This month’s famous person with skin disease is John McCain. Senator McCain has had four melanomas.
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.
To determine whether the cancer had spread to lymph nodes in his neck, the Mayo doctors injected a radioactive dye into the melanoma in a procedure known as a sentinel node biopsy hours before surgery. The doctors waited for the dye to flow in the lymph fluid to the node in the neck to which the cancer is statistically most likely to spread first.
Then they used a gamma counter – an instrument like a Geiger counter – to identify the node, and removed it. Pathologists quickly froze the tissue while Mr. McCain was on the operating table, looked at it through a microscope and did not detect cancerous cells.
The operation was performed mainly to determine whether the melanoma, a potentially fatal form of skin cancer, had spread from his left temple to a key lymph node in his neck; a preliminary pathology test at the time showed that it had not. But because such a test cannot be definitive, the surgeons, with Mr. McCain’s advance permission, removed the surrounding lymph nodes and part of the parotid gland, which produces saliva, in the same operation, which lasted five and a half hours. The final pathology analysis showed no evidence of spread of the melanoma, his staff said at the time.
The melanoma removed in 2000 was Stage IIa on a standard classification that makes Stage IV the most serious. For Stage IIa melanoma, the survival rate 10 years after diagnosis is about 65 percent. But the outlook is much better for patients like Mr. McCain, who have already survived more than seven years.
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.
No spread has been detected in the three or four dermatologic checkups Mr. McCain has undergone each year since 2000.
The Staff and Doctors at Minars Dermatology
In this issue
We realize that most of our “emergencies” in dermatology aren’t exactly heart attacks or strokes, but we still take them seriously. When its the Friday afternoon before a big date or a wedding and you have a giant pimple, we’re here for you. If all you need is a cortisone injection for that pimple or something else that is simple, just call us up and tell us and we can usually squeeze you in.