The Triangle Physician September- October 2018

September/october

2018

The Triangle Physician T H E

M A G A Z I N E

F O R

H E A L T H

C A R E

P R O F E S S I O N A L S

Prostate Cancer Treatment Experts Offering HIFU – A Cutting-Edge, Non-Invasive Treatment with Low Risk of Side Effects

Also in This Issue New Birth Control Options for Women (and Men)

Effective Use of Social Media to Promote Your Practice

Finding a Mohs Surgeon

Table of Contents s epte m b e r / o ct o b e r 2 0 1 8

2

Vol. 9, Issue 4

Prostate Cancer Treatment Experts

Offering HIFU – A Cutting-Edge, Non-Invasive Treatment with Low Risk of Side Effects

FEATURES

6 8 11

Women’s Health

New Birth Control Options for Women (and Men)

Physician Advocacy

DEPARTMENTS

Effective Use of Social Media to Promote Your Practice

9 News Newest Data Shows Childhood Obesity Continues to Increase

Dermatology

12 News

Finding a Mohs Surgeon

Welcome to the Area

On the Cover: (From left to right) Dr. William Kizer, Dr. Frank Tortora and Dr. Mark Jalkut (Not pictured: Dr. Daniel Khera-McRackan) offer a new non-invasive prostate cancer treatment called HIFU with the Sonablate device.

The Triangle Physician T H E

M A G A Z I N E

F O R

H E A L T H

C A R E

P R O F E S S I O N A L S

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Contributing Editors Andrea S. Lukes, MD, MHSc, FACOG Margie Satinsky, M.B.A. Gregory J. Wilmoth, M.D.

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Every precaution is taken to ensure the accuracy of the articles published. The Triangle Physician cannot be held responsible for the opinions expressed or facts supplied by its authors. The Triangle Physician makes no warrant to the accuracy or reliability of this information. All advertiser and manufacturer supplied photography will receive no compensation for the use of submitted photography. Any copyrights are waived by the advertiser. No part of this publication can be reproduced or transmitted in any form or by any means without the written permission from The Triangle Physician.

September/october 2018

1

Cover Story

Prostate Cancer Treatment Experts

Offering HIFU – A Cutting-Edge, Non-Invasive Treatment with Low Risk of Side Effects

MD; and Willian Kizer, MD. While HIFU was approved for prostate tissue ablation in the US in October 2015, many of these physicians have been working with HIFU patients outside the US for more than 10 years.

“While still considered ‘new’ by

While prostate cancer is a fairly common

What is HIFU for Prostate Cancer?

some urologists, I have been working

disease among men in the US, with about

HIFU in a one-time, out-patient procedure

with HIFU patients since 2008 and have

1 in 9 men being diagnosed in his lifetime,

that uses ultrasound energy to heat and

been very impressed by the outcomes

it is also one that usually is very treatable,

destroy tissue in the prostate. It is radia-

and experiences of my patients,” said Dr.

especially if diagnosed early.

tion-free, and studies show that the risk of

Tortora. “As I see it, there are two major

Expert physicians at Associated

side effects such as erectile dysfunction

advantages to the HIFU treatment for

Urologists of North Carolina have part-

and urinary incontinence are significantly

prostate cancer. First, there is minimal

nered with HIFU Prostate Services to

lower with HIFU than with surgery (radi-

change to a person’s lifestyle. For exam-

offer their prostate cancer patients a cut-

cal prostatectomy) or radiation.

ple, there is very little erectile dysfunction

ting-edge, non-invasive prostate cancer

The urologists offering HIFU in the

and no urinary incontinence. Secondly, it

treatment called HIFU, or high intensity

Triangle area include Frank Tortora, MD;

leaves all options on the table if recur-

focused ultrasound.

Dan Khera-McRackan, MD; Mark Jalkut,

rence should occur.”

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The Triangle Physician

How Does HIFU Work?

HIFU is delivered using a medical device called the Sonablate, which is made up of a computer console, a transrectal probe and chilling unit. The probe contains transducers that emit ultrasound energy, providing an image of the prostate, but can also be focused to a central point where the temperature is raised rapidly which causes cell destruction.

This works the same way as sunlight that is focused to burn a hole in a leaf.

During HIFU, the Sonablate software allows doctors to get a real-time image of the prostate and plan exactly where they want to deliver HIFU energy, thus destroying the targeted tissue. The doctor also receives immediate feedback to confirm the targeted

ing of the efficacy of treatment. Because there

prostatic tissue has been eliminated.

is less collateral damage to the tissue around

“HIFU is a non-invasive treatment that

the prostate, HIFU with Sonablate gives us

destroys cancer cells in the prostate with

the ability to cure prostate cancer in men

thermal energy. It is an ideal treatment for

with lower rates of impotence and without

men with prostate cancer detected early and

any significant risk of incontinence. Further-

likely to be confined to the prostate, said Dr.

more, it preserves future treatment options

Jalkut. “The Sonablate technology allows us

should they become necessary.”

Dr. Frank Tortora uses the Sonablate software to image, target and treat prostate cancer as well as to monitor changes in the prostate tissue in real time.

to fine-tune each man’s procedure such that the treatment plan can be customized and

Fewer Side Effects

personalized for each man considering the

The Sonablate has special features that allow

size and shape of his prostate along with the

physicians to visualize the exact location of

extent of his cancer and the level of risk each

the nerves near the prostate that are respon-

cancer carries. It allows for real-time monitor-

sible for helping maintain sexual function.

