Sen. John McCain's battle with the most deadly type of skin cancer began in 1993, when doctors discovered and surgically removed a melanoma on his left arm. A second occurrence, in the middle of the 2000 Republican convention, became big news shortly after his first bid for the Republican nomination for president. Doctors removed the two new melanomas--one on his temple, another on his left arm--and at least one of his lymph nodes as well, likely to ensure that the cancer had not spread. The procedures were successful, though McCain's presidential run was not. He is having better luck this year. Now the likely GOP nominee for the 2008 election, McCain is quick to point out that he's been cancer-free for several years. Still, the possibility that he will be the next U.S. president has brought renewed attention to the potentially deadly disease.
Melanoma is the least common form of skin cancer but the most lethal. It has few treatments. It causes about 60,000 new cases of skin cancer each year, just 4 percent of all skin-cancer cases diagnosed. But it is responsible for more than half of all skin-cancer deaths annually--about 8,000. And while survival rates have steadily increased for melonomas detected early, it is an extremely challenging disease to treat in late stages. If the cancer spreads to distant sites in the body, like the liver, lungs and brains, the chance of survival becomes drastically worse. "In that situation, there's a high likelihood the patient would die from the melanoma," says Martin Weinstock, chairman of the American Cancer Society's skin-cancer advisory group and a dermatology professor at Brown University. Unlike many other common cancers, melanoma strikes at any age, occurring in younger as well as older patients. While rates do increase with aging, melanoma is still one of the most common cancers in adolescents and young adults.
Most of the risk factors for melanoma are unavoidable. Weinstock says the biggest three are family history, having many irregular moles and prior occurrences of melanoma. So McCain's two prior incidents of melanoma put him at increased risk of having a third. Exposure to sun, however, is the one important risk factor that patients can do a lot about. "The standard recommendation for anyone who has had a prior melanoma is to protect themselves from exposure to ultraviolet rays because it's the most important, avoidable risk factor we know about," says Weinstock. "It's not the only one, but [it] is the most important one that is avoidable."
Time of detection greatly effects melanoma's cure rate. At an early stage, when the melanoma is localized and thin, there's a good chance that simple surgery to remove the cancer will be an effective treatment. If the melanoma has exceeded a particular thickness, doctors will also regularly remove a sentinel lymph node to biopsy the area for evidence of melanoma, a procedure that McCain had after his melanoma was discovered in 2000. "That's become pretty common in recent years, just to check if the disease has spread to new areas." (The results of McCain's biopsy are unknown because his health records have not been made public. But it's assumed that the cancer had not spread.) Doctors are using a two-pronged approach to better treat melanoma: improving early detection techniques while also developing new technologies to treat late-stage melanoma that has spread to distant sites. In the meantime, Weinstock stresses the importance of protecting against UV exposure as a preventive measure and of regularly checking for unusual moles or suspicious spots that may be early signs of cancer. For more information on identifying possible melanomas, click here. For more information on skin cancer, check out the Web sites of the American Cancer Society or the Skin Cancer Foundation.