Year of birth: 1955 This is a very interesting question leading to a very special story. Prof. Bernard Ackerman asked me the same question when I first entered his multi-head microscope room at NYU many years ago. At that time, I had just finished my residency in General Surgery in Italy. Despite my love for surgery, I quickly realized that a traditional hospital or university career was not my cup of tea. I craved more freedom and independence to take control of my career and express all my creativity and desire to write my own story. By sheer luck, while searching for articles in the medical library, I came across one of the first issues of the Journal of Dermatologic Surgery and Oncology (JDSO). It was the very first time I read about this subspecialty, and this ‘new’ Dermatologic Surgery intrigued me. What I read was quite a different kind of surgery. It was a kind of ‘miniature’ surgery that was performed under local anaesthesia, without the need for general anaesthetics or large operating theatres. It blended my passion for surgery with my desire for professional independence. I quickly realized that this was a turning point in my life. In the same issue of JDSO, I read an advertisement for an ISDS congress in London. Enthusiastic and eager to learn more about Dermatologic Surgery, I decided to attend and meet leading figures of this subspecialty. I was mesmerized by what I learned there: miniature surgeries, excisions, flaps, grafts, hair transplantation, nail surgery, chemical peels, blepharoplasties—all procedures that I felt I could easily handle with my surgical background. During a coffee break, I met Dr. Carl Vinciullo from Perth, Australia. He enthusiastically described a fascinating surgical technique to excise non-melanoma skin cancers under the guidance of meticulously organized microscopic mapping strategies. It was my first introduction to Mohs Micrographic Surgery. At that time, Carl was a Mohs fellow at NYU, working with Dr. Perry Robins, one of the first trainees of Dr. Frederick Mohs who pioneered the technique. His enthusiasm was contagious and what he described made absolute sense to my surgical mind. I asked Carl if I could visit him and Dr. Robins at NYU. Soon after the congress, I travelled to NYU and there I finally saw the light at the end of the tunnel. I wanted to become a Mohs Surgeon. Dr. Robins recognized my devotedness and was kind enough to mentor me. However, my histopathology skills, essential to reading slides during Mohs surgical excisions, were poor. Nonetheless, across from Dr. Robins' surgical office was Prof. Bernard Ackerman's, one of the world's most renowned dermatopathologists, who offered international fellowships. I applied and was accepted. On the first day, Prof. Ackerman asked all the fellows the same question: ‘Who are you, and what brought you here?’ I was the ‘odd one out’ when I replied that I was a general surgeon interested in Mohs surgery. However, he quickly recognized I was thinking outside the box and welcomed me warmly with a smile. Among the fellows in that room were future leaders such as Dr. Clay Cockerell (who subsequently became president of the AAD) and Dr. Hideko Kamino (who first described the so-called Kamino bodies (KB), found more numerous in Spitz's nevi and helpful in differentiating these lesions from melanomas). We all became friends and shared some awesome time learning and exploring New York. Since my first step into the legendary ‘7J’, Ackerman's world-famous microscope suite, I immediately felt like I belonged. Bernie became not only an excellent mentor but also a friend, accompanying me throughout my career with precious advice. Mohs surgery was just next door, and during breaks, I would observe Dr. Robins and Carl Vinciullo performing procedures, directly connecting what I had just learned under the microscope to real surgical practice. It was extraordinary. After an intense training period, Dr. Robins gave me the green light to perform Mohs surgery independently, and I returned to Italy. I had become a surgeon, a dermatopathologist and a Mohs surgeon, but something important was missing: I was not yet a dermatologist. At that time, dermatology residency programmes were not highly competitive, and a position was available at the University of Trieste, my hometown and where I had completed my medical studies and surgical training. Everything was falling into place. I felt very lucky! I began attending the Dermatology Department as an observing physician and quickly noticed an important gap: there was no dedicated dermatologic surgery service, and patients faced long delays for surgical care. I proposed establishing a dermatologic surgery unit within the department, and the chairman enthusiastically agreed. As