McCain Recovers From Skin Cancer Surgery
"That's called a complete metastatic workup," notes David Leffell, MD, a professor of dermatology and surgery at Yale Medical School, who provided commentary on McCain's treatment for WebMD.
Leffell tells WebMD he suspects doctors ran the array of tests because there was something about McCain's temple melanoma that made them suspicious of whether the cancer had metastasized, or spread. This type of skin cancer commonly spreads to the organs in the chest and the brain.
McCain's doctors had reported that the melanoma on his arm was superficial enough that it could simply be removed. But they have not made it known how deeply the melanoma on McCain's temple had sunk into the skin.
Leffell, author of the book Total Skin, says thickness is an important consideration when a patient has been sent to him with melanoma. "The No. 1 thing I ask," Leffell says, "is, 'What is the thickness of the melanoma?'"
Leffell explains that when a melanoma has not spread more than a millimeter's thickness below the skin, there is a 96% to 99% cure rate. Once the melanoma becomes thicker than a millimeter, or about the thickness of a dime, it translates into lower survival rates.
Leffell says a melanoma bigger than a millimeter and up to 2 mm has a 94% cure rate. Just over 2 mm and under 4 mm has a 78% cure rate. And if a melanoma is thicker than 4 mm, the cure rate plummets to 42%.
Leffell tells WebMD that, although it is a very good indicator, there is more to determining cure than melanoma thickness. The amount of lymph node involvement is important in prognosis.
Leffell says part of the doctors' decision to remove McCain's lymph nodes for testing is associated with the thickness of the melanoma. If the cancer is thicker than a millimeter, then doctors often want to look at the lymph nodes.
But there may have been other reasons why the doctors wanted to look at them, he says. They may have felt swollen lymph nodes by hand or seen that they looked swollen on the MRI.