'Micrographic' skin cancer surgery coming to Nova Scotia

Dr. Robert Strang, Nova Scotia's chief medical officer of health, provides an update on COVID-19 during a news conference in Halifax on June 9, 2020.

HALIFAX — A skin cancer surgery that Nova Scotia's top public health official recently had to travel to receive is now approved for the province, and a Halifax dermatologist is planning to offer the procedure.

Dr. Michael Stevens said in an interview Monday that introducing Mohs surgery -- where thin layers of cancer-containing skin are progressively removed -- will help some patients avoid more invasive surgeries.

He said older, less precise forms of surgery may mean patients "eventually end up in radiation therapy, or some portion of a eye or ear may have to be removed."

The 46-year-old completed a fellowship focused on the procedure at the University of Toronto, under the tutelage of Dr. Christian Murray, a dermatologist and surgeon at Women's College Hospital. He then returned to Nova Scotia and lobbied for public funding of the procedure.

"It took me almost three years of constantly working at it to get a billing code approved, and that's working on it every week," Stevens said.

The Nova Scotia Health Authority agreed to provide a billing number for the procedure earlier this year, after approvals from the Health Department last fall.

The "micrographic" procedure, in use in Ontario for over three decades, removes tumours little by little, with dermatologists examining the tissue as it is removed until testing indicates the absence of cancer.

Stevens said it is the standard of care in most other parts of Canada, including in New Brunswick, and his practice is hoping to provide the surgery later this fall once equipment and space is prepared.

He said he has "verbal commitment" from the health agency to assist with the purchasing of the equipment, but the process has slowed due to the COVID-19 pandemic.

A spokeswoman for Nova Scotia's Health Department confirmed that Dr. Robert Strang, the province's chief medical officer of health, recently travelled to New Brunswick for the treatment.

Strang was absent from pandemic briefings during the mandatory 14-day isolation period that followed.

Murray said in an interview from his clinic in Toronto that while the approval in Nova Scotia is good news, issues of lengthy waiting lists remain across the country.

He predicts Stevens will quickly have large numbers of patients awaiting his service, as the medical community in the province recognizes Mohs surgery is the gold standard procedure to manage various skin cancers.

"It's saving money for the system because it's done in an outpatient clinic and it reduces the likelihood the patients have to come back for second and third operations if it's ineffective the first time," Murray said.

He said at his clinic -- the largest centre for the treatment in the country -- many patients were waiting nine months prior to the pandemic, and since the pandemic patients are facing a one-year wait.

The Health Department in Nova Scotia estimates about 1,000 patients annually will benefit from the service.

The physician fees associated with this procedure are approximately $700 per case, a department spokeswoman said in an email.

This report by The Canadian Press was first published June 22, 2020.