LANDSTUHL, Germany – Over nearly two decades, Richard Reed has traveled from Germany to Walter Reed National Military Medical Center seven times. These weren’t holiday trips but rather medevacs for the treatment of his cancer.
Reed’s treatments required a specialized dermatologist trained in Mohs surgery, which until now, wasn’t available in Germany for U.S. citizens living abroad. Recently, Landstuhl Regional Medical Center reintroduced the service for skin cancer patients, which had been missing for decades.
“There hasn't been a Mohs surgeon here for many, many years,” explains U.S. Air Force Maj. Shannon Buck, a dermatologist specially trained in Mohs surgery. “The retiree population that hasn't had access to this to this service is huge. All the (Service Members) in Europe, Africa and the Middle East, would usually have to go back to the (Continental United States) causing a long time away from the fight. Having it here is not only streamlining the process, it gets them back to their job, back to the war fight a lot quicker.”
Mohs surgery is considered the most effective technique for treating basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), two of the most common types of skin cancers. The procedure has a 99 percent cure rate for cancers that have not been treated previously. Additionally, the precise technique leaves the smallest scar possible while removing the entire tumor.
“The technique has evolved over time, but involves the surgeon cutting out the skin cancer with a very narrow margin, then processing (the tumor) in a lab which is usually located within the clinic,” said Buck. “The nice thing about the surgery is the way the tissues prepped you can actually see 100% of the margin, which is different than other surgical techniques to remove cancer, and the surgeon is the pathologist too.”
As the patient waits for results, a team of health care professionals work to present the surgeon with sectioned microscopic samples of the tumor. Following analysis of the tissue, the Mohs surgeon can determine if all the cancer cells were removed or if another removal is necessary. Following the full removal of the cancer cells, Mohs surgeons then perform wound repair by either allowing the skin to heal itself or through various reconstruction methods.
Aside from being an outpatient procedure, Buck notes that other benefits for patients include the ability to walk and eat while the tissue is processed, fewer medications required during the process leading to speedier recoveries, and minimal scarring.
“Ideally, we're getting cures by doing this procedure of skin cancer, and we're also keeping the scars as small as possible which are usually in very cosmetically-sensitive areas, as most of these cases are on the head and neck,” said Buck.
Reed, a retired U.S. Army warrant officer, has had a long history with skin cancer, dating back to the 70s. Although his health insurance covered the costs of lodging and transportation during his first two medevacs, changes in policy required him to bear the costs for following treatments. Additionally, his treatment, as well as many others who undergo the surgery while living overseas, require a three-day stay near the treating facility. Reed notes the procedure in German health care systems isn’t any quicker.
“(Going to the U.S. from Germany), we spend three or four days going through that operation,” said Reed, 81, a native of Niagara Falls, New York. “(At LRMC) it's one day, less than one day. It's basically an outpatient visit. I don't have to worry about getting on the plane, I don't have to worry about traveling back and forth. I just drive here in the morning and drive home in the afternoon.”
“I think this will be a great thing for LRMC and a great thing for our patients. That's why we're here: to take care of our active duty Service Members, their families and our retirees,” said Buck. “We want to make sure they have high quality care that's both really good, and convenient for them.”
Buck and the LRMC Dermatology Clinic are working toward increasing access to care for those in need of Mohs surgery and anticipate opportunities for more beneficiaries soon.