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Focus on Nita Kohli, MD

Nita Kohli, MDNita Kohli, MD is a dermatologic surgeon who specializes in skin cancer, Mohs micrographic surgery, and occupational medicine.

Dr. Kohli sees patients at Barnes-Jewish Center for Outpatient Health, 4901 Forest Park Ave., Suite 502, St. Louis, MO 63108.


What happened in the course of schooling to influence you to choose your specialty?

Dermatology was the first specialty I was exposed to as a medical student. I really enjoyed the clinical experience, the variety of patients and the opportunity to perform procedures during that rotation. My first exposure in medical school brought me to where I am today – as a procedural dermatologist whose specialty is surgically treating skin cancer.

Did you always know you wanted to be a doctor?

 I didn’t always know I wanted to be a doctor. My parents probably had a little bit of influence, but they never pressured me to be a physician. My mother is a nurse and my father was a chemist, so I was naturally was drawn to the sciences. I chose medicine because I like interacting with people on a daily basis.  I also like being able to think through, diagnose and treat a problem from start to finish.

What brought you to Washington University?

I came to Washington University for an academic career. This is a world-class institution that gives me the potential to do research, collaborate with others, and teach students and trainees – the next generation. This is a great place with a lot of resources and that’s what drew me here.

What new developments in your field are you most excited about?

The development in my field I am most excited about is Mohs surgery. The technique is named after Dr. Frederic Mohs, who developed the surgical technique to remove skin cancer. I perform Mohs on a daily basis.

This technique removes skin cancer with the smallest margin of healthy skin – conserving as much of the normal skin as possible.  We are able to ensure that 100% of the margins are negative for any residual cancer cells. By taking only the cancerous skin, the reconstruction of the wound can be cosmetically appealing.

I like the fact that a patient comes in to see me with a skin cancer, and after having Mohs, he or she leaves the office tumor-free and cancer-free free. This method is exciting in the field of dermatology surgery because it also has the highest cure rate.

Mohs is typically used to treat what types of cancer?

Mohs surgery is typically used for non-melanoma skin cancers, such as basal cell skin cancer and squamous cell skin cancer, which are the most common types of skin cancers.  Mohs can be used on other types of skin cancer, that are less common, but predominately it will be the basal cells and squamous cells.

There are different ways to treat melanoma skin cancer, but it also depends on the stage of melanoma and how deep it has progressed in the skin. The less aggressive and less invasive melanoma skin cancers can be excised (cut out) and sutured in the clinic, with a safety margin of skin.  

The higher stages of melanoma require other types of treatment in addition to excision. Treatments can include biopsy of the lymph nodes, systemic treatments (medications) and possibly chemotherapy.

How does melanoma appear on places that have never been exposed to the sun -- such as the bottom of the foot?

Melanoma can develop from sun exposure, but it can also develop if there is a family history. This means genetics plays a role in whether or not someone is at risk for getting melanoma.

In addition to sun exposure and family history, other risk factors include having multiple moles (both typical and atypical). An atypical mole (dysplastic nevi) looks different from a normal mole, and sometimes it can be hard to tell the difference between an atypical mole and early melanoma.

Over time, an atypical mole can run the risk of turning into melanoma.  Regular skin checks by a dermatologist are crucial for early detection and removal.

What are the ABCDEs of moles and skin cancer?

The ABCDEs of checking moles are a good way for someone at home to check his or her own moles.

A stands for asymmetry. If a mole is asymmetric, which means you can draw a line down the center and one half doesn’t look like the other, it should be checked.

B is for borders. If the borders look irregular, a doctor should be consulted.

C stands for color. If the color does not look homogenous or if there are different colors within the mole, it should be checked.

D is diameter. If a mole is greater than a pencil eraser size, it could be worrisome.

E stands for evolving. If a mole changes over time (color or size), it should be inspected as well.  

We recommend patients use the ABCDEs to check themselves at home, once a month.  Ideal time is after a shower. Just stand in front of a mirror and check under your arms, behind your neck, hands and feet, all the nooks and crannies – places one wouldn’t normally see or look.

Where are you from?

I am originally from Arkansas. I went to school in New Orleans, but my medical training has taken me all over the country -- from the South, to the West coast for training in California, then to Cleveland, Ohio.  I came to Columbia, Missouri for my fellowship, and finally here to Washington University in St. Louis.

Which particular award or achievement is most gratifying?

The time I spent serving in the military with dedicated sailors and Marines has been most gratifying. I had the fortunate opportunity to serve as a medical officer in the Navy. Stationed at the naval hospital in San Diego and then embedded into a Marine Corps unit based at Camp Pendleton. From there our unit was deployed overseas to the Middle East.

We did a humanitarian mission in Cambodia, and I was then stationed in Japan with the Marines as a medical officer.

As a medical officer, I had the opportunity to practice primary care, as well as preventative medicine and occupational health. It was important to teach young sailors and Marines to protect themselves from the sun, because we are now seeing older veterans with skin cancers due to sun exposure from many years ago. Most young people don’t think about sun protection – whether they are in the military or not.

It was an honor to travel with and take care of the Marines -- I have such respect for them. This was the greatest experience in my life, so far.

What is the best advice you’ve received?

The best advice I’ve received  was from one of my professors in medical school -- the advice was to  treat my patients as if they are family members and  also how I would want to be treated if I was the patient.  Show compassion and take the time to answer questions and make sure your patient understands the diagnosis and treatment.

If you weren’t a doctor, what would you like to be doing?

If I wasn’t a doctor, I would probably be an astronaut. I love science and always dreamed of going into the space program and becoming an astronaut who does experiments!

In college, I majored in engineering -- the thought processes between engineering and medicine are very similar. I enjoy the hard core science of taking a complex problem and making it more basic, in order to solve it.