There’s been speculation for years that McCain’s cancer may have metastasized, and yesterday, the NYT’s medical expert echoed the same concerns. Why does it matter? Because if McCain’s serious bout of melanoma in 2000 was a metastasis, then his chances of living through his entire presidency plummet drastically.

And that means, President Palin.

It isn’t pretty, and it isn’t nice, to talk about whether John McCain will die in office. But ignoring the prospect, and ending up with another president who is a blithering idiot (Palin, like Bush), is not an acceptable option. America went that route once. Never again.

Here are some choice excerpts from the Times piece:

Last May, his campaign and his doctors released nearly 1,200 pages of medical information, far more than the three other nominees. But the documents were released in a restricted way that leaves questions, even confusion, about his cancer.

A critical question concerns inconsistencies in medical opinions about the severity of his melanoma; if the classification of his melanoma is more severe, it would increase the statistical likelihood of death from a recurrence of the cancer.…

By not allowing reporters to interview him or his doctors extensively about his entire medical history, he has made it impossible to get a complete picture of his diagnoses and treatment….

In early August 2000, just as Mr. McCain’s rival George W. Bush was about to receive the Republican presidential nomination, Dr. John F. Eisold, the attending physician at the United States Capitol, detected two more melanomas, Mr. McCain’s second and third.

One on Mr. McCain’s left arm was determined to be the least risky type, in situ. But the one on his left temple was dangerous.

A few days after detection of the melanomas, Mr. McCain sought care for them at the Mayo Clinic in Scottsdale. Mr. McCain’s campaign said this year that the left-temple melanoma was 2.2 millimeters at its thickest part and graded as Stage IIA on a scale in which Stage IV is the worst. Stage II meant that the melanoma had not spread into the lymph nodes. The number of melanomas is less significant than the thickness measured in the pathology assessment of any one of them….

The doctors said that a fourth melanoma they detected on the left side of his nose in 2002 was also in situ, the least dangerous type. All four melanomas that Mr. McCain experienced were primary, or new, and there was no evidence that any of them had spread, the doctors said.

However, the reporters’ summary cited a report dated Aug. 9, 2000, from two pathologists at the Armed Forces Institute of Pathology in Washington who examined a biopsy of the melanoma taken from Mr. McCain’s left temple a few days earlier.

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….

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….

If Mr. McCain’s 2000 left-temple melanoma was a metastasis, as the Armed Forces pathologists’ report suggested, it would be classified as Stage III. The reclassification would change his statistical odds for survival at 10 years from about 60 percent to 36 percent, according to a published study.

The greatest risk of recurrence of melanoma is in the first few years after detection. His age, his sex and the presence of the melanoma on his face increase the risk.

The fact that Mr. McCain has had no recurrence for eight years is in his favor. But cancer experts see the 10th anniversary as an important statistical benchmark, and that would not occur until 2010.…

Melanomas can spread to various areas in the body, including the skin and any internal organ. In general, such spreading means the melanoma would not be curable. Treatment would depend in part on what organ or tissues are involved and could include additional surgery, chemotherapy, biologics, vaccines and radiation.

Many such treatments can be debilitating and impair an individual’s physical and mental stamina. If the patient was the president, the location of a recurrence and its treatment could raise the need to invoke the 25th Amendment, elevating the vice president to president, at least temporarily.

On the trail, Mr. McCain has played down concerns about his age by pointing to the vigor of his mother and her twin sister at age 96. Mr. McCain’s father died in 1981 at age 70 after a heart attack.