Q&A with Hubert (Hugh) Greenway, MD

Anybody who practices Mohs micrographic surgical procedure is more likely to know the identify Hugh Greenway, MD, the longtime head of Mohs and dermatologic surgical procedure at Scripps Clinic in San Diego, who was additionally just lately chosen as program director for cutaneous oncology at Scripps MD Anderson Most cancers Middle in San Diego. He’s additionally a former president of the American Faculty of Mohs Surgical procedure.

After incomes his medical diploma from the Medical Faculty of Georgia, Augusta, in 1974, Dr. Greenway was fellowship skilled in Mohs pores and skin most cancers surgical procedure by Frederic E. Mohs, MD, on the College of Wisconsin–Madison. He accomplished his dermatology residency on the Naval Medical Middle San Diego and joined Scripps Clinic in 1983, the place he launched the establishment’s first Mohs surgical procedure program, in addition to a well-liked annual intensive course in superficial anatomy and cutaneous surgical procedure that bears his identify. He was additionally the primary doctor on the earth to make use of interferon as a nonsurgical therapy of basal cell carcinoma.

Head of Mohs and dermatologic surgery at Scripps Clinic in San Diego.

Courtesy Scripps Clinic

Dr. Hugh Greenway (proper) joined Scripps Clinic in 1983, the place he launched the establishment’s first Mohs surgical procedure program.

Up to now, Dr. Greenway has carried out greater than 41,000 Mohs surgical procedure instances and has skilled 61 fellows who apply in educational and medical settings. In 2017, he obtained the Frederic E. Mohs Award from the ACMS on the school’s annual assembly. He’s additionally a previous CEO of Scripps Clinic. On this Q&A, Dr. Greenway opens up about what it was like to coach with Dr. Mohs, what makes Mohs surgeon, and why he’s enthusiastic about the way forward for dermatology.

I perceive that you just first grew to become excited by a medical profession after assembly Dr. Carl Jones, a pal of your father who was your Scoutmaster within the Boy Scouts in Georgia. What about Dr. Jones impressed you to pursue a profession in drugs?

Dr. Jones was an internist/allergist in Atlanta, the place I grew up. His three sons and I had been associates. My dad had handled a number of medical issues being injured in World Struggle II and subsequently present process a few kidney transplantations, so I developed an curiosity in drugs personally. Regardless that Dr. Jones was a specialist, he began out as a household physician like I did, so he was excited by the entire individual and all of his or her medical issues versus these associated to his specialty solely. I traveled with the Boy Scouts to camp at locations like Valley Forge in Pennsylvania, and Dr. Jones was concerned with the medical set-ups of these giant occasions. That additionally contributed to my curiosity in drugs.

As a part of your 9-year service within the U.S. Navy, you spent 2 years because the flight surgeon at NAS Atlanta/Dobbins Air Drive Base. What was your most memorable expertise from that project?

Dobbins is a big facility with two Lockheed crops, and the Air Drive had constructed the medical clinic, which was staffed by the Navy. Attending to know a number of the active-duty members of the Air Drive, the Navy, and the Nationwide Guard, and their dedication to our nation, was memorable. Jimmy Carter was the president in these days. When he would fly in Dobbins, one in all my jobs because the flight surgeon was to be on base when Air Drive One landed or departed. One night time, we had a DC-9 business plane coming from Huntsville, Ala., to Atlanta that received caught in a thunderstorm a little bit above 30,000 toes. Each engines went out and the plane primarily grew to become a glider. The pilots tried to land on our runway however sadly, they ended up 4 miles brief. We had been closely concerned in responding to the crash, which was a tragic occasion. I additionally discovered to fly (second seat) various kinds of plane throughout my project at NAS Atlanta/Dobbins Air Drive Base, all the pieces from the big C-5s to Navy fighter jets and helicopters. Coincidentally, Dr. Jones was concerned with a few free well being clinics in Atlanta after I was stationed there. Each Tuesday night time, my spouse (who’s a nurse) and I might volunteer at a clinic in Cabbagetown, which was one of many poorer areas of Atlanta. It was an opportunity to provide again to a gaggle of people that didn’t have a complete lot.

Within the center your dermatology residency at Naval Medical Middle San Diego, you had been chosen by Dr. Mohs for fellowship coaching in Mohs pores and skin most cancers surgical procedure on the College of Wisconsin–Madison. What do you keep in mind most about your coaching with Dr. Mohs?

Dr. Mohs was a sort, humble man who had this nice thought about pores and skin most cancers. He was not a dermatologist; he was a basic surgeon. The approach he developed was initially referred to as chemosurgery as a result of he put a chemical onto the pores and skin. This was often called the fixed-tissue approach. Then we had a fresh-tissue approach, the place we didn’t use the chemical, however we had been ready to make use of native anesthesia instantly. That developed into the Mohs surgical procedure we all know immediately. Dr. Mohs didn’t identify it that; he was very humble, however he was very pleased with his approach. He was additionally a really onerous employee. On the primary day of my fellowship, I began at 7 within the morning and ended at 7 at night time. It was the identical for the final day of my fellowship. He additionally had a superb workplace employees, a lot of whom had labored with him for a few years. Sufferers with tough pores and skin cancers traveled to Madison from all around the world as a result of there weren’t that many Mohs surgical procedure clinics in these days. Through the latter a part of my fellowship, Michael McCall, MD, and I had the chance to take away a pores and skin most cancers from the nostril of Dr. Mohs. We offered the case at a nationwide convention, and I titled the discuss “Mohs Surgical procedure for Mohs’ Nostril.”

