Despite Sen. John McCain's three bouts with melanoma - including a surgery in 2000 that left his cheek visibly scarred - the presumptive Republican presidential nominee's doctors yesterday declared him cancer-free and in general good health.
The Arizona senator's medical history puts him at increased risk for future skin cancer, so he sees his dermatologist at the Mayo Clinic in Scottsdale, Ariz., every three to four months. This year, he had a minor skin cancer removed from his lower leg.
"At the present time, Senator McCain enjoys excellent health and displays extraordinary energy," Dr. John D. Eckstein, McCain's internist at the Mayo Clinic, told reporters yesterday. "While it is impossible to predict any person's future health today, I can find no medical reason or problems that would preclude Senator McCain from fulfilling all the duties and obligations of president of the United States."
McCain's age - he turns 72 in August and would be the oldest elected first-term president if he wins - has provoked more questions than usual about a candidate's medical condition. It has also prompted closer scrutiny of potential running mates who might be called on to succeed him.
Neither 46-year-old Sen. Barack Obama nor 60-year-old Sen. Hillary Clinton, his younger Democratic rivals, has released medical records.
McCain's campaign released nearly 1,200 pages of records yesterday, ranging from 2000 through a visit to the dermatologist two weeks ago.
During the 2000 presidential campaign, when McCain ran against George W. Bush in the Republican primary, the senator was similarly open with his medical history, part of an attempt to show that McCain is healthy enough to serve as president.
There were no real surprises in the information yesterday.
Since 1993, McCain has had melanoma, the deadliest form of skin cancer, on three separate occasions.
Three spots on his skin found in 1993, 2000 and 2002 were not invasive, but a 2000 spot on his face was considered an "intermediate-stage" melanoma. It was 2.2 millimeters deep and 2 centimeters across, according to Dr. Michael L. Hinni, the Mayo Clinic surgeon who removed it. Hinni said the operation resulted in a roughly circular, six-centimeter wound on the left side of Mr. McCain's face.Tests conducted at the time showed that the cancer had not spread.
McCain's last melanoma, from his nasal sidewall, was removed in 2002. The melanoma has not recurred since then - a good sign, his doctors agreed. He has had other minor skin cancers periodically, the most recent of which was discovered in February.
"There is no way to have a crystal ball," said Dr. Suzanne M. Connolly, McCain's dermatologist, but she said the chance of recurring risk of melanoma "would be thought to be in the single-digit [percent] area."
Dr. Susan Kesmodel, a surgical oncologist at the University of Maryland Medical Center who has not treated the senator, said the five-year survival rate for an invasive melanoma lesion such as McCain's is 80 percent, while the 10-year survival rate is 65 percent.
While he is at risk for new lesions, doctors should be able to catch them early, because he is checked so regularly.
Melanoma is dangerous because of its propensity to spread to other parts of the body, Kesmodel said. "When it does, it gets harder to treat, and we don't have treatment modalities that are very effective," she said.
McCain had surgery but neither chemotherapy nor radiation, standard procedure for melanoma that has not spread, she said.
McCain's fair skin, light eyes and exposure to the sun in his youth and as a young adult are likely to blame for his skin cancer, Connolly said.
Many of the details of McCain's health are known. He has reduced range of motion in his shoulders and his right knee because of injuries he suffered as a Navy pilot during the Vietnam War.
When his plane was shot down in October of 1967, he broke both arms and a leg after ejecting. While he was a prisoner of war in Hanoi for 5 1/2 ears, he was beaten and received fractures of both shoulders.
They did not heal properly, Eckstein said, but he "does not complain of bone or joint pain and does not take pain medication."
Dr. Richard Boehler, chief medical officer at St. Joseph Medical Center in Towson and a former instructor at Harvard Medical School, said he was surprised that the senator isn't taking anything for pain from his war injuries. "I imagine I would be," said Boehler, who has not treated McCain.
Eckstein said McCain has no evidence of heart disease or other cardiovascular problems. His ability to complete a rim-to-rim crossing of the Grand Canyon in 2006 and his performance on a cardiac stress test indicate he is in excellent cardiovascular health. Like many Americans, though, he takes cholesterol-lowering medicine.
"That kind of exercise tolerance is a good prognostic indicator," Boehler said, explaining that it suggests his risk of heart attack is very low.
McCain's father died of a stroke at the age of 70. His mother is in her 90s and joins him on the campaign trail.
Eckstein, who has treated the senator since 1992, said McCain has never complained of memory problems, nor has the doctor seen evidence of cognitive decline.
The medical information McCain released range from the basic (5-foot-9 inches tall, 163 pounds, healthy cholesterol at 192, normal blood pressure) to the mundane (he sometimes takes Ambien to help him sleep while traveling and Zyrtec for seasonal allergies) to the intimate (his urinary function is good, his doctors said).
McCain also has small stones in his right kidney and a few benign cysts in both kidneys, none of which interferes with kidney function. He takes Hydrochlorothiazide to prevent kidney stones.
About one-third of Americans will have kidney stones in their lifetimes, Boehler said.
The Republican senator had four bladder stones that were fragmented with a laser in August 2001. At the same time, doctors removed some benign enlarged prostate tissue, Eckstein said.
A recent colonoscopy revealed six benign polyps, which were removed, and McCain will continue to be screened regularly for colon cancer.
"Age," said Eckstein, "should not be a limiting factor in this day and age."
John McCain's most recent physical was in March, his latest checkup last week. Among the highlights::
*Blood pressure was 134/84. Optimal is below 120/80, and high blood pressure begins at 140/90.
*Total cholesterol is a healthy 192, below the worrisome 240 level. His so-called bad, or LDL, cholesterol is a healthy 123. But his so-called good, or HDL, cholesterol is 42, below the recommended 60.
*He weighs 163 pounds and stands 5 feet, 9 inches. His BMI, or body mass index, was just under 24, which puts him at the upper end of normal; 25 or higher is considered overweight.
Source: Associated Press