'A huge game changer': Facial skin cancer patients thrilled to get world-class surgery in N.S.

For three years, Debbie Clark has been battling basal cell carcinoma, a stubborn cancer that keeps attacking her face — especially around her left eyebrow where a pimple-sized bump is now growing.

"I'm looking in the mirror and it's like, is this getting bigger? It's awful itchy," said Clark, in an interview from her home in Halifax last week. 

"Time goes on and you start to think, 'OK, am I going to lose part of my face?'" 

Relief from constant worry is coming for her and hundreds of other Nova Scotians who have basal cell or squamous cell carcinoma, the two most common cancers in Canada. While basal cell carcinoma can be disfiguring, squamous cell can also be fatal if left unchecked.

For these two skin cancers on the face, Mohs micrographic surgery will soon be available in the province.

The treatment harnesses the power of surgery and pathology to detect and remove even the tiniest specks of cancer, allowing reconstructive surgery to happen —all within the same appointment.

It's considered the gold standard in care because invasive cutting is minimized. And on the nose, eyelid, or ear, sparing even a few millimetres of tissue can make a big difference in appearance and function.

'Not a bells-and-whistles-type service'

"We're ready to go," said Dr. Michael Stevens at his clinic in Bedford, N.S., where he will perform the procedure. "We're hopefully weeks away with the start date, [it's] certainly this fall."

Special equipment recently arrived: two cryostat machines that freeze and slice tissue, a dyeing machine that stains the cancerous cells, and a high-powered microscope to look at the entire margin of tissue.

Many patients in Nova Scotia undergo conventional surgery, which involves aggressive cutting to try to get all the cancer. That's followed by weeks of waiting for results from a pathology report, and then, as is often the case, going back to try to remove missed cancer.

Stevens says for first-occurrence cancer, Mohs surgery has a "99 per cent cure rate, so not a hundred per cent. Nothing is a hundred per cent."

"Not to be too dramatic, but it's sort of like turning on the lights in the room, being able to see what you're doing when you're doing surgery," he said.

Getting here took four years. Stevens's dream of bringing the treatment to his native province began after learning about it during a medical school rotation in Saint John, N.B. He completed advanced training in Toronto, where Mohs surgery has been standard care for about 30 years.

While it's considered the best care, "it's not a bells-and-whistles-type service," he said. With more Nova Scotians being touched with basal cell carcinoma than any other cancer, "to have the standard of care for dealing with those cancers in tricky areas, I think is going to be great."

'Honestly, it's a big relief'

He rallied the medical community to support his bid to have the Nova Scotia government approve the new treatment, create an MSI billing code, and develop a clinic with a long-term plan. 

"Honestly, it's a big relief for me to finally have the ability to offer that service."

His plan is to see four patients a day, gradually moving up seven. He estimates about 1,200 to 1,600 Nova Scotians will require the procedure each year, but he only expects to operate on at least 1,000 of them.

The need was highlighted when a patient went public about Nova Scotia's lower quality of care compared to other provinces.

It was underscored by the province's chief medical officer of health who revealed in June — in the midst of the pandemic lockdown — he was travelling to New Brunswick for the procedure and would need to self-isolate for 14 days. About 40 patients were referred there for treatment in 2017-18.

There are only about 20 Mohs surgeons in the country, and Stevens is the only one in Nova Scotia. While waiting for approvals to come through, he's kept his pathology skills sharp by spending time at New Brunswick's Mohs surgical clinics reviewing slides under the microscope. 

Stevens says he's now at the final stages of starting up — hiring operating room nurses and a histotechnologist.

Debbie Clark is hoping to be among the first Mohs surgical patients in Nova Scotia.

"It's a huge game-changer because you know that it's going to be dealt with and taken care of and then hopefully that's it."

The 62-year-old has been riding an emotional roller coaster for three years ever since cancer appeared on her eyebrow. At first it was treated with liquid nitrogen, but a tumour grew back which was removed by a plastic surgeon. 

But the cancer returned, and there was another operation last fall. A pathology report came back showing that cancerous spots were missed.

Clark was placed on a five-month wait list for Mohs surgery in Saint John, but two days before her operation in March, the procedure was cancelled due to COVID-19. She lost $2,000 in airplane tickets for her and her son, and feared Nova Scotia's "hold up was just going to go on forever."

She's still keeping an eye on the lump on her brow but finally, there's hope close to home — and soon.

"I'm just thrilled that people are going to be able to get the procedure here in Nova Scotia and not have to jump through hoops," she said.

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