This is a reminder.

I've heard TV people make bad jokes about McCain's face. I guess they forgot why his face is this way.

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On the Campaign Trail, Few Mentions of McCain’s Bout With Melanoma

By LAWRENCE K. ALTMAN, M.D.
Published: March 9, 2008

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.

https://www.nytimes.com/2008/03/09/us/politics/09mccain.html



Doug Mills/The New York Times

Senator John McCain’s puffy left check is a cosmetic reminder of his cancer surgery in 2000.

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. Mr. McCain, of Arizona, has said he did not need chemotherapy or radiation.

In 1999, during Mr. McCain’s first race for president, he gave the public an extraordinary look at his medical history — 1,500 pages of medical and psychiatric records that were amassed as part of a United States Navy project to gauge the health of former prisoners of war. This reporter, who is a physician, interviewed the senator’s doctors in 1999 with his permission.



Michael Chow/The Arizona Republic, via Associated Press

Mr. McCain with his wife after having a melanoma removed from his nose in 2002. It was one of four he has had.

But this time around, Mr. McCain has yet to make his full medical records or his physicians available to reporters. At least three times since March 2007, campaign officials have told The New York Times that they would provide the detailed information about his current state of health, but they have not done so. The campaign now says it expects to release the information in April.

So Mr. McCain’s prognosis for the recurrence of melanoma can be gauged only by talking to experts not connected with his case. Those experts say his prospects appear favorable.

The melanoma removed in 2000 was Stage IIa on a standard classification that makes Stage IV the most serious. For Stage IIa melanoma, the survival rate 10 years after diagnosis is about 65 percent. But the outlook is much better for patients like Mr. McCain, who have already survived more than seven years.

For patients with a melanoma like Mr. McCain’s who remained free of the disease for the first five years after diagnosis, the probability of recurrence during the next five years was 14 percent and death 9 percent, a study published in 1992 found.

No spread has been detected in the three or four dermatologic checkups Mr. McCain has undergone each year since 2000, stress tests show no evidence of heart disease, and “his doctors consider him in very good health,” his campaign staff said in a recent statement.

The campaign also said Mr. McCain regularly took Vytorin to lower his cholesterol, a baby aspirin to help prevent heart attacks, a multivitamin and, occasionally, Claritin or Flonase for allergies.

Mr. McCain has proved resilient in the past, surviving serious injuries that he sustained when his airplane was shot down over Vietnam and then when he was captured, and sometimes tortured, as a prisoner of war for five and a half years.

Now he is hoping to be the oldest man ever elected to a first term as president. Even if the melanoma returns, he would not be the first sitting president to have had cancer.

From what information Mr. McCain has disclosed, he is at increased risk for melanoma and other skin cancers because of his medical history, fair skin and prolonged sun exposure at a young age — long before the wide use of sunscreen.

Since the 2008 campaign began, doctors not connected with Mr. McCain’s case have expressed intense interest in the extent of the face and neck surgery that he underwent on Aug. 19, 2000, at the Mayo Clinic Scottsdale in Arizona.

Some of these doctors have noted in e-mail messages and in comments to reporters that the surgery appeared to be so extensive that they were surprised his melanoma was not more serious — perhaps Stage III, which would give him a bleaker prognosis. These doctors said they would be surprised to learn that such an operation would be performed without evidence that the melanoma had spread.

But a number of melanoma experts said in interviews that such an operation was understandable according to the medical standards of 2000 and that the extensive surgery did not necessarily imply Stage III melanoma.

“It was not out of line,” said one of the experts, Dr. Richard L. Shapiro, a melanoma surgeon at New York University. Dr. Shapiro added that he would feel more comfortable in making a judgment if he saw a full pathology report.

“It was a complex problem,” he said, “that was handled very skillfully by a team of experts.”

Michael Cooper contributed reporting.

https://www.nytimes.com/2008/03/09/us/politics/09mccain.html