patient story

patient name: Rudy Kash

age: 13

condition: giant congenital melanocytic nevi

seen in: plastic and reconstructive surgery

providers: Salim Mancho, DO, FACS

Rudy Kash is not just your typical 13-year-old—he's a boy with a fearless spirit and an unbreakable will. His days are filled with swimming, soccer, and a thirst for adventure. But behind Rudy's energetic smile lies a story of resilience, courage, and an extraordinary partnership with Dayton Children’s Hospital that changed his life.

In 2011, Rudy was born with a very large, bloody and black birthmark on his arm and his parents’ joy quickly turned to fear not knowing what the future would hold for him.

Diagnosed with Giant Congenital Melanocytic Nevi (GCMN)—a rare condition characterized by dark patches of skin—Rudy’s journey began with a series of challenges that no parent could have prepared for. The initial diagnosis left the family grappling with uncertainty, as the size and nature of the nevi not only altered Rudy's appearance but also posed a risk of cancer.

With multiple surgeries at an out-of-town hospital, all before Rudy’s first birthday, the goal was to remove the nevi and allow Rudy to thrive like any other child. But by the time Rudy was six years old, his mom, Molly, realized that the “fix” for the birthmark was causing mobility issues and knew this was going to be a major problem that had to be fixed.

“I realized then that I needed to take control of his care. I researched and researched, but none of the doctors we met connected with Rudy or with us. We needed a partnership between a medical team and our family for Rudy's benefit, and until then, we hadn’t found that,” Molly explained.

finding care close to home

Molly interviewed eleven different surgeons in Chicago, Boston, Cleveland, New York City and beyond. While Molly believed each surgeon was capable and she knew they would have done a good job, she didn't feel the connection she was looking for.

Finally, with a recommendation that led the Kash family to their local pediatric hospital, Dayton Children’s, they met the extremely skilled plastic and reconstructive surgeon – Salim Mancho, DO, FACS.

From the moment Dr. Mancho entered the room, it was clear that this time would be different. Rudy’s eyes lit up, and for the first time, the family felt a sense of hope and reassurance. They had found what mattered most - a partner in Rudy’s care.

"I didn't think there was any way our local hospital would be able to do it," said Molly. "To know that there is this level of expertise and care right in our community at Dayton Children's is amazing!"

starting treatment at Dayton Children's

In October 2017, Rudy began his treatment with Dr. Mancho. Rudy's first procedure was tissue expansion, where an empty implant known as a tissue expander was placed under the skin of Rudy's back. The goal over time was to fill the implant with saline to stretch the skin and cause it to grow. The new skin would be used to reconstruct the area on Rudy's arm that was causing mobility issues. The process was complex, but Molly and her husband, Jeff, were confident that the care team would navigate any obstacles.

Unfortunately, Rudy developed an infection causing the new skin to die and Dr. Mancho had to remove the expanders. Molly remembers Dr. Mancho sitting on the sofa in Rudy's hospital room with his head in his hands. It was in the moment Molly knew that he was just as invested in Rudy's journey as their family was.

Over the next year, Rudy’s body recovered, and in October 2018, they restarted the tissue expander process. This time around the process was a success!

fulfilling a dream

From the beginning, Dr. Mancho put the family at ease, emphasizing that Rudy’s care team and family were in this journey together. He and the team allowed Rudy to be himself throughout the entire process. “Anytime we walk into Dayton Children’s they greet him and you can just feel the level of care and compassion,” Molly said.

While the skin was growing, Rudy had a chance to fulfill a dream—swimming in the Pacific Ocean—during a work trip to Los Angeles with Molly. Dr. Mancho and his team cleared him for the trip, creating a cherished memory for Rudy and his mom. “One of my favorite memories is seeing his little face smiling and laughing as he swam and jumped the waves,” Molly shared.

treatment continues

In March 2019, Rudy had flap reconstruction surgery. During this surgery, Dr. Mancho removed the healthy, new skin Rudy grew with his tissue expander and relocated it to the area on Rudy's arm that required reconstruction. While complications occurred, Dr. Mancho and the team persisted, ultimately attaching skin to repair Rudy's arm.

Although Rudy's arm was repaired, he now had a void on his back where the skin had been removed and relocated to his arm. Rudy's back reconstruction was not an urgent matter, and it would be a much easier process than that of his arm, so they decided to give his body time to heal before any more surgeries.

In fall 2022, Rudy was growing so fast that his back needed to be repaired. Taking the knowledge gained from the last few years, Rudy’s care team and family applied it to reduce complications as Dr. Mancho started tissue expanders again.

Rudy had some complications along the way but knowing that swimming during the upcoming Memorial Day weekend mattered most to Rudy then, Dr. Mancho managed to get him patched up in time!

bonding through care

The bond between Dr. Macho and Rudy is strong. Although visiting hospitals is not new territory for Rudy, he has never spoken a word to his doctors. Molly shared it was Rudy’s way of controlling something in the situation. However, despite not speaking, they developed a close bond with lots of laughter filling the halls when they are together.

Rudy spoke his first words to Dr. Mancho in October 2022, when he said, "Hi, how are you?". Dr. Mancho's eyes widened in shock, but he just played along and talked like old friends.

“Dr. Mancho is amazing, and I respect him so much for all that he did for Rudy. He never once gave up, and Rudy was always at the center of care. I’m not sure where we would be without him,” Molly said. “We were a team from the start, and I count Dr. Mancho as a friend.”

what mattered most

As an active kid and the youngest of four kids, Rudy loves to be in the mix with his older siblings. During this entire process, it mattered most to Molly that Rudy would be able to a maintain a typical life, even with tissue expanders and a wound vac in place. She wanted him to be confident and happy with minimal restrictions on his day-to-day activity.

Dr. Mancho listened and made sure Rudy's active lifestyle was not affected by the reconstruction of his arm. He would even make casts that allowed Rudy to climb trees and dig in dirt while keeping him protected.

Rudy wears his scars like a badge of honor. For many years, no matter the weather, he would wear a tank top and proudly show them off. “Whenever someone asks about them, he always says ‘I was bit by a shark,’” Molly said, laughing.

Rudy has been in the operating room 46 times in his life, yet he has zero fears about going to the hospital thanks to Dr. Mancho and the entire surgery department. Dayton Children's is no longer a place he is afraid to visit. He will need additional surgeries in the future, but for now Rudy is enjoying life to the fullest – playing soccer, joining the swim team for the first time and many more adventures!

"I am beyond grateful that we found Dr. Mancho and Dayton Children's," said Molly. "Our community is so lucky to have the expertise and resources of Dayton Children's right here in our own backyard."

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