McCain wrong to hold back biopsy details

The history of American presidential campaigns is punctuated by examples of candidates’ medical problems hidden from the public — the ominous physical condition of Franklin D. Roosevelt as he campaigned for a fourth term, the presence of Addison’s disease in John F. Kennedy, the true extent of Paul Tsongas’ non-Hodgkins lymphoma that killed him two days before he would have completed his first term, had he been elected president. Now we have the case of John McCain, who has kept the curtain closed on the finer details of his 2000 surgery for melanoma, his fourth bout with this dreaded form of cancer. McCain’s cancer raises two crucial questions: What do the American people deserve to know about the health of their presidential candidates? And what does the American voter need to know about this particular form of cancer before casting a ballot on Nov. 4?

In its most benign form, melanoma can be successfully treated. But in its invasive form, melanoma is very often a death sentence. This is why it is imperative that the American people know the details regarding the invasive melanoma on John McCain’s left temple. Although McCain permitted reporters to spend three hours with his medical records earlier this year, what he has released fails to provide enough information to evaluate his risk of this most serious cancer. And only by knowing these details is it possible to evaluate the true threat of a malignancy that could cause McCain to become disabled or even die while in office.

The outlook for recovery or progression depends on the stage of the cancer at diagnosis. There are five precisely defined ranks. These ranks measure the extent of invasion of cancerous cells from the first layer of skin, the epidermis, into the second layer of skin, the dermis, and from there into the subcutaneous fat below, to the fascia, the connective tissue beneath the fat.

Stage 0 is known as melanoma in situ, which means that the malignant cells are confined to the epidermis. Three of McCain’s melanomas were all confirmed as stage 0, according to pathology reports made public. These melanomas are considered cured by the excisions that he underwent. Within the public domain, however, there are currently no detailed pathology reports that rule out the more lethal forms of melanoma or reveal the extent of McCain’s invasive melanoma.

According to published reports, McCain’s doctors said the melanoma removed from his temple was stage IIa, approximately 2.2 millimeters thick. A sentinel node biopsy was performed in the lymph nodes in his neck. These records also indicate that lymph nodes were removed. Some physicians have suggested this treatment was more consistent with stage III melanoma, which occurs when cancerous cells have spread to the regional lymph nodes. I agree.

After surgery, McCain’s staff said that pathology reports showed that the cancer had not spread. McCain has had no recurrence of the cancer found in his neck since then, according to his doctors. What is not known is the actual results of the biopsy examination of the sentinel node and the numbers, if any, of malignant cells in those nodes.

This information is vital because for every 100 people with melanoma cells in all of the removed regional lymph nodes, 70 will not be living at the end of five years. The chance of the cancer spreading after five years is significant. And spread to distant sites may occur even if the regional lymph nodes are not involved. Melanoma is also the cancer with the highest rate of brain metastases.

If his melanoma was a stage IIa, then McCain should release the pathology reports themselves, not just his doctors’ comments about them, so that the American people can make a judgment about this. It is not enough to claim that the pathology reports were consistent with the staging that was reported. If the pathology reports confirm that, why is McCain reluctant to release the actual reports for assessment by authorities on melanoma other than his own doctors, who no doubt are excellent physicians but have patient confidentiality concerns that may limit what they can release to the public?

McCain should release these details. Otherwise, the only reasonable assumption voters can make is the worst.

• Dr. Dan Mackey, an Atlanta resident, is a retired professor of dermatology at Emory University School of Medicine.