Doctor recalls early passion for medicine

The clinical associate professor of dermatology and otolaryngology, University of Pittsburgh Medical Center, remembers when his aunt, who liked to whittle, gave him a small knife. Instead of using it on wood, Dr. Zitelli would use it to dissect road kill. In high school, years later, he worked at a funeral home, embalming bodies.

Carving his niche

Known for his work in facial reconstruction, Dr. Zitelli modified and improved the bilobed flap approach for reconstructing difficult wounds on the nose.

"The bilobed flap has been used for a long time, but it did not work very well because it created tissue protrusion," Dr. Zitelli tells Dermatology Times.

"The design modification that I made just changed the angle a little so that you could move tissue more efficiently from the upper part of the nose to the lower part of the nose, without changing the shape of the nose," he says.

The dermatologist has also made his dent in making Mohs surgery a more accepted approach for treating melanoma.

"Mohs surgery is used for treating many kinds of skin cancers, but for a number of reasons it was not often used by even Mohs surgeons for treating melanoma," Dr. Zitelli says.

"Some have not used it because of medical-legal reasons and the fear of doing anything that was not the standard of care. Another reason is that to do Mohs for melanoma is technically more difficult than it is for treating other types of cancer, such as basal cell cancer. So, it requires special training and a high-quality laboratory," Dr. Zitelli notes.

Dr. Zitelli recommends that Mohs surgeons use a high-tech stain in the laboratory, called immunoperoxidase stain (specifically, MART-1). The stain lights up the melanocytes and allows dermatopathologists and others to more easily see the cells under the microscope than when they use the regular stains.

Dr. Zitelli, who has published and spoken worldwide on Mohs for melanoma, says one of the biggest lessons that he has learned in his research is how cost-effective Mohs can be.

"We did cost analyses on Mohs surgery and have shown that it is just as cost-effective as excisional surgery in the office, but is more valuable because the cure rate is higher," he says. "If you look at the code for Mohs surgery and compare it with codes for other skin cancer treatment types, Mohs Mohs can be.

"We did cost analyses on Mohs surgery and have shown that it is just as cost-effective as excisional surgery in the office, but is more valuable because the cure rate is higher," Dr. Zitelli says.

"If you look at the code for Mohs surgery and compare it with codes for other skin cancer treatment types, Mohs appears to be more expensive, but people forget that Mohs combines all the pathology and all surgery in one code," he says.

Passing on handiwork

Dr. Zitelli combines a love for teaching with his full-time practice in Pittsburgh. The large Mohs practice offers approved slots for two procedural dermatology and Mohs college fellowships.

"We also have dermatology residents and teach the otolaryngology residents their facial plastic surgery," Dr. Zitelli says.