A doctor weighs in about McCain's health

I've gotten a number of emails from readers in the medical profession, sharing their concerns about John McCain's health. As Sam Donaldson said yesterday, McCain's confusion on a series of issues of late raises the "age question" again. It may not be politically correct to ask if John McCain is hiding information from the public about his mental status (senility, dementia, Alzheimer's) or about his cancer, but it's really something we can't ignore, especially now that McCain has chosen Sarah Palin as his VP, someone who would become president if McCain dies in office or is otherwise forced to step down.

One more thing. Let's not forget the highly suspicious manner in which McCain gave the public access to his medical records. He let only a handful of reporters review thousands of pages of records for 3 hours on a holiday weekend. That was it. No photocopies permitted, and once the timer is up, it's over. John McCain is treating legitimate concerns about whether he will survive in office, as if we're playing some grocery story game show in which you only get to keep what you can put in your cart before the bell goes off. We're talking about the presidency. It's still unfathomable that the media agreed to McCain's terms. Here is what I wrote at the time:

I just read that there are 1,173 pages of documents. In the three hours alloted, that's a whopping 10 seconds a page the reporters can spend. Yes, for three straight hours, imagine flipping a page every ten seconds, non-stop. Assuming they're taking notes, and they are, the time would double, conservatively, so they'd have 5 seconds a page. Yeah, real full disclosure.

Here's the email a reader sent me recently:

John,

I've been a long-time reader of the site and I thought you'd appreciate reading the email below that my Dad sent me this morning. My father is an older dermatologist (practicing for 35+ years) and is not at all prone to political activism. I was surprised, then, when he sent this to me -- both because he sent it at all, and then by the content.

McCain should release his entire set of medical for a full review, without any restrictions whatsoever. Please feel free to share this with your readers.

Regard.

The email my father sent me:

As a dermatologist, I'm particularly troubled by the lack of information that has been released by the McCain campaign about the malignant melanoma, or skin cancer, that was removed from McCain's left temple in 2000. I have spent considerable time researching this issue in an effort to compile complete information about McCain's lesion, to no avail. While I have been able to obtain some information, I have to the inexorable conclusion that critical information about this potentially deadly cancer remains missing from the public record.

This is what I have been able to learn: McCain has had four melanomas. Three of these were "in situ," i.e., very superficial, caught at the earliest stage they can be detected, and of no threat if removed upon discovery. However, the left temple melanoma at issue here, which was excised from an area of relatively thin skin, was described as being a Stage 2A lesion that was 2cm, 2.2mm in diameter. Further, it was HMB-45 and S-100 positive; these are special stains, which, if positive confirms the diagnosis of melanoma skin cancer. Despite finding this information, I could find no mention of the Breslow level of the lesion, which describes the depth of the lesion related to the micro-anatomy of the skin, nor could I find any or data about ulceration, mitotic rate, or other common markers that help determine a patient's prognosis after a serious episode such as McCain's in 2000. Because all of this data is a part of the standard pathology report about any melanoma, I can only conclude that the actual pathology report for this skin cancer was not released last spring, when reporters were allowed a few hours to review over 1,000 selected pages from McCain's medical records. The absence of this information is very troubling as this lesion still has significant potential to be life-threatening.

The prevailing statistics suggest a 10 year survival rate of 65% from malignant melanoma. "For patients with a melanoma like Mr. McCain's who remained free of the disease the first five years after the diagnosis, the probability of recurrence during the next five years was 14% and death 9%." (Lawrence K. Altman, MD, NY Times, March 3, 2008).

Remember, however, that the true depth of McCain's lesion in the thin skin of the temple (Breslow level) is not known. Thus, the potential for metastasis (that is, spreading of the skin cancer to internal organs) cannot be determined without more information. This information must have been available to his surgeons and given that McCain had a sentinel node biopsy evaluation (reported as negative) and the removal of an unknown number of lymph nodes from the left neck, (all also reported as negative for melanoma), it strongly suggests that the information his surgeons gave them cause for concern. The steps they took were are common unless there is a real concern about the possibility of spread at the time of biopsy. Metastases in melanoma may bypass the regional lymph nodes in any case.

Given the office he seeks and, particularly, his choice of running mate, the stated odds will be unacceptable to a significant number of voters.

The American public has every right to complete disclosure and an open discussion of McCain's potentially catastrophic health history.