For some people, outdoor activities like swimming and cycling are a fun occasional pastime. But there are also people like Mark Foist, for whom spending time outdoors is a way of life.

A former competitive water polo player and ski instructor, Mark has run in 20 marathons and completed two grueling Iron Man triathlons. When he wasn’t training under the desert sun of Southern California, he often volunteered to help others prepare for marathons or cycling competitions.

And so, in 2004, when he was told that he had both squamous and basal cell carcinoma on his lip, he wasn’t exactly floored by the news. In addition to his love of being outside, he also has a strong family history of cancer.

He had the cancer removed by a respected dermatologist near his home in Redlands, but it returned three years later, this time on his lip and nose. The second time he was treated, he spent 12 hours at his dermatologist’s office for surgical procedures on nine different areas of his face.

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“It was one of the most painful days of my life,” Mark recalls. “And, somehow, I knew they didn’t get it all. I also knew that I didn’t want them to cut me again. I needed something better.”

When the skin cancer recurred for a third time in 2014, his dermatologist confirmed that he needed a level of care higher than she could offer. After consulting with other doctors and reaching out to friends and family for recommendations, a trusted family member told him to make an appointment at Keck Medicine of USC.

Because his cancer was becoming more widespread and had multiple occurrences, Mark was immediately categorized by the team at Keck Medicine as high-risk and his case was brought before the USC Multidisciplinary Cutaneous Tumor Board, a group of 15 skin cancer specialists that includes dermatologists, oncologists, radiation oncologists, otolaryngologists and plastic surgeons.

“The skin cancer treatment experience at Keck Medicine is unique because of the skin cancer tumor board,” explains David Peng, MD, MPH, chair of the Department of Dermatology at the Keck School of Medicine of USC and dermatologist at Keck Medicine of USC. “The tumor board offers the opportunity for multiple experts to come together to discuss one patient’s case and to combine all of their expertise to generate a customized plan of care for each patient.”

In Mark’s case, removing 100 percent of the cancer also meant removing a portion of his face, including parts of his left nostril and upper lip. The team also found, during the Mohs procedure, that Mark had perineural invasion, meaning the cancer had started to grow along the nerves. To reduce the risk of the cancer recurring, Mark underwent six weeks of radiation treatment before the team could begin reconstruction work on his face.

Mark says one of the benefits of having his treatment at Keck Medicine is having his team of specialists all in one location. His care was overseen by the Mohs surgery team, but all members of his team could track his progress. Following radiation, one of the otolaryngologists reconstructed his nostril by taking skin from other parts of his body and a vessel from his forehead.

Following the surgery, some additional laser and reconstructive procedures were used to minimize the scarring on Mark’s face, and he’s now on a strict regimen of prevention that includes both medication and solid advice about sun safety.

Although forced to take a break from his outdoor activities while he was undergoing treatment, Mark says it was worth it.

“I’m really happy with the results and I get all of my health care at Keck Medicine now,” Mark says. “I found that at Keck Medicine, you get some of the best doctors in the world who also happen to be people you’d want to play golf with.”

But never without sunscreen and never during peak sun hours.

What is Mohs Procedure?

Mohs procedure is a micrographic surgery. It is done under local anesthesia and has a high cure rate in treating high-risk skin cancer. It also allows the surgeon to preserve as much tissue as possible, which minimizes the extent of reconstruction the patient will need following treatment.

By Hope Hamashige