John McCain and Skin Cancer
According to Reuters, Senator John McCain, who has suffered from skin cancer in the past, had a spot removed from his face on Monday during a routine checkup by a doctor in Phoenix. The Republican presidential candidate has already had four malignant melanomas -- a potentially lethal type of skin cancer -- surgically removed since 1993.
With election season heating up and election politics coming into full swing, skin cancer and melanoma may play a part in deciding on who is our next president. John McCain has been diagnosed with squamous cell carcinoma recently but more importantly has been a history of melanomas. The squamous cell carcinoma treated recently is a very common type of skin cancer appearing on sun damaged skin and is easily treated surgically and essentially cured. Melanoma, however, is a much more dangerous type of skin cancer and there will be discussion of this cancer as voters are concerned about the health of the candidates and want to know if the cancer can spread during the next several years. This is a valid concern and his personal physicians are discussing his health in the media. Let's talk a little more about his skin cancers so you can have more information to help you decide if this should affect your vote.
John McCain has had 4 tumors treated that are classified as melanoma. Three of these are diagnosed as "melanoma in-situ," indicating that they were diagnosed early in that they were superficial and did not penetrate into the deeper layers of the skin. This is important as melanoma in-situ is treated less aggressively as these do not spread to other parts of the body. The cancer that is the cause of cocern is the melanoma on his left cheek that was diagnosed and treated in 2000. This melanoma went fairly deep into the skin, with a depth of 2.2 mm. Because of this depth, it excised with wide margins and he had a lymph node dissection that showed that the cancer had not spread to the lymph nodes and presumably not to any other internal organs.
Because of these findings, it is classified as being stage 2, indicating that the tumor was greater than 2mm in depth without ulceration or spread to the lymph nodes or other organs.
The five year survival rate of this stage melanoma is about 80%. So should we be concerned for his health as a presidential candidate?
This is not an easy question with a clear cut answer.
Overall, younger people have a better prognosis than older people, women have a better prognosis than men, and melanomas on the limbs have a better prognosis than those on the face.
However, each individual is unique and the fact that he is cancer free 8 years later is a good sign that his deep melanoma is likely cured. But melanoma is deadly because it can reappear later without any warning on any internal organ. We hesitate to use the word "cured", as periodic tests are done to ascertain that there has been no spread although he appears to be "out of the woods."
Senator McCain will be monitored every 3 months with a full body skin exam to look for new or suspicious moles. It is curious that he has had multiple melanomas, as having as many as four melanomas diagnosed within several years is uncommon. This likely is the result of excessive sun exposure from when he was younger although there may be genetic and other environmental factors that remain unknown. Because his health is very closely monitored, I expect that any new skin cancer would be discovered at a very early stage. It is difficult to place odds on if he will develop new skin cancers or complications from the facial melanoma so it is not clear how and if this should affect his campaign.
Hopefully, we can also learn from his experience on how serious skin cancer can be and protect ourselves from the sun. Senator McCain is from a generation in which sunscreen and sun protection were not priorities, but we now know a lot more about the effects of the sun and ways in which to protect ourselves. So use sunscreen, avoid suntanning, and be a part of our democratic process and vote in November