Report on the visit Prof. Glenn Goldman, Dr. Kendra Lesiak and Mrs. Justine Kinerson in Wroclaw (Poland)

Between June 4, and June 10, 2016 there were in Poland, members of Dermatology / Dermatological Surgery at the University of Burlington / Vermont  / USA. The team was composed of: Prof. Glenn Goldman, Dr. Kendra Lesiak and Mrs. Justine Kinerson. The American guests were invited by Assoc. Prof.  Andrzej Bieniek and Prof. Jacek Szepietowski of the Department of Dermatology at the Medical University in Wroclaw.

The visitors were hosted also by the Private Centre of Plastic and Skin Surgery "Centrum Medyczne Bieniek" Research travel was organized and sponsored by the International Travelling Mentorship Program of the American Society for Dermatologic Surgery. The visit of the US guests was devoted primarily for Mohs Micrographic Surgery, and methods of reconstruction of integument defects. During they stay they participated in qualifying patients with skin diseases, especially skin cancers for various form of treatment, in the surgical procedures (mainly Mohs), in the analysis of histological sections and in various forms of reconstructive procedures, as well as some procedures within the field of aesthetic dermatology. In the diagnostic and therapeutic activities on the part of Doctor Bieniek team. Guests participated in a routine manner of Mohs surgery employed in Centers run by Dr. Bieniek. It consisted of (oblique) excision, with specific form of tissue marking (with use of surgical sutures), freezing of tissues and tissue block in the spray of liquid nitrogen (in the original patented apparatus, allowing to align the surface of the block to the surface of the tissue cutting knife without manual adjustment, and to increase the area of ​​the sections). The next self-modification is the mapping of the tumor using own designed computer application.

Dr. Goldman and Dr. Lesiak performed numerous surgical procedures in a way characteristic for the University in Burlington. It consisted of (oblique) excision, and the method of marking on the specific tissues using a scheme of double and single incisions, which permitted to avoid marking with sutures. Interesting for us was the observation that tissue from the tumor were cut off from the main specimen by histological technician, and placed on a glass slide together with sections from the circumference. During the preparation in the laboratory we had the opportunity to admire the professionalism of Mrs Justine Kinerson, which, due to rich experience was perfectly and quickly preparing histological slides. We watched with interest the tissue processing employed in Vermont. It was based on the spraying the freezing gas on the glass slide with the tissue adhering to glass and pressed by the finger. Due to the lack of original “histo-freeze” we successfully replaced it with a can of compressed air (typically used for cleaning computer equipment). Frozen in this way tissue was pasted in the freezing medium distributed on the surface of the object disc, and then cut in a microtome cryostat knife (with use of manual adjustment). According to the final opinion of American and Polish specialists, in Mohs Surgery less important is applied laboratory technology, it is rather crucial to obtain a histological slides of good quality in possibly short time.

Despite Mohs excisions, Prof Goldman and Dr. Lesiak performed many reconstructive procedures. Especially we admired their individual approach to reconstruction, based on a thorough knowledge of reconstructive surgery, of anatomy, and attitude to achieve optimal aesthetic result.

To sum up - for me and my team, visit of our respectable guests from the USA created an earlier  non-existent opportunity to observe Mohs surgery at the highest level. We enjoyed the perfect organization of work, excellent communication between the surgeon and the technician as well as speed and accuracy of a laboratory technician. It also gave the chance to ask many questions, to discuss existing in our countries differences in surgical and laboratory methodology. The visit left us inspiration to improve our own work and improve the quality of Mohs micrographic surgery conducted in Poland.

Our guests got acquainted with the working conditions of both the State and private medical centers. We hope that in addition to hard work, our guests also had the opportunity to familiarize themselves with the city of Wroclaw, which is locally popular tourist destination. And - not least - the everyday way of life of Poles.