A Conversation With Thomas Knackstedt, MD, MPH

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Dr Thomas Knackstedt is a board-certified dermatologist and board-certified, fellowship-trained Mohs surgeon practicing at Pinehurst Dermatology and Mohs Surgery Center in Pinehurst, N.C. He also serves as an adjunct associate professor of dermatology at the Case Western Reserve University School of Medicine. Dr Knackstedt completed his dermatology residency at Dartmouth Hitchcock Medical Center, where he served as chief resident in his final year. He then completed a micrographic surgery and dermatologic oncology fellowship at Dermatology Professionals, Inc., in East Greenwich, RI. Dr Knackstedt received extensive training with an emphasis on surgical technique, complex facial reconstruction, and nail surgery. He is considered a national expert in nail cancers. Dr Knackstedt has published over 60 peer-reviewed articles and book chapters on skin cancer surgery, nail disease, and facial reconstruction. He serves on multiple clinical committees of the American Academy of Dermatology and the American College of Mohs Surgery. In addition to being engaged in medical education and clinical research, Dr Knackstedt regularly presents at regional, national, and international meetings. 

 Q. What part of your work gives you the most pleasure? 

A. I take great pleasure in educating my patients. Having a skin cancer diagnosis can be scary. While removing cancers by Mohs surgery and reassuring patients in real-time of their negative margins and complete cancer removal is gratifying, I find the preprocedural time spent with the patient equally satisfying. Teaching about the nature of different skin cancers or dermatologic conditions, explaining procedures in detail, and aligning outcome expectations are the cornerstone of a fruitful patient-physician relationship. 

Q. Who was your hero/mentor? 

A. I have had the privilege of having many mentors along my career path. I certainly must give credit to a friend of my parents, Dr Richard Deangelis, who introduced me to Mohs surgery at the tender age of 15 by teaching me about his profession and later allowing me to shadow his practice. My practice, approach to patient care, and bedside manner are significantly influenced by my Mohs surgery fellowship director Dr Nathaniel Jellinek. He inoculated me with his passion for nail disease and nail tumors, a unique and oftentimes neglected niche in dermatology. 

Q. Which patient had the most effect on your work? 

A. Early in my career, I had the honor of caring for a 29-year-old patient with cystic fibrosis. Her double lung transplant required her to be on immune-suppressing medications, which brought a significant skin cancer burden with them. Unfortunately, over the 5 years of our patient-physician relationship, her lung condition deteriorated. During this time, she taught me a lot about inner strength, life’s fairness, faith, and the appropriateness of medical care. Indeed, diagnosis, patients, and procedures are not “one size fits all.” Deciding the best treatment approach in the presence of all the scientific evidence is the art of medicine. 

Q. Which medical figure in history would you want to have a drink with? 

A. I would like to have a drink with Karl Koller, who is considered by many to be the first physician to use local anesthetics for an operation in 1884. While we use local anesthetics like lidocaine on a daily basis, the quantum leap in patient comfort and satisfaction this achieved has gone somewhat unrecognized. We take for granted the excellent safety profile of most modern local anesthetics but the fact that the original local anesthetic used by Koller was, in fact, cocaine would make for an even more interesting conversation.