I began my dermatology residency, I operated regularly and learned general clinical dermatology, which continued to fascinate me. My career was rewritten. I truly felt like I had found the place where I truly belonged. Over the years, I have had the privilege of learning from many outstanding teachers. Those who have had the greatest impact on my professional development include: A. Bernard Ackerman (USA)—Dermatopathology; Perry Robins (USA)—Mohs Surgery; Eckart Haneke (Germany)—Nail and General Dermatologic Surgery; Jay Barnett (USA)—Hair Transplantation and General Dermatologic Surgery; Richard Fitzpatrick and Mitchel Goldman (USA)—Laser Dermatology; Carl Vinciullo (Australia)—Laser Dermatology, Mohs and General Dermatologic Surgery; Michael Albom (USA)—Mohs Surgery; Thomas Alt (USA)—Aesthetic and Cosmetic Dermatologic Surgery; Regis Legré (France)—Hand Surgery; Pierre Fournier (France)—Liposuction and Aesthetic Surgery; Patrick Rabineau (France)—Hair Transplantation and Aesthetic Surgery; Ian Jackson (USA)—Plastic and Reconstructive Surgery; Glenn Jelks (USA)—Oculoplastic Reconstructive Surgery; Dan Backer (USA)—Plastic and Reconstructive Surgery; Barry Zide (USA)—Oral Plastic and Reconstructive Surgery; Darryl Hodkinson (Australia)—Aesthetic Plastic Surgery; Helmut Breuninger (Germany)—Slow Mohs' Surgery. A. Bernard Ackerman, Eckart Haneke, Richard Fitzpatrick, Perry Robins and Helmut Breuninger were undoubtedly my greatest teachers and mentors. Dr. John Richards from Augusta, Georgia (USA), who was an exceptional clinician and incredible medical entrepreneur, once told me: ‘Always give room to your curiosity and do what you feel good at. If you have the passion for what you do, do not be afraid of any obstacles, you will surely succeed’. We met while I was serving as Chief Medical Officer in the Italian Navy with the Multinational Force and Observers (MFO) in the Sinai Peninsula in 1983 and he was serving as a Major in the US Army. Observing the organization of the US medical team in such a remote desert land deeply impressed me. John invited me to visit him, and I discovered the vibrant medical world in the United States at that time. I returned home recharged and full of energetic enthusiasm. I knew I wanted to work in that kind of elite environment, and, if necessary, I was going to create such an environment in Italy. Marini, L. SPF-RR sequential photo-thermal fractional resurfacing and remodelling with the variable pulse Er:YAG laser and scanner-assisted Nd:YAG laser. J Cosmet Laser Ther. 2009 Dec;11(4):202–11. Marini, L., Odendaal D, Smirnyi S. Importance of scar prevention and treatment—an approach from wound care principles. Dermatol Surg. 2017 Jan;43(Suppl 1):S85–90. Marini L, Marini S, Cutlan J, Hreljac I. Q-S laser micro-drilling and multipass full-beam Q-S laser for tattoo removal - a case series. Lasers Med Sci. 2022 Apr;37(3):1763–71. Mitrofanoff L, Marini S, Marini L. Persistent eschar-like wound healing after Q-switched 1064 nm hybrid nanosecond-picosecond laser monochromatic tattoo removal: management and evolution. Lasers Med Sci. 2024 Jun 11;39(1):153. Kassirer S, Marini L, Zachary CB, Sarnoff DS, Landau M. Esthetic and medical tattooing: part I: tattooing techniques, implications, and adverse effects in healthy populations and special groups. J Am Acad Dermatol. 2025 Jul;93(1):1–15. I was the founder and first President of the European Society for Laser Dermatology (ESLD), and am now an Honorary Member of the Society. I am also co-founder and past treasurer of the European Society for Mohs Micrographic Surgery (ESMS), and currently serve as Advisor to the Board. In addition, I am co-founder and past president of the European Society for Cosmetic and Aesthetic Dermatology (ESCAD), honorary president of the Hellenic Society for Dermatologic Surgery (HSDS) and former chairman of the EADV Task Force for Laser and EBD Dermatology. My greatest achievement has been the planning, designing, and creation of SDC—The Skin Doctors Center of Trieste, an advanced day surgery clinic entirely dedicated to Dermatology and auxiliary specialties. I am a meticulous organizer and strong believer in the importance of functional ergonomics to facilitate and optimize efficient workflows within complex medical environments. After years of training and visiting prominent colleagues around the world, I collected many interesting strategies and practical insights. Each detail was carefully analysed and integrated as part of a complex puzzle that progressively led to a perfectly final picture. The proverb ‘the devil is in the details’ could not have been more appropriate. After nearly 5 years of planning and building, we opened the doors to our Skin Doctors' Center (SDC) on 17 September 