Transducers in the probe of the Sonablate deliver ultrasound energy to the prostate while leaving healthy tissue around the prostate unharmed.

september/october 2018

3

Since doctors have the ability to see these nerve bundles, they can avoid them and therefore, men have lower risk of erectile dysfunction.

Additionally, studies have shown that men who have HIFU for prostate cancer are less likely to have issues with urinary incontinence, or the ability to control their bladders.

“HIFU is extremely well tolerated and compared to other treatments and has very minimal side effects. For a patient to qualify, the cancer would have to be a low- or moderate-risk tumor that is completely localized to the prostate, said Dr. Khera-McRackan. “Often we can treat only the part of the prostate that is cancerous and spare the rest; this is called focal HIFU. In that case, there are even fewer side effects.”

Recovery After HIFU HIFU is an outpatient procedure which typically last one to three hours depending on the size of the prostate. After a brief recovery at the treatment center, patients return home to recover more comfortably and often return to their normal lifestyle after a few days.

“Patients return home the same day of the procedure

The Sonablate HIFU System includes a console, monitor, transrectal probe and chilling unit.

and are able to go out to eat for dinner that evening. HIFU really isn’t a huge disruption to their normal life,” said Dr. Kizer.

“There really is minimal change to a patient’s lifestyle with HIFU. This is drastically different than other more traditional options for prostate cancer, such as a radical prostatectomy which will require recovery overnight in a hospital and a few weeks before patients can return to their normal lifestyle.”

Additionally, unlike with radiation and surgery, if for some reason there is a recurrence of prostate cancer, HIFU does not exclude patients from having any other treatments. This also means that, while not common, HIFU may be repeated if necessary. If a man chooses to have HIFU, he is not limiting himself down the road to pursue other treatment options.

Who Qualifies for HIFU? While only a physician can determine if a patient qualifies for HIFU or not, typically men with

4

The Triangle Physician

a prostate gland of less than 40 grams with localized prostate cancer (tumor has not spread outside of the prostate gland) may be candidates for HIFU. The other information that physicians usually look at to determine if a patient qualifies for HIFU is a PSA of 20 or less and a Gleason score of 7 or less.

“We offer patients all types of treatments – from surgery and radiation to HIFU – Not all prostate cancer is lethal, but not all prostate cancer is slow growing either. The treatment is extremely individual depending on the person and the type and extent of disease he has,” said Dr. Tortora.

Anyone interested in HIFU for localized prostate cancer should speak with a doctor about his specific diagnosis and whether or not it would be a good treatment option in his case.

and treat only the tumor.

Effectiveness of HIFU

the United Kingdom on 625 men with pros-

Studies show that HIFU has rates of efficacy similar to other treatments for prostate cancer but with less risk for side effects such as incontinence and erectile dysfunction.

“HIFU is a great option in specific circumstances; it has a lower risk of side effects and, for the right patients, can be just as effective as those ‘gold standard’ treatments,” said Dr. McRackan.

Focal HIFU Focal therapy, often referred to as a “male lumpectomy,” is a general term for a variety of non-invasive techniques for destroying small tumors inside the prostate while leaving the gland intact and sparing most of its normal tissue.

Advanced imaging techniques allow doctors to pinpoint exactly where in the prostate the tumor is located. By utilizing multiparametric MRI and UroNav fusion biopsies, doctors are able to target the tumor within the prostate, leaving healthy tissue unharmed.

Focal therapy with Sonablate HIFU technology creates a small, precise lesion. This

A paper was published from a study in

Dr. William Kizer and Dr. Mark Jalkut review a Sonablate HIFU prostate cancer treatment on the monitor.

tate cancer treated with Focal HIFU in the prestigious journal European Urology*, reporting outstanding five-year results in terms of disease control and side effect profile.

The study shows that after 1-2 years, 97% of men were continent, and after 2-3 years 98% of men had no issues with incontinence.

The study also indicated that erections sufficient for penetration were maintained in 85% of men who were able to achieve an erection sufficient for penetration prior to focal HIFU. Overall survival rate after focal HIFU was reported at 99%.

Where is HIFU Available?

HIFU is currently available at several different locations in the greater Raleigh-Durham area including Rex Surgery Center, WakeMed Cary Hospital and North Carolina Specialty Hospital.

Anyone interested in learning more about HIFU or speaking with a physician should contact HIFU Prostate Services at 1-877-884-HIFU (4438.)

targets the tumor within the prostate, leaving

*A Multicentre Study of five-year Outcomes Follow-

the surrounding tissue unharmed. Experi-

ing Focal Therapy in Treating Clinically Significant

enced physicians use software to merge MRI

Non-Metastatic Prostate Cancer. European Urology.

and real-time images of the prostate to locate

June 27, 2018.

september/october 2018

5

Women’s Health

New Birth Control Options for Women (and MEN!)

By Andrea S. Lukes, MD, MHSc, FACOG

Andrea S. Lukes, MD, MHSc, FACOG, founded the Women’s Wellness Clinic (private practice) and the Carolina Women’s Research and Wellness Clinic (research center) which are both located in Durham, NC. Dr. Lukes received a combined medical degree and master’s degree in statistics from Duke University and completed her residency at the University of North Carolina School of Medicine. Her areas of expertise is in women’s health, including heavy menstrual bleeding, uterine fibroids, endometriosis, contraception, menopause and migraines. Most recently, Dr. Lukes was hired as the Chief Medical Officer of Health Decisions CRO which is specialized within women’s health.

