In an ongoing campaign to hint that John McCain shouldn’t be president, the latest is a NYTimes article bringing up the “C” word:
On the Campaign Trail, Few Mentions of McCain’s Bout With Melanoma

The article then goes on to discuss McCain’s scars on his neck, his refusal to release more recent medical records, and hints that this is a very malignant form of cancer.

If you read down past the overwrought drama in the first few paragraphs, all the way down to paragraph eight you will find that the experts say his prognosis is good, and you get a nice discussion of melanoma.

Unlike the days when John Wayne went around saying he had beaten “The Big C”, and that surgery had cured his lung cancer, cancer treatments have changed.

Cancer is no longer a death sentence, and with new drugs and treatments being discovered all the time.

Let’s talk about Malignant melanoma.

For laypeople with the disease, or with a loved one who had melanoma, a good multimedia teaching session can be found HERE.

Most people know that moles that darken, grow, bleed or change in any way need to be taken off. That is because they might be skin cancer. Most skin cancers are the slow growing squamous cell or basal cell cancers, which start in the skin cells, and which rarely are fatal. This is not true for melanoma, which is cancer of the pigment forming cells in the skin. melanoma

Illustration from NIH webpage. Ugly, isn’t it? In fact, one old study showed artists could pick out the melanomas better than docs: Because of the characteristics. The NIH uses the “ABCD” list to teach people to recognize melanoma:

Asymmetry (irregular shape)Border (edges fuzzy)

Color (dark or mottled color)

Diameter (growing larger)

Last year, over 60,000 cases were diagnosed, and 8000 people died of that form of skin cancer.

But if you catch the cancer early, you can remove it surgically by taking out the cancer and a “wide margin” of skin nearby. That’s why McCain has scars: they had to cut a quarter to half inch of skin around the mole.

The reference to the neck scars means they were worried it had spread.

If you have a cancer that spreads, often the body’s first line of defense is the local lymph nodes (the “glands” that pop up in your neck when you have a sore throat are lymph nodes).

So back then, they would do a neck dissection to check the nodes and take out any they could find to make sure there was no cancer there.

That’s usually as far as I went when I was in practice. But things are changing fast, and presumably McCain, who is being treated in the Mayo Clinic in Scottsdale, will have the latest treatment if the disease should recur.

Indeed, the NYTimes article mentions that McCain has had four melanomas. Does he have Dysplastic Nevi syndrome? If so, more of the melanomas might get take off in the next few years. The good news is that since suspicious moles will be removed, the cure rate is good. The real danger is is one has moles (especially on the back) which don’t get taken off.

Most cancers are considered cured at five years. Melanoma is know to have rare “late recurrances” (especially in premenopausal women…it’s thought to be partly due to hormones), but those with pale skins also are at risk of new melanomas popping up, so doctors usually do a complete body exam to check and take off all suspicious lesions.

So am I worried about McCain’s health? Well, yes.

But I am old enough to remember when Ike has his stroke.

Even Bill Clinton had emergency bypass surgery shortly after he left the presidency for heart disease that in an earlier age might have killed him in his fifties.

So I agree: It is an article that needs to be discussed, but with a different headline.

Health problems are indeed important to discuss, but since one of the largest risk factors is family history, McCain’s quip that anyone worrying he is too old needs to talk to his 95 year old mother is indeed pertainent, because it suggests his family is a long lived one.


Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket, and she writes medical essays at Hey Doc Xanga Blog.

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