How Bad Is McCain's Melanoma?

By Sam Stein, Huffington Post. Posted October 3, 2008.

Over the last few weeks, the issues of John McCain's age and health have been pushed, with much resistance, back into the heart of the political discussion. Prompted in part by the selection of Sarah Palin as the Republican vice presidential candidate, the topic crested with the release of a political advertisement calling attention to McCain's history of skin cancer and the need for more information about his medical records.

Cable news stations were too skittish to run the spot, produced by Brave New PAC. CNN refused to air it, Fox's Bill O'Reilly called it shameful, and MSNBC, which initially aired the ad, reversed course and took it off the air.

All of which has come to the anger and befuddlement of Democrats as well as members of the medical community, both of whom ask a very basic question: what more important information is needed to elect a president other than his fitness for office?

"I don't see anything wrong with opening up the discussion," said Ronald Bronow, former chief of dermatology at Cedars-Sinai Medical Center in Los Angeles. "What we want to know is, what stage is this melanoma? Particularly with the prospect of the vice president becoming the president... If you are an objective physician, you have to be concerned about this."

With just weeks before election day, McCain's campaign says it has released all of the information needed to make a thorough assessment of his health, and then some. In late May, the Senator allowed the vetting of over 1,000 pages of his records that showed him in generally good condition despite having skin cancer eight years ago. But the process was far from transparent.

Dr. Sanjay Gupta, CNN's medical correspondent who was one of only a handful of reporters allowed into the review, summarized the problems to the Huffington Post:

"We were given three hours to go over 1,200 pages of records. That is a lot to go through. It was very sort of cloak and dagger and I'm sure they had their reasons. Given that I had my medical training, I was able to hone in on what it thought was important more quickly. But the pages weren't numbered, so I had no way of knowing what was missing... As a reporter I can only comment on what I saw but I can't say by any means that this was complete... As far as the secretiveness of it, what they said to us is that you can't take anything out of the room, but you could make notes. So it was a lot to go through in a short period of time."

Provided with only a scant review of the information, questions have begun to rise as to the danger of McCain's most recent bout with cancer. Bronow noted that there are two reports detailing the stage of McCain's latest (his fourth) bout with melanoma. One report put it at a stage 2a, which has a relatively high five-year survival rate; another put it at a stage 3b, which is much more dire in nature.

"As a dermatologist, if I hear about a stage three melanoma, I say 'My God this guy is walking on nails here," said Bronow. "There is that much difference between a stage 2 and a stage 3."

Asked to detail his notes, Gupta said the pathology report -- which lists the size and other attributes of the cancer removed -- indicated a stage 2a:

"It was 2 centimeters across, 0.22 centimeters deep, and not ulcerated, which gives him a 66 percent survival rate over ten years. Melanoma is a particularly aggressive cancer. Mainly because skin is the largest organ in the body it can spread to the lungs, liver and the brain... Most of the occurrences will occur right away. I am reassured by the fact that it has been eight years now and there hasn't been a reemergence of that melanoma."

And yet, the debate over the status of McCain's health is accompanied by a separate, equally significant argument: mainly, what level of medical disclosure should voters demand of presidential candidates? As Bronow noted, Barack Obama has given the public far less information on his health than McCain -- a one-page report detailing the last 21 years of care he has received.

"Let's have the same thing for him," he said. "Let's have a complete disclosure of everything. It isn't just McCain."

And as Gupta argued, there is something sadly ironic with the fact that physicians and airline pilots are required to release medical records, but not the would-be president of the United States.

"[Former Senator] Paul Tsongas -- when he ran for office in 1992, he was a cancer survivor at that point, but said he had been cured," recalled Gupta. "We now know that had he been elected to a second term, he would have died in office. It was Tsongas who went to Clinton and said we should really have a requirement for the release of physical and mental medical records. Which, looking back now, is pretty remarkable."

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