The Women’s Wellness Clinic is accepting new patients, 919-251-9223, www.cwrwc.com

6

The Triangle Physician

Contraception allows individuals control over

able donut-shaped ring. The ring is is non-biode-

the timing of pregnancy and can prevent unin-

gradable and flexible. A woman places it within

tended pregnancies. Health care providers play

the vagina for 3 weeks then removes it for one

an important role in educating and counseling

week to allow for withdrawal bleeding, so this

women and their partners on available choices of

is the older version in terms of regimen (21/7).

contraception. Many factors can influence which

This ring, however, lasts for one year, providing

contraceptive is used: effectiveness, side effects,

thirteen 28-day menstrual cycles. The device does

prevention of sexually transmitted infections, ac-

not require refrigeration prior to using (the NU-

cess, convenience and in some cases noncontra-

VARING does require refrigeration). This newer

ceptive benefits.

ring, ANNOVERATM, will be available within the

Although versions of the male condom have

US in 2019.

been around for centuries, the birth control pill

The hormones within ANNOVERATM include

was introduced into the US in 1960. Since that

a ‘new’ progestin called Nestorone® (segester-

time, the type of hormone used has changed with

one acetate) and a widely used estrogen (ethinyl

more varieties of progestin than estrogen. Also,

estradiol). Similar to the pill, patch, and shorter

the regimen or days of active hormones versus

acting vaginal ring, the mechanism of action for

placebo pills has changed. Initially there were

ANNOVERATM is by preventing ovulation (or the

only 21/7 regimens (21 active pills and 7 placebo

release of an egg by the ovary). Similar to other

pills). Now there are several options which allow

combined hormone contraception (CHC) it has

for no placebo pills or continuous active pills, ver-

a black box warning stating that females over 35

sus 24/4, 26/2 and more.

years old who smoke should not use ANNOVER-

One convenient method that was recently ap-

ATM. Cigarette smoking increases the risk of seri-

proved by the U.S. FDA is ANNOVERATM . This

ous cardiovascular events from CHC use. Further,

is a new vaginal ring that provides one year of

it has not been adequately evaluated in females

contraception. ANNOVERATM is a combined

with a body mass index of 30 kg/m2 or greater.

hormonal contraceptive (has both an estrogen

The research which led up to the approval

and a progestin) that is delivered through a reus-

of ANNOVERATM was through the Contracep-

lead, but also the fundamental work of

Another development within contra-

The CCTN was established in 1996 and

organizing large scale phase three clini-

ception is a new ‘birth control APP’ called

supports research on both male and fe-

cal trials”.

Natural Cycles which was approved by

male contraception. The CCTN is man-

Health Decisions has also coordinat-

the FDA just recently in August 2018. It

aged through the National Institute of

ed large-scale phase three studies within

prevents pregnancy through tracking a

Child Health and Human Development

male contraception as well. Currently

woman’s body temperature and her men-

(NICHD) Division of Intramural Popula-

there are no hormonal contraceptive op-

strual cycle. The reliability of this APP in

tion Health Research. The statistical and

tions for men (remember the condom is

preventing pregnancy is not as good as

clinical coordinating center the the CCTN

not hormonal). As highlighted in Time

ANNOVERATM or other hormonal op-

is through Health Decisions. Health De-

Magazine (June 18th, 2018) the CCTN

tions, but it is a method that can prevent

cisions has worked with the CCTN since

began a study using a gel contraceptive

pregnancy and allow for family planning.

its inception in 1996. Health Decisions is

for men. Over 400 couples in six differ-

The new development within contra-

a clinical research organization which fo-

ent countries will enroll 400 couples.

ception for individuals is exciting. Health

cused on women’s health (www.health-

According to Clint Dart, enrollment will

care providers who counsel women and

decisions.com). I joined Health Deci-

likely begin in October, 2018, and take

men on contraception will have even

sions as the chief medical officer in 2018

approximately 12 months to complete

more options in the next several years.

and have been fortunate to learn more

enrollment. The gel which will be used

Our role at the Women’s Wellness Clinic

about the work done by the CCTN.

by men actually uses the same progestin

is to make sure we provide the most up-

The principal investigator at Health

Nestorone® that is contained within AN-

to-date information to the women we see.

Decisions for the CCTN research is Clint

NOVERATM but also a synthetic testoster-

Dr. Kristen Feldman who joined the staff at

Dart, who leads the statistical analysis. Mr

one. The mechanism of action in men is

the Women’s Wellness Clinic is an expert

Dart is the Senior Director of Biostatistics

through blocking the testes from making

within contraception and notes that she

and Programming at Health Decisions.

enough testosterone to produce sperm.

likes “offering all options to patients and

His expertise has helped with on-going

Given this produces side effects, some

then helping an individual make best deci-

research in contraception for both wom-

testosterone is added back through the

sion based on her own health and needs

en and men.

gel to minimize the side effects.

regarding contraception”.