Telemedicine is in style amongst Mohs surgeons – for now

Early in your profession Dr. Mohs requested you to take over his apply, however you accepted a suggestion to determine the primary Mohs surgical procedure workplace at Scripps in San Diego as an alternative. What satisfied you to go West?

After my fellowship, I returned to San Diego to finish my residency with the Navy, the place we opened a Mohs surgical procedure clinic. Dr. Mohs got here out for the ribbon chopping. Throughout that point, I used to be taking good care of a number of sufferers that he had handled in Wisconsin. By way of that my spouse and I ended up going to dinner with Cecil and Ida Inexperienced, philanthropists who made a number of monetary presents to Scripps Clinic – and for whom Scripps Inexperienced Hospital is called. Cecil cofounded Texas Devices and was knighted by Queen Elizabeth. Throughout dinner, he advised that I keep in San Diego for a yr and work at Scripps after my residency project with the Navy. I agreed and have been right here ever since.

What do you discover most attention-grabbing about Mohs surgical procedure?

In Mohs surgical procedure, you’re capable of present not solely surgical care to get rid of the tumor, but additionally the pathology and the reconstruction. That was attention-grabbing to me. Dr. Mohs was not that excited by reconstruction. He was extra targeted on the tumor, partially as a result of with the unique fixed-tissue approach you possibly can not do the reconstruction. You needed to wait for an additional layer of tissue to separate. However with the fresh-tissue approach, you had been capable of present the reconstruction that day. Mohs surgical procedure offers with a subset of tumors which might be difficult to deal with. That additionally spiked my educational and medical curiosity.

In your opinion, what’s been an important advance in Mohs surgical procedure to this point?

In recent times, immunology has come into play, so now we’ve groups of clinicians in dermatology, medical oncology, surgical procedure, and different subspecialties offering sufferers one of the best of care. Within the area of Mohs surgical procedure itself, within the Eighties, the American Faculty of Mohs Surgical procedure developed a 1-year fellowship program, which enabled us to coach many women and men to apply Mohs surgical procedure. Most of them are dermatologists.

Please full the sentence: “You may inform Mohs surgeon by the way in which he/she …”

Treats sufferers, is prepared to spend time with them, and exhibits an curiosity in them. One of many issues we should always try for is to let sufferers know that they as an individual are vital; it’s not simply the melanoma on their nostril. We’re not solely coping with a pores and skin most cancers; we’re coping with a affected person who has pores and skin most cancers.

For the previous 39 years, you may have led Hugh Greenway’s Superficial Anatomy and Cutaneous Surgical procedure course, which takes place each January in San Diego. What’s been key to sustaining this coaching course for practically 4 a long time?

There have been many individuals concerned in its success, so it’s not simply me. After I first began my apply, there actually was not a give attention to anatomy within the basic dermatologic neighborhood. Dermatologic surgical procedure textbooks contained little or no content material on surgical anatomy so I developed an curiosity a placing collectively a course that will cowl a few of this materials. I met with Terence Davidson, MD, an otolaryngologist who was dean of constant medical training on the College of California, San Diego. The course contains lectures from consultants in lots of subspecialties and hands-on laboratories utilizing cadavers to work on anatomy and surgical strategies. After about 16 years of doing the course Dr. Davidson informed me: “Once we began this course, as a gaggle, the pinnacle and neck surgeons had been one of the best to do the reconstructions on the face with pores and skin flaps and grafts and layered closures. However now, as a gaggle, the dermatologists are finest at doing that.” That’s what we need to hear in medical training.

Through the peak of the COVID-19 pandemic, what had been your most vital challenges from each a medical and a private standpoint?

I’m lucky to apply at a spot like Scripps, the place there are numerous assets to take a look at what was taking place with COVID-19. Clinically, we needed to put quite a lot of issues on maintain, however we tried our greatest to maintain our most cancers sufferers specifically within the forefront of care. It has been a problem, however luckily we’ve been capable of maintain sufferers after a short timeout. Many people keep in mind the polio vaccine again within the Fifties. Having labored abroad and at missionary hospital the place we had kids die of measles as a result of they weren’t vaccinated gave me a bigger appreciation for the significance of vaccines. I like to recommend all younger physicians who work with me to learn, “The Nice Influenza: The Story of the Deadliest Pandemic in Historical past,” by John M. Barry, which recounts the 1918 flu epidemic.

Who evokes you most in your work immediately?

I don’t view what I do as work. Dr. Jones and Dr. Mohs proceed to encourage me with what they achieved throughout their careers. You must love individuals and love sufferers. Each affected person who involves see me has a narrative, so I attempt to perceive their story. One of many issues I actually take pleasure in is coaching the younger fellows. We practice three Mohs fellows per yr at Scripps, and it’s an important problem day by day.

What growth in dermatology are you most enthusiastic about within the subsequent 5 years?

Dermatology will proceed to evolve identical to all different medical specialties. We’re going to see a big development in telemedicine, and immunotherapy is enjoying a key position in dermatologic oncology. What excites me essentially the most in drugs is the younger individuals who enter the sector prepared to contribute their lives to serving to others.

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