the skin and incorporates education in clinical dermatology and dermatopathology as they apply to dermatologic surgery.

Cutaneous reconstructive surgery, which includes the repair of skin and subcutaneous defects that result from the surgical removal of tumors or other skin disease, scar revision, and restoration of the skin following skin surgery to its best possible appearance. This is based upon knowledge of cutaneous anatomy, wound healing, cutaneous repair techniques, and aesthetic procedures that maintain the cosmetic appearance and function of the skin following surgery.

Dermatologic oncology, which incorporates knowledge of the clinical and pathologic diagnosis, staging, and treatment options for patients with cutaneous malignancies. This includes knowledge of cutaneous cancer syndromes and optimal surgical and non-surgical management of cutaneous malignancies.

For additional information, please email the Program Coordinator at blh6n@virginia.edu