ACCO Certification in Skin Cancer Surgery

The ACCO Certificate in Skin Cancer Surgery certifies that a medical practitioner can manage most skin cancers that present to his / her practice. The examination is available to those having completed the flaps and grafts workshop.

The ACCO Sur gery Certificatelevel has been designed with the vast rural areas of Australia in mind. In rural and remote Australia patients frequently expect their doctor to manage their problems locally. A holder of  will be able to manage most of their patient's skin cancers in their own town. In towns that have a hospital, the ACCO Surgical Certificate indicates the doctor has the knowledge to safely effect skin cancer surgery in the hospital's facilities.

For urban and regional doctors the ACCO Surgical Certificate indicates the knowledge and surgical skills to manage most skin cancers that present to the clinic.

Surgical Certificate holders are not expected to manage all skin cancers. More difficult malignancies will frequently be referred to more senior colleagues.

Knoweldge and skills required at Surgical Certificate level?

All knowledge requirements of the Certficate level are required, but at a more sound and substantial level.

Knowledge and skills of full thickness and partial thickness skin grafts is now required including halo grafts.

Skin flap knowledge and skills are required. The ACCO has identified 10 core flaps to be understood at Diploma level. These are as follows:

  1. Single advancement
  2. Twin advancement
  3. A - T
  4. Rhomboid
  5. Rotation
  6. O - Z / S
  7. Simple transposition
  8. Bilobed
  9. V - Y island advancement
  10. ROM

These flaps have been chosen as statistically they will allow a doctor to close 95% of defects that he / she might be faced with in clinical skin cancer practice. Most defects will however be closed directly.

ACCO Surgical Certificate holders are also required to have a sound knowledge of facial anatomy including the facial nerve, trigeminal nerve, arteries on the face and facial landmarks.

Basic dermatopathology skills are also required at Surgical Certificate level . The exam includes histology photomicrographs of common cutaneous malignancies. Understanding these histology features is explained in the flaps and grafts workshop.

Candidates are expected to know a little of some rarer skin cancers such as atypical fibroxanthoma, merkel cell tumour and sebaceous carcinoma. However knowledge of management of these tumours is not required at Diploma level.

Diplomats are expected to have a sound knowledge of photodynamic therapy, usage of topical imiquimod and 5 fluoro uracil and diclofenac. A range of skills with the dermal curette are also required at Surgucal Certificate level.


The examination for ACCO Certificate in Skin Cancer Surgery involves demonstrating surgical skills during the flap and graft workshop as well as passing the ACCO on-line examination.

The on-line examination has 200 multiple choice questions. Time allocated is 240 minutes and pass requirement is 140 correct answers. The exam involves theory questions as well as recognising clinical images, dermoscopic images and some histology photomicrographs.

The first 146 questions of the diploma exam involve theory questions. There are 6 possible answers to each question of which only one answer is preferred. Many of the questions are of a case study format. you will be guided through a patient's experience with skin cancer and asked how you would choose management and advice options at each stage. The emphasis is on the clinical management of common skin cancers and benign skin lesions.

The remaining 54 questions of the exam include 9 pages of 6 images each. Candidates have to match every image on each page with 6 diagnoses. As such answers A through F will appear each only once on every image page.

The images in the surgical certificate exam include clinical images, dermoscopic images as well as histopathology photomicrographs.

The exam progresses from page to page. Once you press submit at the end of every page your answers to that question will be submitted and you will be forwarded to the next page.