By C. William Hanke, MD
Both in 1985 and 1987, Drs. Martin Braun and Harry L. (Ted) Parlette removed basal cell carcinomas (BCCs) from President Ronald Reagan’s nose. The President had been an athlete and outdoorsman who spent much of his life in California’s blazing sun, which left him highly vulnerable to skin cancer. It caught up to him in 1985. The Presidents’ physicians invited two esteemed practitioners of Mohs micrographic surgery to the White House, since cure rates with Mohs surgery for BCC, squamous cell carcinoma, and certain other skincancers are the highest of any method. It is also an excellent technique for small areas around the face, so it was ideal for the President’s skin cancer. Plus, Drs. Parlette and Braun were local, so they could easily come back and forth to the White House for surgery and follow-up away from reporters’ prying eyes.
Getting the Call
In the fall of 1985, early in President Reagan’s second term, Dr. Braun, Past President of the American College of Mohs Surgery, received a call from Admiral William Narva, Chairman of Dermatology at the National Naval Medical Center, in Bethesda, MD. Before Narva would say why he was calling, he extracted a promise of secrecy. “The President had just healed from colon cancer surgery, and they were sick of surgeons criticizing one another for mismanaging the operation, so they wanted this kept from everybody,” Dr. Braun recalls. “I said I’d just tell my wife,” and Dr. Narva agreed reluctantly. Dr. Braun recommended that they also involve Dr. Parlette, a Mohs surgeon colleague who was Chairman of Dermatology at the Bethesda Naval Hospital. On October 10, Dr. Braun transported his sterile surgical instruments to the White House, where he was met by Col. John Hutton, the President’s personal physician. Dr. Hutton’s office, in the basement of the White House, was adjacent to a standard outpatient operating room with overhead lights, an electric operating room table, and resuscitation equipment.
Shortly after Drs. Braun and Parlette arrived at Hutton’s office, a staffer pushed a curtain aside, and through a window they saw the President’s helicopter land on the White House lawn, surrounded by staffers on one side, reporters on the other. The President had the helicopter keep its rotors turning noisily as he stooped low to disembark, so that he could point to his ears to let everyone know he couldn’t hear their questions. Five minutes later, the President was in the OR with Drs. Braun and Parlette. He was remarkably friendly and chatty. He spoke about his friendship with Shirley Temple, America’s grown-up little girl sweetheart, who was actually then married and pregnant. “The President was pleased to point out that he had actually been the first to marry her. . . in the movies,” says Dr. Braun. “There was nothing intimidating about him, nothing to make you nervous. No Secret Servicemen were in the room, and the conversation was easy.” In fact, the President seemed ready to talk for hours, so Braun and Parlette urged him to move forward with the surgery. He lay back on the table, and a 5-6 mm area on the bridge of the nose was anesthetized. “He stayed very still and was an excellent patient,” notes Dr. Braun. “The only thing he didn’t do that I asked was leave his hearing aids in. I wanted to be sure he heard our instructions, but he was afraid the devices would squeal during the surgery, so he took them out. He heard us fine anyway.”
The Great Escape
So the Mohs procedure began. A thin layer of tissue was removed, about 1 cm in diameter. Dr. Braun gathered up the specimens in a Petri dish and prepared to drive quickly in Dr. Hutton’s VW Rabbit to Dr. Braun’s nearby lab to analyze the specimens under the microscope. To keep questions from being asked, Dr. Hutton had Braun hide the Petri dish under a sports coat folded over his arm. “He stayed with me so there would be no interference leaving, and as we walked down the long hallways of the White House and Executive Office building, every single Secret Serviceman was staring at the coat on my arm. We were afraid that any minute they were going to knock the specimens onto the floor and step on them.” Braun, Parlette, and Hutton climbed into the car, and a moment later, as they pulled out onto Pennsylvania Avenue, a car came flying at them. “We came within a hair of being broadsided,” Braun remembers. “Dr. Hutton started laughing. ‘Couldn’t you just picture the news in the Washington Post tomorrow?’ he said. ‘President’s nasal specimens crushed by cars on Pennsylvania Avenue.’ ”
Clean Bill of Health
While the excised tissue was being processed, the White House kept calling for the results. Finally they had their answer: the specimen’s edges were clear. Only a single skin layer had been removed to achieve a cancer-free plane beyond the tumor.
