President’s Nose Cancer Surgery Goes ‘Very Well’

Surgeons excised a small patch of cancerous skin from the tip of President Reagan’s nose Friday afternoon in a two-hour procedure that White House officials said went “very well.”

The surgery, performed at Bethesda Naval Medical Center using a local anesthetic, removed two pieces of skin totaling about half an inch in diameter, White House spokesman Marlin Fitzwater said.

“The opening is very small. The whole procedure has been successful and the President is in good spirits,” he said.

Back in White House

Reagan, returning to the White House Friday evening from the Maryland hospital, said he felt “fine.” When asked whether the wound hurt, Reagan told reporters: “Not yet.” He wore a white patch that covered much of the right side of his nose.

The wound was closed with sutures after doctors decided that a skin graft was not necessary. The sutures leave fine scars that can be “sanded” away with abrasives six to eight weeks after the surgery, Fitzwater said.

Experts said that surgery for the mild form of skin cancer, known as basal cell epithelioma, is successful in 98% of the cases treated, although the condition often can recur.

Fourth in Two Years

Friday’s surgery was the fourth time in two years that such lesions--caused by exposure to ultraviolet sunlight--have been removed from the President’s nose. Tissue was removed twice in 1985 and again last Wednesday.

The surgery was performed by two Navy dermatologists, Capt. Theodore Parlette, chief of dermatology at the Bethesda hospital, and Rear Adm. William Narva. Two plastic surgeons, Capt. Diane Colgan and Cmdr. Michael Vincent, closed the wound.

The surgery began about 4:30 p.m. after Reagan flew by helicopter to the hospital. The President returned to the White House, where he plans to spend the weekend, about 8 p.m.

Fitzwater, relaying a report from Col. John Hutton, the White House physician, said that the first piece of skin removed was determined by microscopic examination to contain cancerous cells. The second piece was excised to ensure that no more cancer remained.

“It appears the excision has gone very well,” he said.

Hutton later told reporters that the stitches would be removed in five to seven days, and that Reagan would receive pain medication, such as Tylenol, as required.

“The President anticipates attending to official duties on Monday,” Hutton said. The bandage on Reagan’s nose likely will be replaced by a small piece of tape by Monday, he said.

Doctors decided that the surgery was needed after the patch of malignant skin was found during a routine skin cancer examination at the White House physician’s office. An examination of a scraping of the tissue taken Wednesday showed evidence of the basal cell epithelioma, also known as basal cell carcinoma.

‘Fairly Small’ Cell

Dr. Ronald Moy, a Pittsburgh, Pa., dermatologist specializing in the treatment of recurrent skin cancer, said that a half-inch slice of skin is “a fairly small basal cell.” Larger cancers are more difficult to treat, he said.

Doctors have said there is no connection between the skin cancer and colon cancer for which Reagan, 76, underwent major abdominal surgery in July, 1985.

White House officials sought to treat the skin cancer procedure casually. No senior staff members went with the President to Bethesda, a suburb of Washington.

Reagan gave the thumbs-up sign to well-wishers on the White House driveway as he and his wife, Nancy, boarded the helicopter shortly before 4 p.m.

‘Good Frame of Mind’

” . . . He’s very cheerful and he’s had it done before and understands the circumstances, so he’s in a good frame of mind,” said White House Chief of Staff Howard H. Baker Jr.

During a photo session earlier in the day with visiting President Omar Bongo of Gabon, Reagan, when asked how he felt about the upcoming surgery, replied to a reporter: “It seems a little overdignified to call what’s going to happen ‘surgery.’ They’re going to scrape a patch on my nose.”

Describing the procedure before it took place, Fitzwater said that “Dr. Parlette removes the tissue around the area of the nose that has the basal cells in it. That tissue is examined under a microscope and it is determined where the (cancerous) cells are located in the tissue.”

Continue Removing It

Dye is applied to the tissue during the procedure, known as the “Mohs’ technique,” to help in the microscopic identification. The surgeons continue removing small tissue portions with a small-blade scalpel until no more malignancy is found.

“You don’t want to take any more (tissue) than you have to, but you want to take enough to ensure a margin of safety,” the press spokesman said.

Fitzwater said that the procedure on Friday was carried out at the hospital to allow doctors to examine the removed tissue immediately so additional patches could be excised, if necessary. Reagan’s previous skin cancer surgeries have been done in the White House physician’s office.

Most Common Form

Basal cell carcinoma--the form of cancer for which Reagan is being treated--is considered the most common and easily treated form of cancer. It afflicts an estimated 500,000 Americans each year. It is especially prevalent among Caucasians who live in sunny climates.

Since the malignant tissue was first detected two years ago, Reagan has limited his exposure to the sun, although he spends hours each day outside on his ranch during his California vacations.

Fitzwater said that Reagan is “concerned” about his exposure to sunlight. “He does apply sun-screen, but it’s hard to always be protected,” the spokesman said.