The records detail the five-hour operation in August 2000 to remove the most severe of McCain's four cases of melanoma, efforts to reduce the facial puffiness the surgery produced, and the strategy of dermatological hypervigilance that followed.

Melanoma is a form of skin cancer that is rapidly fatal if it spreads to distant organs, such as the lungs and brain. Physicians now examine the senator's skin every three or four months. He has had more than a dozen patches of abnormal skin cut out or chemically destroyed this decade. . . .

In a meeting attended by McCain, his wife, Cindy, and an unidentified "physician friend," Mayo Clinic ear, nose and throat surgeon Michael L. Hinni described how he was going to remove a large oval piece of tissue from the left side of the senator's face. He told them "it seems feasible to use this incision to remove all of the lymph nodes in his neck that are at risk, as he is going to incur the morbidity [damage] of the incision" anyway.

A "sentinel" lymph node — located by injecting the melanoma with blue dye before surgery — proved to be cancer-free. Nevertheless, a total of 38 lymph nodes, along with a portion of the parotid salivary gland, were removed.

The large opening in McCain's face was filled with a flap of skin that was cut from behind his ear.