McCain's Skin Cancer History
Michael Yardley, chair of public affairs at the Mayo Clinic, issued the following statement on July 29 regarding a skin biopsy performed on Republican presidential candidate John McCain:
"Senator McCain visited the Mayo Clinic in Scottsdale, Arizona, yesterday for a routine check of his dermatological health. The biopsy that was performed did not show any evidence of skin cancer. No further treatment is necessary."
McCain's official Web site presents a detailed history of his skin cancer and treatment. McCain authorized the release of his medical information. According to Victor Trastek, MD, CEO of the Mayo Clinic in Arizona, the following three physicians comprise the team that has been primarily responsible for caring for McCain over the past several years at Mayo Clinic:
- John Eckstein, MD, a physician in Mayo's Internal Medicine division, has been caring for McCain for the past 16 years.
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Michael Hinni, MD, a surgeon in Mayo's Otolaryngology/Head and Neck Surgery department, performed Senator McCain's left lower temple melanoma surgery in August 2000.
- Suzanne Connolly, MD, a specialist in Mayo's Dermatology department, is McCain's dermatologist.
McCain has been a patient at Mayo Clinic since 1992. He had periodic comprehensive physical examinations during the 1990s and annual examinations since August 2000.
McCain had his most recent comprehensive evaluation in March 2008. He had a follow-up visit and tests in May. Following the May visit, Dr. Eckstein stated, "At the present time, Senator McCain enjoys excellent health and displays extraordinary energy. While it is impossible to predict any person's future health, today I can find no medical reason or problems that would preclude Senator McCain from fulfilling all the duties and obligations of president of the United States."
Dr. Eckstein said McCain has received skin care at Mayo Clinic in Arizona since August 2000. Dr. Eckstein's comments:
Four malignant melanomas were surgically removed in the past. Three of these were in situ melanomas, meaning they were limited to the top layers of the skin and were not invasive. These three early melanomas -- on his left shoulder, left arm and left nasal sidewall -- were removed in 1993, 2000 and 2002, respectively. A fourth melanoma that was invasive was removed from his left lower temple in 2000."
Each melanoma was a new primary melanoma and did not represent a recurrence of any previous melanoma. There was and is no evidence of recurrence or metastasis...of the invasive melanoma nearly eight years after surgery. Other less serious skin cancers have been removed over the years without complication. These have been non-melanoma basal cell and squamous cell cancers.
We continue to find no evidence of metastasis or recurrence of the invasive melanoma as we approach the eighth anniversary of that operation. This was most recently confirmed with his comprehensive examination and tests in March 2008 and with Dr. Connolly's skin examination on May 12, 2008. The prognosis for Senator McCain is good because the time of greatest risk for recurrence of invasive melanoma is within the first few years after the surgery.
Here is Dr. Hinni's summary of the surgical procedure that he performed on McCain in 2000:
In August 2000, following a 27 month absence from care at Mayo Clinic, Senator McCain was diagnosed with a melanoma that was 2.2 millimeters thick at its thickest part and was 2 centimeters across. This melanoma was located on the left lower temple region of the face.
Prior to surgery, numerous tests were performed, including CT scans, an MRI
scan of the brain, liver tests that included LDH, and there was no evidence that
the cancer had spread.
A comprehensive surgical procedure was done that included sentinel lymph
node biopsy, removal of the cutaneous melanoma and key lymph nodes, and
reconstruction of his left temple region.
A 2 centimeter margin of normal skin was removed around the 2 centimeter
melanoma, resulting in a 6 centimeter by 6 centimeter roughly circular wound
on the left side of the Senator's face. The underlying Parotid salivary gland was
also removed to assure a clear deep margin, to protect facial nerves from injury
and to remove the sentinel and other lymph nodes that were inside the Parotid
gland. None of Senator McCain's lymph nodes showed any evidence of
metastatic disease.
The large incision was necessary to safely remove all cancer with an
appropriate margin, resulting in a wound requiring sizeable reconstruction. This
explains why the large incision was made -- it was necessary so that a flap of
skin and soft tissue consistent with the color and texture of the Senator's facial
skin could be elevated and advanced/rotated into the wound.
To answer what appears to be numerous questions about the prominence of the
Senator's left jaw: This is a result of an absence of soft tissue on the face in
front of his ear that makes the masseter (the chewing muscle) over the jaw
appear more prominent. To be clear, the swelling is not due to any evidence of
cancer.
Here is Dr. Connolly's summary of the skin issues associated with McCain's care at Mayo Clinic:
Senator McCain's risk factors include light skin, light eyes and a history of excessive sun exposure. Senator McCain has no known family history of melanoma. He has few moles and he has no known history of atypical moles.
As Dr. Eckstein and Dr. Hinni stated, there has been no evidence of recurrence of the invasive melanoma on the left lower temple that was removed in 2000. I would repeat that the period of greatest risk for metastatic disease from that melanoma was within the first few years.
At the present time, the Senator has no evidence of melanoma; he continues to monitor his skin carefully; he comes in for a skin examination every 3-4 months; and he not only practices good habits of sun safety but also advocates them publicly.