Whether pundits dub it melanoma-gate, relapse-gate, or perhaps prognostic model-gate, there’s an unprecedented amount of interest in the odds that John McCain will drop dead in the next four to eight years due to a skin cancer relapse.

The latest armchair doctoring comes in the pages of The Lancet, from a physician who has donated $4600 to the Obama campaign and another $28,500 to the Democratic National Committee.

John Alam, a Cambridge, Massachusetts, physician with 17-years in clinical research who now works as a biotechnology consultant, estimates that Senator John McCain has a 6% risk of dying of a melanoma recurrence each year – or about 22% over four years. “There is a one-in-four to one-in-five chance that he would not survive a first term,” he told New Scientist.

This is higher than the estimate of McCain’s physician at the Mayo Clinic, who previously told reporters that he had a less than 10% chance of deadly relapse. On the other end of the scale, a group of physicians – and Obama supporters – has called on McCain to release more health records, claiming that his risk of relapse could be higher than 60%.


Alam’s estimate is based on studies of the survival rates of others with melanoma, where the patients were grouped by the size and location of their tumour, their gender and age. His estimate – which is no more than an educated guess, of course – falls between the previous estimates of 10 and 60% for one important reason.

New procedure

Many of the prognostic models that others have cited are based on patient studies that did not perform a sentinel lymph node (SLN) biopsy, a relatively new procedure that attempts to determine whether a tumour has spread to lymph nodes that serve as a cellular superhighway for aggressive tumours.

If the biopsy turns up no melanoma after surgery, patients are at a far lower risk of relapse and mortality than patients who are SLN-positive, according to two recent clinical studies.

However, some dermatologists worry that failing to detect melanoma in the biopsy can lead to false negatives and an underestimate of relapse risk. However, the procedure has become routine in patients with more advanced melanomas, such as McCain’s, Alam says.

McCain, according to records posted on his campaign website, was SLN-negative when doctors performed the biopsy in August 2000, Alam writes in a short letter to The Lancet.

Alam says he performed the analysis independent of the Obama campaign. “Because the analysis is an objective, evidence-based analysis, I believe my having contributed has no bearing on the results of the analysis,” he adds.

For comparison, a quick web search reveals the odds of dying in the US of other causes, natural and unnatural:

Heart disease (lifetime) 1 in 5

Poisoning (lifetime): 1 in 180

Firearm (lifetime): 1 in 324

Car accident (lifetime): 1 in 247

Bicycle accident (lifetime): 1 in 4,472

Defenestration (lifetime): 1 in 6,422

Venomous plants and animals (lifetime): 1 in 46,539

Legal execution (lifetime): 1 in 72,494

Lightning (lifetime): 1 in 81,949

Fireworks (lifetime): 1 in 1,884,832

Shark (annual): 1 in 8,000,000

Journal reference: The Lancet (vol 371, p 1462)

US Election 2008 – Science and technology are at the heart of many of the issues facing the candidates. Find out more in our special report.

Cancer – Learn more about one of the world’s biggest killers in our comprehensive special report.