As noted by Clint Dart, the phase 3 pivotal clinical studies which led up to the approval for ANNOVERATM included

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2,265 females enrolled in multicenter trials. Most of the females (67.1%) were from the United States with the remaining being from the Dominican Republic, Brazil, Chile, Finland, Hungary, Sweden, and Australia. The mean age was 26.7% years and the mean BMI was 24.1 kg/m2 (range 16.0 – 41.5). The Pearl Index (PI) was 2.98 per 100 woman-years of ANNOVERA use (95% Confidence Interval 2.13, 4.06). Led

by Clint Dart, statisticians at Health Decisions did the analysis of this data which led to approval by the FDA. Mr. Dart explains that “there were three open labeled studies which led up to the approval for ANNOVERATM . The

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tors within the CCTN are mostly academic institutions with the US. The staff at HD is focused on women’s health but supports the network in a number of ways, including the statistical analysis which I

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Category Physician Advocacy

Effective Use of Social Media to Promote Your Practice, Part 2

By Margie Satinsky, M.B.A.

This article is the second of a two-part series on the effective use of social media to promote your practice. The first article, which appeared in the 2018 May/June edition of Triangle Physician, contained an introduction and two recommendations. This article contains two more important suggestions.

the physician and asks a specific question about his/her personal condition. The provider responds, disclosing PHI that should not be shared or viewed by anyone other than the patient.

Here’s another situation that occurs frequently and that may be a HIPAA violation. Patients often like the convenience of websites such as www.

Margie Satinsky, MBA, is President of Satinsky Consulting, LLC, a Durham, NC consulting firm, that specializes in medical practice management. She’s the author of numerous books and articles, including Medical Practice Management in the 21st Century. For additional information, go to www. satinskyconsulting. com. Nancy MacCreery, MBA, is President of Broad Reach Marketing Services, a Cary, NC company, that specializes in market strategy, digital campaigns, market research and customer engagement.

For additional information, go to www.broadreachmarketingservices.com.

Alice Saunders, President of Trisecta, is a marketing consultant and writer.

For additional information, go www.trisecta.com.

8

The Triangle Physician

Use Social Media Safely to Avoid

caringbridge.com or www.carepages.com to

Inappropriate Disclosures of Protected

communicate with family and friends when they

Health Information (PHI)

are ill or in the hospital. People sign up to be

The theory behind social media is that partici-

part of a group that receives blog posts on the

pants voluntarily consent to contribute social

patient’s condition. All too often, health care pro-

and personal data to a social media electronic

viders comment on the condition and treatment,

storage system. Depending on the type of social

mistakenly assuming that the blog post is equiva-

media, there may be ways to restrict access to

lent to patient authorization to reveal PHI.

some of that information so not all users can see

Still another common situation arises when

it. Medical practices that use social media are not

someone posts a negative comment about a

exempt from HIPAA. As Covered Entities, they

provider and/or practice. In many instances, the

are obligated to protect the use and disclosure of

individual physician or practice has a knee-jerk

protected health information (PHI) and to honor

reaction and counters the comment as quickly

the specific patient rights that are identified in the

as possible. Often the provider discloses PHI

Privacy Rule as amended by the HITECH Act of

without even thinking about the potential HIPAA

2009 and the 2013 Omnibus Final Rule.

violation.

Let’s examine some real-life situations that

Social media and HIPAA are related but not

we’ve seen with clients. A patient and provider

incompatible. Providers, not patients, are respon-

are Facebook friends. The patient reaches out to

sible for maintaining HIPAA compliance. The saf-

Select the Appropriate Option(s)

time to learn new skills, you may be better

through a secure patient portal. However,

for Maintaining Your Social Media

served by outsourcing the responsibility

if you expect to enter into social media

Presence

to a qualified professional.

“friendships,” require patients to sign a

Many practices make the mistake of del-

If you do decide to outsource the respon-

written authorization regarding online

egating the responsibility for developing

sibility, here are questions to ask of the indi-

disclosure before entering into the online

and maintaining social media to an enthu-

viduals/companies that you are considering:

relationship. Even with the patient’s writ-

siastic workforce member. When a solid

• What do you know about health care

ten authorization, review what you post,

strategy is in place and if that individual

making sure not to use or disclose PHI

understands the big picture – i.e. all that

• How well do you understand HIPAA?

without proper prior authorization. For

we’ve mentioned above – the decision to

• With what social media platforms do

additional guidance, read the Federation

select an internal person may be appro-

you have professional experience?

of State Medical Boards’ Model Policy

priate. But if the individual assuming the

Guidelines for the Appropriate Use of

responsibility for social media doesn’t

Media and Social Networking in Medical

understand the context into which social

• What reports will you send me?

Practice

media must be put and doesn’t have the

• How do you measure success?

(http://www.fsmb.org/Media/

Default/PDF/FSMB/Advocacy/pub-social-media-guidelines.pdf).

practices?

• What is your process for planning and content development?

Visit this link to learn more about getting more from your social media: http://www.broadreachmarketingservices.com/blog/seven-steps-to-get-more-our-of-your-social-media-efforts.

Newest Data Shows Childhood Obesity Continues to Increase Across all ages, African-American and Hispanic Children Have Highest Rates Despite reports in recent years suggest-

The long-term trend is clearly that obesity

amination Survey (NHANES) in 2015-16, a

ing childhood obesity could be reaching

in children of all ages is increasing.”

large database updated every two years.

a plateau in some groups, the big picture

The data are based on body-mass in-

on obesity rates for children ages 2 to 19

dex (BMI) for 3,340 children participating

remains unfavorable.

in the National Health and Nutritional Ex-

Researchers examined data back to 1999 that includes 33,543 children.

