South Texas Veterans Health Care System (STVHCS)

Exterior sign of the Dermatology Clinic

When John Dill, U.S. Air Force Veteran, first noticed the small, scaly spot on the side of his nose he thought nothing of it.

It was so out of mind that after a while he didn’t spot it anymore and assumed it vanished.

“I thought it went away, but my wife noticed it, so I came to [Audie Murphy] and got it biopsied and it turned out to be precancerous,” he recalls.

After learning the news, Dill made an appointment at the outpatient Dermatology clinic at the Audie L. Murphy Veterans Hospital in San Antonio, Texas where he has since had several spots of skin cancer removed over the years since noticing the first.

According to the American Academy of Dermatology, situations like Dill’s are quite frequent. In fact, current estimates suggest that one in five Americans will get skin cancer at some point in their lifetime.

Thankfully, the outpatient clinic at Audie Murphy is helping reinvent the process of skin cancer treatment, and by doing so, allowing Veterans get the treatment they need while minimizing unnecessary hospital trips.

The clinic is a frequent user of the Mohs (pronounced “moes”) micrographic method of surgical skin cancer removal. This method starts at the center of the cancerous cells and continues to move outward until no new skin cancer cells are detected. This method has been widely used in recent years, but at Audie Murphy, the Outpatient Dermatology Clinic has developed a “one stop shop” using this technique as it’s backbone.

Normal reconstructive surgery following a Mohs procedure usually takes place a day or so after the surgery, and typically requires the patient to book a trip to the operating room. Now, Veterans can have both their skin cancer removal and reconstructive surgeries done in the same day.

“[This is] really the Rolls Royce of treatment for these types of skin cancers,” says Dr. Valerie Shiu, a Mohs surgeon. “Not only are [the Veterans] getting their skin cancer cured, but also are getting the best possible reconstructive surgery and outcomes,”

The Audie L. Murphy Veterans Hospital has partnered with other institutions such as the University of Texas Health Science Center and the Department of Defense to help optimize procedures such as these. This three-pronged approach allows some of the best military facial plastic surgeons to share their abilities with Veterans and allows opportunities for training for the next generation of physicians. Here, medical students and residents are given an invaluable chance to learn directly from practicing physicians in the field.

Perhaps most importantly, the clinic also has the ability to do multiple patients in one day, along with the ability to do reconstructive surgery on site. This not only saves taxpayer money but also saves Veterans multiple trips to and from the hospital for reconstructive surgery in an operating Room.

“In the time of COVID, I personally think it’s important that the less time a patient spends in the hospital or multiple visits in and out of a hospital will put them at less risk of getting a COVID infection,” says Dr. Chad Hivnor, the Section Chief for Dermatology.

“We are certainly blessed to be here and be able to do all of this for the patients and get it done all in one day,” Hivnor says. 

Caregivers at the clinic often go above and beyond the call of duty, even going so far as to let patients call them after hours. Factors such as these contribute to the outstanding outcomes generated by the outpatient dermatology clinic at Audie Murphy and make patients comfortable coming back, if necessary.

“It’s comforting here,” Dill says. “How can you put a value on that? You can’t.”