2005. My family and I were exhausted but extremely happy. We wanted to celebrate this important milestone and so we held a small Congress on the morning of the official opening. Prof. Martino Neumann, Prof. Roland Kaufman and Prof. Peter Bjerring were among the invited speakers. Collecting genuinely positive comments was the perfect reward for all the work required. In 2025, we celebrated our twentieth anniversary, a true milestone. SDC has grown into a highly advanced clinical and educational center. It has hosted eight EADV teaching courses and many others, sponsored by different prestigious scientific societies, laser and EBD companies, not to mention the many observational trainings for colleagues coming from all over the world. Continuous learning and teaching have always been at the heart of our practice. The increasing complexity of medical and governmental bureaucracy, along with occasional professional rivalries can sometimes create unnecessary obstacles to the advancement of medical knowledge and to the spirit of collaboration among senior and junior colleagues, healthcare providers and patients alike. During my dermatology residency, the vice-chair of the Dermatology department prohibited the use of adrenaline in local anaesthetics. I never understood why, but that was the rule. At that time the University Clinic was not adequately equipped to perform advanced dermatologic surgery procedures, so I performed most of the surgical procedures, often using my own instruments, sutures and anaesthetics. One day, I was asked to prepare a patient for a procedure the vice-chair intended to perform. I used my own lidocaine 2% with epinephrine 1:200,000 and waited for him to arrive. When he began the incision and noticed minimal bleeding, he said to me, ‘See, you do not need epinephrine to work on a bloodless surgical field. It is just a matter of waiting the right amount of time’. What I enjoy most in my profession is discovering the best combination strategies to help my patients achieve the best possible outcomes. I also take great satisfaction in studying and understanding the many innovations continuously emerging on the dermatologic horizon. Equally rewarding is the opportunity to teach and share my experience with colleagues. Paul Gerson Unna, Moritz Kaposi, A. Bernard Ackerman, Otto Braun-Falco, Ferdinando Gianotti, Thomas B. Fitzpatrick, Albert Kligman, Stefania Jabłońska, Sheldon Pinnell and Leon Goldman. Günter Burg, Giuseppe Argenziano, Dieter Manstein, Merete Hædersdal, Lorenzo Cerroni, Jean-Hilaire Saurat, Helmut Kerl, Eckart Haneke, Thierry Passeron and Martino Neumann. Beyond dermatology, my major interests include history, military strategy, miniature modelling and tending to my kitchen garden. Among writers, I am particularly drawn to Ernest Hemingway, while in music I admire Richard Wagner. As for visual art, I am captivated by Gustav Klimt. The most recent discovery is advanced thermo-fractional laser-assisted PDT for preventive rejuvenation, non-melanoma skin cancer and chronic HPV warts. A perfect day is when you look in the mirror and see happiness reflected both inside and out. Dermatology is primarily a visual specialty, with extremely complex, dynamic interaction with the inner body organs. The ability to ‘read the messages’ conveyed by the skin requires many years of experience. AI will increasingly assist in interpreting these messages, proposing possible diagnoses and treatment options. One of the main challenges dermatologists will face in the near future is patients engaging in self-diagnosis and autonomously exploring treatment strategies, which may further complicate the already challenging patient–physician relationship in the age of ‘Dr. Google’. Automatic skin analysis will provide guidance on the best skincare options and even the optimal parameters for lasers and energy-based devices. Teaching and learning in dermatology will be revolutionized by this amazing technology. It will be essential to strike a careful and effective balance between human and AI dermatologists, ensuring that professional medical education remains strong despite the influence of uncontrolled social media. Robotic skin surgery is inevitable, but its widespread adoption will still require many years to come. AI-assisted dermatologic diagnosis and treatment. The key message I would give to my younger colleagues is to be passionate about what you do. When you are driven by passion, you can achieve success despite the odds. If you truly love your work, you will never feel as though you are working a single day in your life. *Note: The Pioneers in Dermatology and Venereology interview was conceived and conducted by Johannes Ring. None declared.
Leonardo Marini (Tue,) studied this question.