Baseball Caps and Sunscreen: McCain's Melanoma Cover-Up

Editor's note: On Monday, July 28th John McCain said a blemish was removed from his face during a physical examination The mole-like spot was discovered during the Arizona senator's routine three-month examination, which he undergoes because he has a history of skin cancer. This article offers larger context on McCain's case, and the dangers of melanoma.

When John McCain rode an airboat through the sun-drenched Florida Everglades in June, he was sure to lather up with plenty of sunscreen (SPF-30 is his preference) and wear a baseball cap. For someone with his melanoma history, this was poor preventive medicine. In a UVA-saturated wetland, this outfit made him vulnerable for more melanomas on his face, neck, hands and other exposed areas.

In fact, the most effective preventive sunscreen is not found in an expensive 6-ounce bottle, which generally offers little or no melanoma protection. It is simple avoidance of the sun between 10 a.m. and 4 p.m., proper clothing and eyewear, wide-brimmed hats (4 inches or more) and shady structures.

The facts are readily before us. McCain's cherished SPF-30 rating is meaningless when it comes to melanoma. The SPF rating scale applies only to ultraviolet-B radiation (290 to 320 nanometers along the sun's spectrum), which causes red sunburn and is a major contributor to the more easily curable basal and squamous cell skin cancers. However, the consensus of biomedical research and opinion is that melanoma is strongly related to exposure to ultraviolet radiation type A (UVA), the long solar waves (320 to 400 nanometers along the sun's spectrum) that travel beneath the skin's surface to damage melanocytes, the pigment-making cells.

And McCain's baseball cap won't protect against either type. According to the National Cancer Institute, baseball caps are insufficient sun protectors because they "do not fully protect the face, neck, and ears." The NCI is actively trying to dissuade people from using them, urging instead the use of big hats or draped baseball caps.

McCain's activities may have cost him his life (as we'll discuss), and more importantly, they may contribute to the loss of thousands of lives for those who emulate his behavior. As the most well-known melanoma victim of our times, McCain's decision to shun the best sun-smart policies, noted below, sets a very bad example.

But McCain apparently doesn't know, doesn't care, or just doesn't want to draw attention to his disease by donning a showy 4-inch wide-brimmed hat for his ongoing public appearances. One can speculate on reasons why. Fashion is a form of communication, and politicians want to communicate that they are fit and healthy. They do not want to communicate that they are a cancer victim or a worrywart.

A wide-brimmed hat, unlike the hip-hop baseball cap, may not be perceived as being "cool." The broad hat breaks a cultural denial mechanism. It's apparently far too risky, from a public relations standpoint, to send a non-macho "I fear the sun" message. For McCain, apparently, image politics trumps public health.

What's Covered Up

Melanoma is one of the fastest-growing cancers of our time. If not caught early, there's a good chance that it will metastasize and kill you. So far it might have been caught early enough for Troy Aikman, Sam Donaldson and McCain (but we cannot know for sure). But sadly it was not for Maureen Reagan, Bob Marley or rising folk musician Eva Cassidy, gone at 33. The problem with melanoma is that it is a very tricky and unpredictable cancer that can silently metastasize to the lungs and brain (common targets) years, even decades, after the original tumor was excised from the skin. The absolute key is prevention.

In 1930 melanoma was rare, with a lifetime risk of just one in 1,500 people. Since then, it has grown exponentially, with a lifetime risk in the United States of 1 in 250 in 1980, 1 in 120 in 1987, 1 in 75 by 2000 and 1 in 32 in 2007. Worldwide, it annually strikes an estimated 132,000 people with an estimated 48,000 deaths.