John McCain has had 4 melanomas. The fourth may have spread from an earlier melanoma.
The Armed Forces pathologists suggested that the left-temple melanoma had spread from another melanoma, known as a metastasis or satellite lesion. "The vertical orientation of this lesion," the report said, "with only focal epidermal involvement above it is highly suggestive of a metastasis of malignant melanoma and may represent a satellite metastasis of S00-9572-A," which is the "skin, left temple, lateral" biopsy.
This increases the chances that McCain has metastatic cancer that may have spread to other parts of the body.
The candidates need to release their full medical records. Many questions are raised by these observations that cannot be answered without a thorough review of the records.
The Armed Forces pathologists did not speak in the teleconference in May 2008, and questions raised by their report have remained unanswered. The selected reporters did not ask about that report, and the Mayo Clinic doctors did not discuss it. A complete Mayo pathology report was apparently not included in the pool summary.
In interviews, several melanoma experts questioned why the Mayo Clinic doctors had performed such extensive surgery, because the operation was usually reserved for treatment of Stage III melanoma, not Stage IIA.
On Aug. 18, 2000, the day before Mr. McCain’s operation, his surgeon, Dr. Michael L. Hinni, wrote in the records that he planned to do the extensive operation because of the size and location of Mr. McCain’s melanoma. In the teleconference in May 2008, Dr. Hinni explained that because the melanoma was two centimeters across he had to make "a 6-by-6-centimeter island of skin, a fairly sizable wound" to remove it.