Drs. Braun and Parlette returned to the White House and concluded the procedure. They re-anesthetized the wound, elongated enough skin to cover the defect, closed the wound with sutures, and put a small bandage on the site. The wound was small enough so that no flaps or grafts were required, but the President was concerned about what the First Lady would think when she saw the bandage. Followed by Dr. Braun, he went into the bathroom, leaned over the sink, and stared into the mirror. Dr. Braun, lightly touching the President’s back to keep him steady, leaned with him, pointing out how small the bandage was and telling him everything was going to be just fine. “I was only in my 30s, and standing there with my hand on the President’s back, I couldn’t help but think what an unusual moment this was in my life. It was an honor.”
So Much for Secrets
The plan was for the President to go to Camp David for a week to recover. If this had happened, the country might never have known about the skin cancer. But instead, the terrorist hijacking of the cruise ship Achille Lauro required the President to go immediately on national television to comment on the international incident. He had to explain the bandage on his nose, because the bandage was all anyone wanted to talk about. He spoke briefly about the basal cell carcinoma and explained that the margins were clear. He told the press that the bandage was a “billboard” that said “Stay out of the sun.”
Despite this public airing, the White House managed to keep the doctors largely incognito. “I wasn’t asked a lot about it because people didn’t know I did it,” says Braun. “A Washington Post reporter called me afterwards and said, ‘Did you operate on the President?’ When I answered yes, he said, ‘Sorry, we left you out of the article.’”
Staying on Top of Things
Braun and Parlette made several more visits to the White House to check the wound, then continued to monitor the President for skin cancer, so over time, word got out that they had performed the procedure. For some reason, people were more interested in the President’s hair color than in any details of his skin cancer surgery. “They wanted to know if it was real or dyed,” says Braun. “It was real. Mostly dark but with some gray — salt and pepper all the way through.”
They treated a second BCC on his nose on July 31, 1987, this time at the National Naval Medical Center. Basking in the President’s glow, physicians from many different specialties gathered around him, until Dr. Parlette took control of the situation. He chased all the non-dermatologists out except for Dr. Hutton, saying “We dermatologists have work to do.” As Nancy and Admiral Narva waited in the next room, Parlette and Braun anesthetized the President’s nose and removed the first Mohs layer. This time when the specimens were viewed under the microscope, residual BCC was found. So they removed a second layer, and found no additional tumor cells. Since the skin cancer had been in a more problematic spot, on the tip of the nose instead of the bridge and fairly large (12 mm diameter and 5 mm deep), it required some plastic surgery to cover the wound. Nancy secured the services of Dr. Diane Colgan, who had performed successful plastic surgery on Nancy. Dr. Colgan repaired the wound with a “transposition flap” (the Lindberg rhomboid flap), where layers taken from the immediately adjacent skin are formed into a flap to cover the wound. The surgery was entirely successful, and the wound healed uneventfully.
Over the years, Dr. Parlette saw the President at the White House and at the Naval Hospital many more times. “It was always relaxed,” Dr. Parlette recalls. “The President’s casual sincerity was the same persona he projected to the public. He always greeted you with a warm smile, a handshake, and a joke … usually a good one, and we always laughed loudly, because when the President of the United States thinks his joke is funny, you do too.” Dr. Parlette, continuing as the President’s regular military dermatologist, found a couple more skin cancers over the years, and both he and Dr. Braun also several times used cryosurgery (a technique using liquid nitrogen) to freeze off actinic keratoses. When the President wondered where these lesions kept coming from, Dr. Braun explained that they were skin precancers that might turn into skin cancers if not removed, and that they were caused by solar exposure like his BCCs were. The President begged to differ. “ ‘You know what I think?’ he said, smiling. ‘I think I’m not getting enough sun.’ That was right in keeping with his typical sense of humor.”
Used with permission from The Skin Cancer Foundation
C. WILLIAM HANKE, MD, is Senior Vice President of The Skin Cancer Foundation. He graduated from the University of Iowa College Of Medicine and has practiced Mohs surgery in Indianapolis for many years. He is Past President of the American Society for Dermatologic Surgery, the International Society of Dermatologic Surgery, the American College of Mohs Surgery, and the American Academy of Dermatology.