The researchers identified notable

Three decades of rising childhood obesity continued their upward trend in 2016 according to a new analysis from Duke Health researchers.

The findings, which appear Feb. 26 in the journal Pediatrics, show 35.1 percent of children in the U.S. were overweight in 2016, a 4.7-percent increase compared to 2014.

“About four years ago, there was evidence of a decline in obesity in preschoolers,” said Asheley Cockrell Skinner, Ph.D., lead author and associate professor of population health sciences, who is also a member of the Duke Clinical Research Institute (DCRI). “It appears any decline that may have been detected by looking at different snapshots in time or different data sets has reversed course.

september/october 2018

9

Duke Category News

est way to communicate with patients is

Duke News

spikes between 2014 and 2016 in obesity

overweight and Class II obesity (BMI that

in Asian-American children, the race or

for preschool boys, which rose from 8.5

is at least 120 percent above the 95th per-

ethnic group in whom rates were actually

percent to 14.2 percent, and girls aged 16

centile for age and sex) among Hispanic

lowest, at 23.2 percent.

to 19, whose rates of obesity jumped from

males.

35.6 percent to 47.9 percent.

Armstrong, who is also a pediatrician,

“Despite some previous reports, the

acknowledges the paper focuses on the

Boys and girls aged 16 to 19 had the

obesity epidemic has not abated,” said se-

problem of obesity rather than solutions,

highest rates of any age group in 2016,

nior author Sarah C. Armstrong, M.D., as-

and wanted to encourage families with di-

with 41.5 percent considered overweight,

sociate professor of pediatrics who is also

rect advice.

defined by the Centers for Disease Con-

a member of the DCRI. “This evidence is

“Although the latest trends show that

trol and Prevention (CDC) as having a BMI

important in keeping the spotlight shined

we haven’t figured out what works as a

at or above the 85th percentile for age and

on programs to support healthy changes.

population, we do know individual chang-

sex. Among these 16 to-19-year-olds, 4.5

Obesity is one of the most serious health

es can support families’ health,” Arm-

percent have Class III obesity, the highest

challenges facing children and is a predic-

strong said. “We know families can avoid

of three categories defined by the CDC.

tor for many other health problems. When

added sugar in beverages and food, get at

we see that leveling off, we can become

least an hour of activity a day, and incorpo-

complacent -- we can’t afford to do that.”

rate vegetables into every meal to improve

Both Class II and Class III are considered severe and are linked with greater risk of heart and metabolic health prob-

Skinner said the study has limitations,

WIRB 20141577

their health.

Even if your child is a picky #13314497.0

BAY15001 lems, such as high blood pressure and on 1 cholesterol.

5 Across all age groups, African-Amer-

relying on two-year data that provides tion. But she said the NHANES database

Through projects at Duke Health, DCRI

ican and Hispanic children had higher

is a broader data source than sources for

and the Duke Center for Childhood Obe-

rates of overweight and all levels of obe-

studies that have found declines in obe-

sity Research, Armstrong and other Duke

sity, while Asian-American children had

sity rates among smaller or segmented

scientists are assessing the most effective

markedly lower rates. The most promi-

populations. The NHANES 2015-16 data

strategies to reduce obesity in children,

nent trend since 1999 is the increase in all

is also the first to include enough data to

including programs that offer at-risk chil-

levels of overweight for Hispanic girls, and

create a nationally representative sample

dren access to free medical care, partner-

snapshots in time across a wide popula-

eater and wants to eat the same vegetable every day, that is still a good choice.”

ships with municipal recreation programs across North Carolina, and even studying

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The Triangle Physician

children’s gut bacteria to determine how the gut microbiome is related to weight.

In addition to Skinner and Armstrong, study authors include Sophie N. Ravanbakht and Eliana M. Perrin of Duke, and Joseph A. Skelton of Wake Forest University.

The study received no outside funding, and authors had no conflicts of interest to disclose.

The Triangle Physician T H E M A G A Z I N E F O R H E A LT H CARE P R O F E S S I O N A L S

By Gregory J. Wilmoth, M.D. of Southern Dermatology & Skin Cancer Center

Hearing the words “skin cancer” come from a

certified dermatologist who performs Mohs sur-

medical professional’s mouth can be a terrifying

gery on a regular basis. The more experience

experience. However, there is a procedure that

the dermatologist has, the better prepared they

removes the skin cancer and allows us to get the

will be in the event of any complications.

highest cure rate of skin cancer while removing the least amount of tissue– Mohs surgery.

Today, Mohs surgery has come to be known as the single most effective technique for remov-

Two organizations that provide training standards for Mohs surgery are the American Society for Mohs Surgery and American College of Mohs Surgery

ing both Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC), two of the most

Interview the Surgeon

common types of skin cancer.

