JL, an M.D., sent me the following NYT article from earlier this year, and then commented on it. Here is the excerpt from the article that JL suggested we note:
Along with his signature bright white hair, the most striking aspects of Senator John McCain’s physical appearance are his puffy left cheek and the scar that runs down the back of his neck.JL then wrote me the following:
The marks are cosmetic reminders of the melanoma surgery he underwent in August 2000. Mr. McCain, the presumptive Republican presidential nominee, sometimes tells audiences that he has “more scars than Frankenstein.”
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.
When a surgeon takes a node, or any tissue for biopsy, there is always an initial or preliminary path test. That's usually called a frozen section, it's done while the patient is in surgery and gives the surgeon info as to whether or not he or she has to go further. But it's the final path report that counts; that's the one that is done with more precision. Just as all x-rays have a first "wet read" and then a 2nd final read, biopsies similarly have a frozen section or quick assessment and then a 2nd more thorough assessment. The two reports usually agree. If they don't, it's the 2nd one, not the preliminary, that is the final say.
Now, as for this line in the NYT article: "The final pathology analysis showed no evidence of spread of the melanoma, his staff said at the time." That does seem definitive, but, do those who say no spread, mean no spread to the parotid gland? A spread there, by the way, would be a continguous spread, not a metastatic one. Or do they mean "no evidence of cancer in the lymph nodes"? The fact that the ct scan and chest xray show nothing is great for McCain, but those tests don't pick up small small subtle spread that could be showing up now. What about a ct now? A cxr now? Bottom line: 50% of people with satellite lesions survive to 5 years. The odds DO NOT get better at 10. Thats so different than breast cancer for instance where the longer you survive, the better your chances get.
We need to see the final path reports on the removed lymph nodes. Obviously the doctors were concerned enough that they did an invasive biopsy into the area of his left cheek/temple. His doctors are hedging their answers when they say, he's fine for now, or we see no evidence of metastatic disease now -- and that if they had seen it they would've treated it. But that was a very serious and deep enough lesion (at 2.2) to have them do such an invasive surgery. Furthermore, if the node was positive they would not necessarily have offered treatment before they had evidence of actual disease. The treatment is debilitating and severe. We need to see the medical records.
In medicine, the rule is: You look for one explanation that covers all the phenomena, before you look for three explanations. The chances of two unrelated melanomas next to each other [McCain had two melanomas, side by side, removed in 2000], when several of the commenting physicians are thinking satellite... it's unlikely that the side-by-side melanomas are unrelated.
Second, the mets (metastatic sites) from melanoma do not show up on the skin, that's not the worry. They metastatize to liver, lung, brain -- very often brain. From what I've seen, there was no official determination that is was not a satellite melanoma. Assigning a "stage" to a patient's cancer is a way to organize the data from thousands of patients and predict for your patient. But its not like the inside of a clock where the pieces are all there. When someone has a satellite lesion, the Stage IIA standard predictions are not the same as someone with simply a Stage IIA lesion (I believe that's what they gave him?) without the satellite lesion.
The significance of a satellite melanoma is that it puts him in a more serious, poor prognostic category.
WE NEED THE PATH REPORTS.
WE SHOULDN'T BE GUESSING ABOUT SOMEONE WHO IS GOING TO BE PRESIDENT.
WHY ARE WE GUESSING?
I wouldn't fly on an airplane with a pilot 10 years post melanoma who had not been followed/staged/ examined because he might seize and the FAA wouldn't let him fly as far as I know.
