His & Hers Procedures

Specialist performs ‘amazing’ husband-and-wife skin cancer reconstruction.

When the area around their Fort Lauderdale home became a bit too crowded for their liking, Marilee Kishner and her husband, Richard Kishner, MD, packed up and moved to Vero Beach. After that move, Marilee rediscovered an old hobby.

A recently retired interior designer, Marilee rekindled another aspect of her artistic side and began painting abstracts again. She even dedicated a section of their new home to her passion, ostensibly turning that area into an art studio.

“I’m still in the pre-infancy stage of getting back to the more artistic and creatively free-spirited side of my world,” Marilee says. “I’m starting from scratch with a completely blank canvas and no limitations. It’s very exciting.”

Marilee Kishner and her husband, Richard Kishner, MD

Marilee Kishner and her husband, Richard Kishner, MD

In addition to painting, Marilee likes to play golf. So does her husband, a neurologist who still practices medicine but doesn’t work anywhere near as hard as he did during the 30 some years they lived in Fort Lauderdale.

“I actually still work in Fort Lauderdale, but I only go down there once or twice a month to do procedures,” Dr. Kishner explains. “A lot of the work I do now is through telemedicine. It’s been that way since COVID-19 started.”

Dr. Kishner also likes to fish when he can, but he recently learned that all his time in the sun came at a cost: the development of a lesion growing on his left lower eyelid.

“It looked like a small pimple, white and raised above the skin a bit,” Dr. Kishner details. “At one point, I visited my dermatologist in Fort Lauderdale about it and, after he looked at it with his skin scope, he said, That doesn’t look bad; it’s nothing to worry about.

“But over time it got somewhat bigger, and then, from me rubbing on it while washing or drying my face, it started to bleed. That’s when I knew it was a problem. That was just after we moved to Vero Beach, and at first, I couldn’t get in to see anybody about it.”

While searching for a provider to examine the growth, Dr. Kishner told a friend that he also needed to find an eye doctor in the Vero Beach area. The friend suggested he visit Alexander D. Blandford, MD, at the Center for Advanced Eye Care.

Dr. Kishner’s friend could not have made a better recommendation because Dr. Blandford is a board-certified oculofacial plastic surgeon who specializes in cosmetic and reconstructive surgery around the eyes and face.

In addition to eyelid lift (upper eyelid), under eye bag removal (lower eyelid) and brow lift, his specialties include cosmetic laser procedures, BOTOX® Cosmetic, dermal filler injections, orbital surgery, tear-drainage system surgery, and skin cancer removal and reconstruction.

Removal and Reconstruction 

Dr. Kishner and Marilee visited Dr. Blandford simultaneously for annual eye examinations. After learning of his fellowship training in oculofacial plastic surgery, however, Dr. Kishner asked Dr. Blandford to examine the growth that had been worrying him.

“It was growing, non-healing, red and flaky, so a biopsy was performed and it came back as a form of skin cancer called nodular infiltrative basal cell carcinoma,” Dr. Blandford reports. “It also had some depth to it, and after discussing options, Dr. Kishner was referred to a local Mohs surgeon for the removal.”

During Mohs surgery, microscopic layers of skin are repeatedly removed and examined until the borders of the tissue removed no longer contain cancerous cells.

Dr. Kishner underwent the procedure within days of his examination. The surgery left him with a defect on the eyelid that could have prevented the eye from closing if not properly reconstructed. To restore eyelid function and appearance, Dr. Kishner returned to Dr. Blandford.

Using a procedure known as local flap surgery, Dr. Blandford rearranges healthy tissue surrounding the defect so it covers the defect and avoids a skin graft. This allows for faster healing and, when done correctly, leaves the patient looking as if no surgery was performed. 

Dr. Blandford used his expertise to achieve such an outcome with Dr. Kishner.

“We used a local flap and kept the incisions below the eyelashes in what we call the relaxed tension lines,” Dr. Blandford explains. “Those are the lines that are normally present in our face. By using those lines, the incision lines are less conspicuous once they heal.

“In Dr. Kishner’s case, we had a functional goal and a cosmetic goal, and we were able to achieve both with one surgery. His eyelid functions normally, and it’s almost impossible to see the incision lines because of where they were placed.”

Dr. Kishner says the defect he was left with following Mohs surgery was “about the size of a nickel.” He was naturally concerned that he might be scarred forever. That is no longer a concern.

“Dr. Blandford did an unbelievable reconstruction job,” Dr. Kishner raves. “He put that thing back together like an origami puzzle. You would never know I had surgery of any kind in that area.”

Quiet, Confident Manner

The reconstruction project Dr. Blandford performed on Dr. Kishner was not the last he would provide for the couple. A few months after Dr. Kishner’s case was completed, Marilee learned she also had a skin cancer that required Mohs surgery and reconstruction.

A dermatologist discovered Marilee’s cancer on the right nasal ala, the external wing-shape wall on the side of each nostril. Marilee chose Dr. Blandford to do the skin cancer removal and reconstruction, largely because of the “tremendous job” he did treating her husband. 

“When I told the dermatologist I wanted Dr. Blandford to do the whole thing, he said, I trust Dr. Blandford,” Marilee recalls. “He also said Dr. Blandford is going to do the pathology knowing exactly how he wants to suture it up, and that’s exactly what Dr. Blandford did.”

Dr. Blandford removed the skin cancer by working with a pathologist, who examined the excised skin cancer using a technique called frozen section margin control. Margin control is important prior to reconstructive surgery to decrease the risk of recurrence.  Once clean margins, meaning noncancerous tissue, were found, Dr. Blandford again performed a local flap surgery to repair the defect. In this case, he made incisions in the ala groove, the natural line between the nasal ala and the cheek.

“There’s a natural arch there,” Dr. Blandford explains. “It’s not a true relaxed skin tension line, but a flap can be advanced into the groove to hide the incision.”

Marilee’s surgery was performed in August. She healed quickly, and by the middle of September was already looking as if she had never had surgery. She considered the doctor’s work a piece of art.

“It’s amazing. I never expected it to look so good so quickly,” Marilee enthuses. “My husband and I are very happy with everything Dr. Blandford has done for us. He’s very good, and just the way he presents himself is very comforting.

“He has a very quiet, very confident manner, and when he explained everything to me, he always stopped and asked, Do you have any questions? Do you understand what I’m saying? And if I did have a question, he took his time and explained it all. I never felt like he was in a rush to get through the conversation. 

“After the procedure, I received multiple follow-up calls from Dr. Blandford checking to see that everything was OK, and I really appreciated that.”

As a physician, Dr. Kishner rates other doctors more critically than Marilee. But just as his wife found favor with Dr. Blandford, so too did Dr. Kishner, who gives the surgeon high marks for professionalism.

“He’s a doctor’s doctor,” Dr. Kishner notes. “He does a very thorough evaluation. He speaks to you in clear tones, and he’s extremely meticulous. He cares as much about the results as the patient does.

“I happily recommend him, and the group as a whole is very good, too. The day after my surgery was a Saturday, and I woke up that morning feeling something tugging a little bit around the surgical site, so I called his office.

“One of his partners answered the phone and said, Come on over immediately. He looked at it, took care of it and could not have been nicer. And this was early Saturday morning, so I’m sure I messed up his golf day. But he had no complaints, and he could not have been more helpful or more professional.”

© FHCN article by Roy Cummings. Photo by Jordan Pysz. mkb
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