Many health care providers have been trained do

When looking for a provider to perform

surgery in different settings. Some providers under-

Mohs surgery, it’s important to do your home-

went training during their residency, while others

work. Patients will want a highly qualified der-

spent extra time after their residency on the train-

matologist to perform the procedure and will

ing. There are currently no specific requirements.

want them to:

In residency, dermatologists are routinely

• Be a board-certified dermatologist,

exposed to a wide variety of dermatological sur-

• Specialize in Mohs surgery,

gical procedures. They’re also trained to look at

• Accept their insurance ,

the skin and understand simple to complex re-

• Fully answer all questions as they arise and

construction of surgical defects. While a pathol-

• Have reconstruction expertise to repair

ogist may be on the team, most Mohs surgeons

Mohs defects.

wear two hats during the procedure– surgeon and pathologist. In general, dermatologists will

Asking Around

have more training in both cutaneous pathology

As basal cell carcinoma and squamous cell car-

and surgery than other health care providers.

cinoma are both incredibly common, chances

As the patient narrows down their list of pos-

are the patient will know someone who has in-

sible dermatologists, they should call each of-

teracted with a dermatologist who specializes

fice to schedule a consultation and meet with

in Mohs surgery. The patient should ask their

the dermatologist who would be performing the

friends, family and other health care providers

procedure. During this consultation, patients

they trust for recommendations.

should have a list of questions ready, such as:

There are surgeons who perform Mohs surgery exclusively and provide same-day reconstruction.

• Do you typically treat patients with the same skin concerns/problems as me?

• How many Mohs surgeries do you perform a year? For how many years?

Research Credentials

• How frequently do you encounter compli-

Technically, any doctor who cuts into the skin

cations during this procedure?

and processes the tissue using the Mohs meth-

• How do you avoid complications?

od is performing Mohs surgery. While they may

• What do you do to fix any issues if a com-

be performing Mohs surgery, they may not be performing it well.

Dr. Gregory Wilmoth, a board-certified dermatologist at Southern Dermatology & Skin Cancer Center in Raleigh, specializes in Mohs surgery and skin cancer reconstruction, among other specialties.

He earned his bachelor of science degree in chemistry from the University of North Carolina at Chapel Hill and his medical degree from Bowman Gray School of Medicine, Wake Forest University. He completed his internship at North Carolina Baptist Hospital and residency at Mayo Clinic, Rochester, Minn. Dr. Wilmoth is a fellow of the American Society for Mohs Surgery. He is a member of the American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, American Academy of Dermatology, American Medical Association and the North Carolina Medical Society.

plication does arise?

While some dermatologists do complete a

Taking the time to research the doctor’s

fellowship training in Mohs surgeries, not all do,

credentials can go a long way to easing a wary

so it’s important to ask about any specialized

patient’s mind. Patients should look for a board-

training as well.

september/october 2018

11

Dermatology

Finding a Mohs Surgeon

News

Welcome to the Area

Physicians

Mahmoud Al Masry, MD

Mary McGowan Buckley, MD

Nicholas Christian DeVito, MD

Neurology

Pediatric Rheumatology; Pediatrics

Ophthalmology

UNC REX HOSPITAL Raleigh

Duke University Hospitals Durham

Hematology and Oncology, Internal Medicine

Guy Thomas Alexander, MD

Charles McGonegle Burns, MD

Diagnostic Radiology; Musculoskeletal Radiology; Neuroradiology; Nuclear Medicine; Nuclear Radiology; Pediatric Radiology; Therapeutic Radiology

Internal Medicine

Juliana Marie Dial, MD

Duke University Medical Center Durham

Pediatrics

Raleigh Radiology Raleigh

Cathleen Marie Dascenzo Bury, MD

Peter John Allen, MD

Duke University Hospital Durham

Jenna Marie Bottorff, DO Carolina Eye Associates, P.A. Southern Pines

George William Dignan, DO Anesthesiology

UNC - The Dept of Anesthesiology Chapel Hill

Richard Everett Gandee, DO Critical Care-Internal Medicine

UNC Dept of Neurology Neurocritical Care Chapel Hill

Adrienne Lynne Gentry, DO Obstetrics & Gynecologic - Surgery; Endocrinology/Infertility

UNC Fertility Center Raleigh

Anjni Patel Joiner, DO Emergency Medicine

Abdominal Surgery; Colon and Rectal Surgery; Surgical Oncology

Dept of Surgery Durham Head and Neck Surgery; Otorhinolaryngology; Rhinology

Marcus Allen Carden, MD

UNC Otolaryngology/Head & Neck Surgery Chapel Hill

Arthur David Kalman, DO

3106 Hosp South Durham

Sara Kathryn Keller, DO Hospitalist; Internal Medicine

Duke Hospital Medicine Durham

Sheila Krishnan, DO

Internal Medicine; Pediatrics

Abdulaziz Saleh Alrasheed, MD

Rami Nayef Al-Rohil, MD

EmergeOrtho Durham

Robert Andrew Campbell, MD UNC Hospitals Chapel Hill

Duke University Medical Center Durham Physical Medicine & Rehab Neuromuscular and Pain Medicine

Emergency Medicine

Dermatopathology; Pathology

Hematology, Internal Medicine; Pediatric Hematology-Oncology

UNC School of Medicine Pediatric Hematology Oncology Chapel Hill

Maria Gabriela Castro, MD Family Medicine

General Surgery

UNC Div of Surgical Oncology Chapel Hill

Sommer Ebdlahad, MD Neurology

Duke University Hospitals Durham

Emily Marie Eichenberger, MD Infectious Diseases, Internal Medicine

Duke University Hospital Durham

Rami Raouf Eltaraboulsi, MD Internal Medicine; Pediatrics

Center for Aging and Health University of North Carolina at Chapel Hill Chapel Hill

Aaron Kyle Cecil, MD

John Anthony Engler, MD

Sacha Chanelle Baldeosingh, MD

Ananda Mishra Chowdhury, MD

Pediatrics

Internal Medicine

Pediatric - Emergency Medicine

UNC Hospitals Chapel Hill Administrative Medicine; Critical CareInternal Medicine; General Practice; Hospitalist; Pulmonary Disease

