Cookie Dubney didn鈥檛 like hearing she had skin cancer on her face, in the corner of her eye.
The James Bay resident was even less impressed to discover she needed a Mohs surgeon to remove it 鈥� and because there are none on Vancouver Island and just three in Vancouver, the waiting list is about 12 months long.
鈥淵ou don鈥檛 wait for something that is cancerous, especially on your face and near your eye,鈥� Dubney said.
In Mohs surgery, developed in the 1930s by a general surgeon named Frederic E. Mohs, a surgeon removes thin layers of cancerous tissue and evaluates each layer, while the patient waits, to locate the depth and border of the cancer. This method of removal spares as much healthy tissue as possible.
Conversely, when a skin cancer is removed by a plastic surgeon, a wide margin section is excised in the hope of capturing all the cancer and then some.
In sa国际传媒, there are 17 practitioners certified to perform Mohs micrographic surgery by the American College of Mohs Surgery, which is the world regulatory body. Sixteen of the practitioners are Fellows of the Royal College of Physicians certified in dermatology, according to the Skin Care Surgery Centre in Vancouver.
In sa国际传媒, publicly-funded Mohs surgery is performed at the Skin Care Centre behind Vancouver General Hospital. Most Mohs surgery is out-patient surgery performed in a clinic.
Victoria dermatologist Dr. Mark Lupin said the wait to see a Mohs surgeon is about 10 to 12 months.
Lupin, who has worked as a mathematician for NASA's space program, said simple math shows that an increasing incidence of skin cancer against a shortage of dermatologists and Mohs surgeons is not serving patients well.
Skin cancer patients requiring Mohs surgery have to go out of province or out of the country, Lupin said. Ideally, patients should be followed by the dermatologist/surgeon who performed the surgery.
Dubney, 79, started doing her homework and found a Calgary Mohs surgeon. She also looked in the U.S. and was considering going to Toronto.
She said she鈥檚 privileged to be able to consider options that others on a restricted income couldn鈥檛 afford. The government offers a ferry pass and a special rate at a nearby hotel for those getting Mohs surgery in Vancouver, she said.
Meanwhile, Dubney was put on the waiting list in Vancouver.
鈥淲hat else do you do?鈥� she said.
One day the 鈥渟tars lined up鈥� and a cancellation meant she waited only three months. She was seen in March.
鈥淚 think skin cancers and melanomas have to be the most underrated cancers and I don鈥檛 know why,鈥� Dubney said.
Originally from Montreal, Dubney was well acquainted with the story of former Quebec premier Robert Bourassa, who died in 1996 of a malignant melanoma.
Dubney said she asked what would happen if she waited indefinitely for her skin cancer to be removed and was told it could grow into her eye, tear duct or the bone and spread.
鈥淚t鈥檚 very scary because you don鈥檛 know where to turn,鈥� Dubney said. Her husband Jack had a melanoma about 25 years ago and is now checked regularly.
鈥淚 feel very fortunate being connected with Dr. Lupin. That whole office is very vigilant with me and my husband,鈥� she said.
Lupin said the statistics should speak for themselves and the government should listen. 鈥淚t鈥檚 a crisis when a doctor has to tell a patient with a growing cancer, usually on the face, there is a 10- to 12-month wait list for Mohs surgery,鈥� Lupin said.
Plastic surgery is an option, but cosmetic disfigurement and large facial scars cause further distress for patients, he said.
Life-threatening melanomas are not always the easily diagnosed 鈥渦gly duckling鈥� moles people imagine them to be, Lupin said. Instead, these pigmented lesions can be flat rather than raised and colourless rather than dark brown.
Each year in Victoria there鈥檚 a free skin cancer screening clinic held as part of Sun Awareness Week. During those, Lupin said he always finds skin cancers.
If there were more dermatologists and more routine screening, more could be detected earlier, Lupin said.
Dubney鈥檚 scar is healing and, this past week, she was able to put her eyeglasses back on. She鈥檚 hoping to get followup care from Lupin to save her from having to return to Vancouver.
鈥� Cindy E. Harnett
