Need to have a suspicious or cancerous mole removed, but afraid of the scarring the procedure may leave?
Enter Surgical Dermatologist Hilary Reich, MD, who specializes in Mohs surgery—a procedure that excises skin cancer while causing a minimal amount of scarring. Reich recently joined the University of Minnesota Health team and sees patients at the Dermatologic Surgery and Laser Center on the University of Minnesota Medical Center campus and at University of Minnesota Health Maple Grove Clinics.
We spoke with Reich to learn more about her passion for dermatology.
What’s your primary role with University of Minnesota Health?
I perform what’s called Mohs surgery, a special kind of skin-cancer excision that removes the smallest possible amount of normal tissue, while still maintaining safe margins and ensuring all the cancerous tissue was removed.
How is that different from standard skin cancer surgery?
When a person has a traditional excision—for example, to remove a basal cell carcinoma on your back—I visually identify the edges of the tumor, draw a standard safety margin of roughly 4 millimeters around the whole tumor, and then remove it. After the procedure, the tissue is sent to our pathology department for review and testing. Using this method, I’ll know within a week whether I’ve removed all the cancerous tissue, or if a patient may need come back for a repeat visit. With Mohs surgery, I take the smallest margin of tissue—as little as 1-2 millimeters. Within an hour, I personally review the pathology in my on-site lab, and confirm for the patient whether or not we need to take any more tissue, or if we can begin repairing their surgical wound.
Why is Mohs surgery important?
The surgery can be less disfiguring, which is really important when you’re working on a person’s nose, on the forehead or around the eyes—areas that are highly visible or where we have less skin to work with. Because we can review pathology results so quickly, the patient doesn’t have to come back for another surgery a week later if we discover additional cancerous tissue. When that happens, it’s really demoralizing for both the patient and the doctor!
Why isn’t the Mohs surgery used in all skin cancer removal, then?
It’s more expensive and in some cases, it isn’t necessary. The three governing bodies for dermatology have created appropriate criteria for Mohs surgery. If a patient had a smaller, less aggressive tumor on his or her back, or other areas where there is a lot of skin, it just makes more sense for the doctor to take a bigger margin, and have the patient in and out in 30 minutes.
What attracted you to dermatology?
I was originally interested in primary care, but I changed my mind during my third and fourth years of medical school. Both my parents are dentists, and I worked in their office for a long time growing up. When I took a rotation in a dermatology clinic, it felt really familiar because of the small, intricate procedures and quick patient visits. Dermatology is all about pattern recognition. Many times, just by examining a person’s skin, you instantly know the diagnosis and are able to prescribe a treatment. It’s really gratifying to provide immediate help for most people who walk into my office.
Your job clearly inspires a lot of passion. Why is that?
As part of my training, I spent a lot of time at the Minneapolis VA Hospital. One of my patients was a gentleman with three melanoma skin cancers—all of which I discovered on his first visit to our clinic. All of them were dangerous, but one of them was so deep it required extensive surgery and lymph node testing to ensure the cancer hadn’t spread. I still see him regularly and his wife always gives me a big hug. It’s really great to have that kind of personal connection with someone; it’s a really big deal for me.
Why are you practicing at the University of Minnesota?
I’m a native Minnesotan. I grew up in International Falls and am very proud of my home. More importantly, by working at the university, I can be involved in high-level research and can treat incredibly complex patients every day.