Division of Pulmonary Disease Chapel Hill

Annika Marie Barnett, MD Anesthesiology

Duke University School of Medicine Durham

Andrew Joseph Kubinski, DO Family Medicine - Sports Medicine

Duke University Medical Center Durham

Alissa Michelle Collins, MD

Duke University Hospitals Durham

Mari Mansfield Bentley, MD

Duke University Hospitals Durham

Family Medicine

Otorhinolaryngology

Critical Care - Internal Medicine; Hospitalist

A Preferred Women’s Health Center Raleigh

Central Carolina Hospital Sanford

Jason Jamier Bethea, MD

Louis John Michaelos II, DO Ophthalmology

Duke University Hospitals Durham

UNC Kittner Eye Center Chapel Hill

Anatomic Pathology; Blood Banking, Pathology; Clinical Pathology; Cytopathology; Dermatopathology

Shaily Pandey Bhatnagar, MD Dermatology

UNC Hospitals Chapel Hill

Amber Moss, DO

UNC Dermatology Chapel Hill

Jeremy Andrew Cypen, MD

Raleigh

Stephanie Michelle Downs-Canner, MD

Thurston Arthritis Research Center

Joshua Ryan Arenth, MD

Duke University Hospitals Durham

Family Medicine

Duke University Hospitals Durham

UNC Chapel Hill Chapel Hill

Pulmonary Disease and Critical Care, Internal Medicine

Steven Paul Michael, DO

Duke University Hospitals Durham

Neurology

Ana Corcimaru, MD Dermatology

Chapel Hill

Jennifer Michelle Crimmins, MD

Hospitalist; Internal Medicine

Neurological Surgery, Critical Care

Rex Neurosurgery and Spine Associates Raleigh

Brendan James Flanagan, MD Emergency Medicine Duke University Hospitals Durham

Gitanjali Madan Fleischman, MD Allergy; Facial Plastic Surgery; Maxillofacial Surgery; Neurotology; Otolaryngic Allergy; Otolaryngology; Otolaryngology - Sleep Medicine

UNC Hospitals Chapel Hill

Derrick Alwyn Fox, MD Internal Medicine; Neurology; Neuromuscular Medicine

Duke University Medical Center Durham

Lewis Watson George II, MD Diagnostic Radiology; Musculoskeletal Radiology; Neuroradiology; Nuclear Medicine; Pediatric Radiology; Vascular and Interventional Radiology

Hospitalist; Internal Medicine; Public Health

Durham Veterans Affairs Medical Center Durham

UNC Hospitals Chapel Hill

Duke Children’s Hospital & Health Center Durham

Duke Raleigh Hospital Raleigh

Stephanie Duggins Davis, MD

Hospitalist; Internal Medicine; Other; Psychiatry; Psychosomatic Medicine

Timothy Michael Brand, MD

Janice Seulgy Ahn, MD

Cardiovascular Surgery; Critical Care Surgery; Surgery; Surgical Oncology; Thoracic Cardiovascular Surgery

UNC Dept of Pediatrics Chapel Hill

Duke University Hospitals Durham

Clerio Francisco De Azevedo Filho, MD

John Daniel Hales III, MD

Katherine Jane Ryan, DO Pediatric Hematology-Oncology

Clinical Neuropathology; Pathology

Duke University Medical Center Dept of Pathology Durham

12

The Triangle Physician

Satasuk Joy Bhosai, MD

UNC Hospitals Chapel Hill

Pediatric Pulmonology; Pediatrics

Duke Cardiovascular Magnetic Response Ctr. Durham

Elizabeth Bronwen Gilbert, MD

Family Medicine - Sports Medicine; Family Practice

UNC Hospitals Chapel Hill

News

Welcome to the Area Emily Hanna, MD

Jeffrey Hamilton Howe, MD

Andrew Paul Landstrom, MD

David Mendez, MD

General Preventive Medicine

Diagnostic Radiology; Radiology; Vascular and Interventional Radiology

Pediatric Cardiology; Pediatrics

Family Medicine

Duke University Medical Center Durham

DUC Harps Mill Raleigh

Suh Hyun Lee, MD

Julia Antoinette Messina, MD

Emergency Medicine

Infectious Diseases, Internal Medicine

Duke University Hospitals Durham

Duke University Infectious Diseases Durham

Craig Ray Louer Jr., MD

Andrew Tyler Miller, MD

Orthopedic Surgery: Hand, Spine, Adult Reconstructive, Musculoskeletal Oncology, Pediatric; Sports Medicine

Diagnostic Radiology; Radiology

Carrboro

Olga Hardin, MD Allergy & Immunology; Internal Medicine

UNC Hospitals Chapel Hill

Durham

Jingquan Jia, MD

Mandy Nichole Hatfield, MD

Hematology and Oncology, Internal Medicine;

