Like most modern presidential races, this year's campaign has given us its fair share of health lessons. First there was Bill Bradley's atrial fibrillation. Then we learned about Dick Cheney's heart attacks and bypass surgery. Now Senator John McCain is fighting a renewed battle against malignant melanoma, the deadliest and most aggressive form of skin cancer, whose incidence has grown dramatically over the past 50 years. McCain's office reported last week that doctors found two cancerous lesions--one on his left temple and the other on his left arm. An earlier melanoma was removed from his left shoulder in 1993.
As McCain and his family are all too aware, his outlook for recovery depends in large part on how deep the new melanomas are and whether they have spread. Surgery cures 95% of malignant melanomas that are confined to the top layer of skin. Once the cancer penetrates farther or reaches the lymph nodes, the chances of survival decline rapidly. Fortunately, McCain's lesions appear to be new growths that are unrelated to each other or to the melanoma he had removed in 1993.
Because chemotherapy and radiation don't have much effect on advanced melanoma, researchers are experimenting with various drugs and vaccine-like therapies to try to rev up the body's defenses against the tumors. There has been enough success with interferon, says Dr. Ronald Blum, director of the Beth Israel Cancer Center in New York City, to make the immune-boosting drug be considered a standard of care. And, he adds, "for those who can withstand the short but very toxic inpatient treatment program, interleukin-2 can lead to significant reductions in tumor size." In most advanced cases, however, all that these and other valiant efforts can do is buy a few months, maybe a couple of years at the outside.
You can lower your risk of developing melanoma by slipping on a shirt, slopping on lots of sunscreen and slapping on a hat when you go outdoors. Look for a sunscreen that absorbs both UVA and UVB radiation. (Sunblocks are also good because they physically prevent the sun's rays from reaching your skin.) But even the best sunscreen won't protect you forever. If it normally takes you 10 min. to burn, a sunscreen rated SPF-15 gives you 15 times 10 min., or 2 1/2 hr. of roasting time. Any more, and you'll exceed your radiation dose for the day, even if you reapply.
Dark skin doesn't guarantee protection. Though uncommon, melanoma does occur in men and women of African descent--usually on the palms, soles and underneath the nails.
Know your ABC's (and D's): any moles on your skin that are Asymmetric, have an irregular Border, change in Color or have a Diameter greater than 1/4 in. (6 mm) should be checked immediately by a physician. (Melanomas often grow within a matter of a few months.) Most important, if you are ever diagnosed with a malignant melanoma, follow McCain's example and keep those doctors' appointments. Since his 1993 melanoma, McCain has had his skin checked every three to four months for new cancers. It could very well turn out that he owes his life to that kind of unrelenting vigilance.