The NY Times on John McCain's malignant melanoma history

Senator John McCain, the presumptive Republican nominee for President, and I have a similar medical history. In a NY Times article yesterday, Lawrence K. Altman M.D reported the following.

Mr. McCain has had four (malignant) melanomas.

Until 2007 I was equal with the US Senator. I had four of these deadly skin cancers diagnosed in 1993-94. A fifth was located on me and biopsied in 2007.

Around 150,000 a year world-wide are diagnosed with melanoma. A little under 50,000 die of the disease every year. It is the most common cancer for women under the age of 30, second most common for women age 34 and under.

Multiple melanoma survivors aren’t that common. I’ve been an active participant in MM support groups for 12 years. I can count the people I know who have had more than one of these skin cancers diagnosed. Senator McCain is the only one I know to have a total equal to mine.

In 1993, he waited more than six months before seeking care after a Navy doctor recommended that he consult a dermatologist for a lesion on his left shoulder that turned out to be his first melanoma. It was excised and has not recurred.

Pathology tests showed that the two other melanomas — detected on his upper left arm in 2000 and on his nose in 2002 — were of the least dangerous kind, in situ. In that type the malignant cells are confined to the outer layer of skin.

The most serious melanoma was spotted on his temple in 2000 by the attending physician at the United States Capitol after it had escaped the eye of Mr. McCain’s personal physician at Mayo Clinic Scottsdale. (The Capitol physician also spotted another melanoma that was in situ.)
The melanoma on Mr. McCain’s left temple was 2 centimeters in diameter and 0.22 centimeters deep, and was fully excised with wide margins, 2 centimeters in each direction, his campaign staff said.

Two of the melanomas were in situ, which are very superficial and almost never(Wikipedia says 100% survival rate. I wouldn’t go out on that limb) a threat after their removal.

Dr. Altman’s article is most concerned with the 2000 melanoma. At 0.22 depth, it is a Clark Level II. Clark Levels are used for the degree of invasion of the MM into the patient’s skin. So far as Clarks go, .22 only penetrates into the second layer of skin. Of my five melanoma, three were .26 or less. What are the survival rates for this type of melanoma?

For patients with a melanoma like Mr. McCain’s who remained free of the disease for the first five years after diagnosis, the probability of recurrence during the next five years was 14 percent and death 9 percent, a study published in 1992 found.

The melanoma is almost eight years old. In 2000 Sen. McCain had surgery to have lymph nodes removed(This resulted in noticeable puffiness and scarring on his face still seen today), they tested negative.

Any oncologist will tell you, that a MM patient is never totally free or safe from having the disease come back. The statistics in the Senator’s case are strongly in his favor.

A member of Congress, New Mexico Rep. Steven Schiff, died of melanoma in 1998.

Since the above article came from the NY Times, some have considered this another ‘hit piece’ on the Senator. Ed Morissey writing-

Altman then launches into an indirect criticism of McCain for not releasing his medical records yet in this campaign. He released those records early in his previous campaign, but as Altman notes, that was because they were part of a public study on the health of former POWs. Altman fails to mention that no other candidate in this race has released medical records.

The criticism isn’t indirect. The article ends saying- “Mr. McCain is occasionally asked on the campaign trail about his age. But he is almost never asked about his health.”

Professor Bainbridge writes

The Times has taken the gloves off and is digging deep for mud to sling. Ironically, of course, McCain bashing by the Times at this point redounds to the Senator’s benefit. Lots of conservatives worried that McCain was too cozy with the liberal media. The Times is solving that problem for McCain. The people in the base who need to come around loathe the Times for its pretensions and biases. It’s the old “enemy of my enemy” story.

Even so, it’s damn shoddy journalism. I’ve known about Sen. McCain’s melanoma history, it isn’t common knowledge to the American public. I can recall next to no mention of it in this Presidential cycle. The Times article may have been overdue. Bringing the facts out to the public about a possible future President’s health and cancer history doesn’t seem like a hit piece to me but in depth reporting instead.

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