An important aspect of any family medicine resident’s training is the ability to competently diagnose and manage common skin conditions, including differentiating between benign and potentially malignant skin lesions. This is particularly important for residents planning to practice in rural or underserved areas where patients may have limited access to specialty dermatologists due to barriers related to their social determinants of health. The authors believe that training family medicine residents in the effective use of dermoscopy can improve the accuracy with which they are able to differentiate between benign and malignant skin lesions, and thereby reduce the need for unnecessary and burdensome referrals to dermatology specialists. Use of the triage amalgamated dermoscopic algorithm (TADA) as part of a family medicine residency’s dermatology curriculum is a simple and effective way to train residents in the use of dermoscopy, and could prove to be an important part of how FM GME programs produce a primary care workforce with the knowledge and skills required to care for the healthcare needs of rural and underserved patient populations.

(1) Background: Pelvic organ prolapse (POP) is common among post-menopausal women affecting more than 25% in their lifetime—with 11% having a lifetime risk of undergoing an operation for a POP. In April 2019, the Food and Drug Administration (FDA) took surgical mesh for transvaginal use off the market due to safety and effectiveness concerns. This leaves colporrhaphy or colporrhaphy with bio-graft options for a POP surgical repair. (2) Case: In this report, we look at a case with anterior mesh erosion complicated by poor wound healing secondary to heavy tobacco use and how it was successfully removed and augmented with a Coloplast axis allograft dermis biological graft secured with an Anchorsure sacrospinous ligament/arcus tendineus fascia pelvis fixation device and prolene suture. (3) Results: After failing two prior surgeries to rectify the mesh erosion, a final procedure was performed using a biologic dermal graft and a double-layer closure to aid in protecting and increasing the integrity of the tissue. (4) Conclusions: Collectively, the patient and her surgeries highlight the difficult nature of complete mesh removal and how tobacco use can significantly affect the proper healing of surgical sites. The number of surgeries necessary to address the patient’s chief complaint and the resolution of her symptoms with the biologic graft supports the challenges one faces with mesh removal and poor wound healing secondary to tobacco use. This case illustrates that complicated transvaginal mesh erosion should initially be augmented with a biologic dermal graft secured via sacrospinous ligament/arcus tendineus fascia pelvis fixation and double-layer closure and not only if visible mesh removal alone fails.