Neurology

UNC Hospitals Chapel Hill

Duke University Hospitals Durham

Eric Allen JohnBull, MD

Gabrielle Monet Hawkins, MD

Anesthesiology

Gynecology/Oncology; Obstetrics

Duke University Hospitals Durham

UNC HealthCare Chapel Hill

Jasmine Danielle Johnson, MD

Justin Thomas Low, MD

Abdominal Surgery; Obstetrics & Gynecologic Surgery

Neurology

UNC Hospitals Chapel Hill

Ashley Reynolds Helseth, MD

UNC Dept of OB-GYN Chapel Hill

Neuro-Oncology Fellowship Program Durham

Duke University Hospitals Durham

Andrea Anita Jordan Hayes, MD

Dorothy Anne Lowell, MD

James Taylor Herbert, MD

UNC Hospitals Chapel Hill

Child/Adolescent Neurology; Clinical Neurology, Neurophysiology; Neuromuscular Medicine; Pediatrics Neurodevelopmental Disabilities

Anesthesiology; Anesthesiology Critical Care Medicine

Duke University Hospitals Durham

John Hall Herndon, MD Neurology

UNC Hospitals Chapel Hill

Sarah Mabrey Heston, MD Pediatrics

Duke Pediatric Infectious Diseases Durham

Cory Michael Hines, MD

Abdominal Surgery; General Surgery; Pediatric Surgery; Surgical Oncology

Swarupa Kancherla, MD Ophthalmology

Raleigh Eye Center Raleigh

Atul Kapila, MD

Radiology

Duke University Hospitals Durham

Stephanie Treffert Lumpkin, MD General Surgery; Surgery

UNC Hospitals Chapel Hill

Gaurav Luther, MD

Family Medicine - Sports Medicine

UNC Hospitals Chapel Hill

Jharna Rakesh Patel, MD Hospice and Palliative Medicine; Internal Medicine

Cardiovascular Surgery; General Surgery; Thoracic Surgery

Abdominal Surgery; Urological Surgery; Urology

Durham

Wake Physician Practices Urology Raleigh

University of North Carolina, Pulmonary Division Chapel Hill

Shetal Arvind Patel, MD

Pediatric Cardiology

John-Paul Adriel Ceir King, MD

WakeMed Physicians Practices Pediatric Cardiology Raleigh

Diagnostic Radiology

Duke University Hospitals Durham

2599 Evans Rd Morrisville

Sneha Arun Mantri, MD

Anne Elizabeth West Honart, MD

Kevin Zachary Kinlaw, MD Hospitalist; Internal Medicine

Duke Health Movement Disorders Durham

Maternal and Fetal Medicine; Obstetrics and Gynecology

UNC Hospitals Chapel Hill

Anne Louise Marano, MD

1421 Barony Lake Way Raleigh

Neurology

Dermatology; Internal Medicine

Internal Medicine; Pulmonary Disease and Critical Care

Oncology, Internal Medicine

UNC School of Medicine, Division of Hematology and Oncology Chapel Hill

Michelle Vernali Pearlstein, MD Dermatology

UNC Hospitals Chapel Hill

Deborah Anne Phipps, MD Family Medicine; Obstetrics and Gynecology

Emergency Medicine

Duke University Hospitals Durham

Aycock Family Medicine Center Chapel Hill

Amanda M Korzep, MD Pinehurst

Stacey Ann Maskarinec, MD

Megan Elizabeth Pike, MD

Amanda May Korzep, MD

UNC Dermatology Chapel Hill

Mukesh Kumar, MD

Mohammed Merajul Hoque, MD

Cone Health Burlington

Diagnostic Radiology; Vascular and Interventional Radiology

Joseph Anto Kundukulam, MD

Duke University Hospitals Durham

Marcia Nicole NewbyGoodman, MD

Kunal Parimal Patel, MD

Molecular Genetic Pathology; Pathology, Immunopathology; Pathology-Medical Examiner

Anesthesiology Pain Management

UNC School of Medicine Chapel Hill

Matthew Delfino Lyons, MD

Shuhua Ma, MD

Christian Horazeck, MD

Nuclear Medicine

Jeffrey Edward Keenan, MD

Duke University Hospitals Durham

UNC Health Care Chapel Hill

Mitchel Alan Muhleman, MD

WakeOrtho Raleigh

Pediatrics

Dermatology

Duke Maternal Fetal Medicine Durham

Duke University Hospitals Durham

Stephen William Kenny, MD

William David Hoover III, MD

Maternal and Fetal Medicine; Obstetrics and Gynecology

Internal Medicine; Rheumatology

UNC Hospitals Chapel Hill

UNC Dept of Maternal-Fetal Medicine Chapel Hill

Courtney Jetun Mitchell, MD

Orthopedic - Surgery of the Hand; Orthopedic Surgery, Trauma

Emergency Medicine

Jason Griffith Ho, MD

Duke University Hospitals Durham

Hematology and Oncology, Internal Medicine

Anesthesiology - Pain Medicine; Anesthesiology Pain Management

Wake Spine and Pain Cary

Infectious Diseases, Internal Medicine

Hospitalist; Pediatrics

Duke University Hospitals Durham

Duke University Hospitals Durham

Jennifer Lynn McCauley, MD

Aaron Mark Pulsipher, MD

Internal Medicine; Pediatrics

Jennifer L McCauley, MD Chapel Hill

Austin Lee Roach McJunkins, MD Aerospace Medicine; General Medicine; Occupational Medicine

Seymour Johnson Flight Medicine Seymour Johnson Afb

Hospitalist; Internal Medicine; Pulmonary Disease and Critical Care

Duke University Hospital Durham

Milly Turakhia Rambhia, MD Anesthesiology

Duke University Dept of Anesthesiology Durham september/october 2018

13