Advanced Certificate of Skin Cancer Medicine

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The course is delivered fully online with the option to attend a six-hour practical workshop. The modules are set up in such a way that you are not required to be online at specific times but can view and replay video lectures at your convenience. The suggested timeline is weekly learning over 15 weeks, with 12 weeks of teaching followed by the submission of required activities.  There are no face-to-face requirements for exams which can be conveniently completed online.

Course Outline

Module 1 – Suturing and perfecting the ellipse

Unit one looks at the most common type of excision (elliptical excision). The detailed marking out process consists of dotting and assessing the edge of lesion, determining solid line surgical margin and designing the ellipse. The unit is illustrated by mathematical diagrams and clinical images of performing the ellipse on various parts of the anatomy. Recordings of key suture techniques and procedures support the learning on both pigskin and in the clinical setting.

Unit two continues with the ellipse procedure. It describes how best to cut the ellipse and how to hold the scalpel. Diagrams and images demonstrate the best practice approach to cutting the ellipse. Videos of blade handle tilt and cutting ends of the ellipse are illustrated in this unit. Attention is also paid to atraumatic technique and undermining supported by clinical recordings.

In unit three, different types of sutures are listed describing pros and cons of each suture type. These include dermal, the slider, dermal pulley, butterfly dermal, simple interrupted, mattress and continuous sutures. Knotting techniques for sutures is described in detail. Multiple clinical images, recordings and diagrams assist with understanding these techniques. The unit concludes with suturing in elderly patients with thinner skin.

Module 2 – Local Anaesthesia

The module lists the pharmacology and guidelines of the two main classes of local anaesthetic - amides (lignocaine, bupivacaine, prilocaine) and esters (procaine, benzocaine, cocaine). Two routes of administration of local anaesthesia are described - local field infiltration and/or nerve block. The process of infiltration is listed, including bevel and needle orientation. Recordings of preparation and injecting the site support the learning. Practical tips for the patient are outlined to minimise wound damage due to site numbness.

The second part of this module focusses on injecting the ear and lip, paying attention to sensory nerve blocks including the trigeminal nerve, infra-orbital nerve, mental nerve and temporal nerves. Diagrams, images and clinical recordings of nerve blocks are provided. ‘Tiger country’ complexities are described and supported by diagrams and images. Areas of extreme complexity like Erb's point, facial nerve (temporal branch and marginal branch), and the common peroneal nerve are listed. Signs and symptoms of nerve injury are included and practice tasks are provided.

Module 3 – Biopsy, haemostasis and halo grafting

Unit one defines monopolar and bipolar modes of cautery, including pros and cons of each mode. Electrical and fire risks of cautery are mentioned. The unit concludes with haemostasis options for punch and shave biopsy. Procedures and sizes of punch biopsies are given in addition to the use of marini sutures for biopsy closure if required.

The second unit looks at shave biopsies and shave excisions. Attention is paid to using shave excisions for excising melanoma. The technique, advantages and limitations of halo grafting are explained, including three skin graft phases - plasmatic imbibition, Inosculation and neovascularization. Clinical diagrams, mathematical equations and recordings are provided. The final section of this unit outlines suitable dressings and dressing changes. Recordings of procedures on pigskin and in the clinical setting are provided.

Module 4 – Curettage and cautery

This module commences with a comparison of thermal injury with liquid nitrogen to mechanical and thermal injury with electrical desiccation. A table of (pre-)malignant conditions, the freeze time, freeze-thaw cycle and halo diameter are included. The process of cryotherapy (cryosurgery) and where it is appropriate to use cryosurgery including which lesions and locations is explained. The use of a cryogun is described, illustrated by several videos.

The second part of this module focusses on when to use curettage and cautery and locations for curettage, dividing these into three zones of recurrence - high, middle and low risk. The process of curettage and cautery is listed and supported by videos and images. Tips for diagnosis of small basal cell carcinomas and sBCC including a patient case of a small BCC on the nose finalize this module.

Module 5 – Ellipse planning

The first unit looks at the three priorities in skin cancer surgery: cut the cancer out, close the resulting defect including the limitations of the ellipse, and minimising scar lines. The unit reviews designing the ellipse and applying the ellipse around different anatomical locations with consideration to skin tension lines. Different techniques are demonstrated to determine the best direction to design an ellipse. Diagrams are included of tension lines on face, limbs and chest. Images and videos illustrate the learning in this unit.

The second unit focusses on ellipse planning on various areas of the face and hands. Curving ellipses may be used when following skin tension lines. Clinical recordings and images are provided. ‘Tiger country’ is reinforced at the conclusion of this module.

Module 6 – Chaos and clues

This module focusses on the Chaos and Clues algorithm looking at pattern recognition and analysis. A chaos and clues flowchart for this decision algorithm for cutaneous malignancy and revised pattern analysis is included. Many dermoscopic images are used to demonstrate the application of this algorithm. The definitions of the different patterns are listed, with a focus to understanding colours in dermatoscopy as well as clues to a specific diagnosis or malignancy.

Pattern + Colours + Clues = Diagnosis. The use of this equation is demonstrated throughout the presentation. The identification of chaos in lesions is outlined. Histopathology images are also included for consideration.

Module 7 – The big three: BCC, SCC and melanoma

Unit one commences with outlining the clinical and dermoscopic features of BCCs, biopsy options, pathology and treatment approaches. The module then moves to solar keratosis and examines the use of topical non-surgical treatments.

Unit two continues with field-directed treatment methods including photodynamic therapy, and lists the pros and cons of available treatments. Two patient cases are included.

Unit three covers SCC lesions and outlines the clinical and dermoscopic features, biopsy options, pathology and treatment approaches. Clinical cases including images are provided for various SCCs.

Unit four focusses on melanomas and sentinel lymph nodes and again outlines the clinical and dermoscopic features, biopsy options, pathology and treatment approaches. Clinical cases are provided for various melanomas.

Module 8 – Case management

This module builds on the course learning and relates this information to clinical case studies. It includes planning surgical procedures, suturing techniques (simple interrupted, dermal, mattress, mirini, pulley and continuous), and suturing on "paper-thin" skin. Curettage and cautery, elliptical excisions, biopsies, lower leg grafts are also applied to these cases. Determining when to refer to others is included. Presented as three units, clinical case management of various cancers on different anatomical areas are featured throughout this module.

COURSE INCLUSIONS

For your one-off investment, you will receive unlimited access to all course content, additional learning materials, ongoing post-course support and more.

• Online pre-course activity to be completed in your own time.
• Eight online video modules to be viewed, replayed and completed at your convenience.
• All presentation slides and further learning materials available for permanent access and download.
• Instruments and consumables for practical sessions in the optional practical workshop.
• Post-course online assessment to be completed in your own time within six months of the course start date.
• Ongoing post-course support in monthly webinars with the opportunity to discuss cases with course presenters.
• Access to the HealthCert Community with additional free learning opportunities, special offers and other benefits.

If you choose to attend the optional practical workshop and there is cause for postponement or you cannot travel due to Covid-19 restrictions, full workshop refund, transfer or alternative learning opportunities will be available for you. View full refunds and cancellation policy here.

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