FDR May Have Had Melanoma

Though shrouded in secrecy during his lifetime, historians have gone to great lengths to posthumously chronicle the mysterious circumstances surrounding the health of Franklin Delano Roosevelt, the 32nd president of the United States.

That he suffered from both polio and heart disease is now well-documented. But a new study suggests that he may also have had--and possibly even died from--melanoma.

"I'm not stating unequivocally that he had melanoma," said study author A. Bernard Ackerman, MD, director of the Ackerman Academy of Dermatopathology in New York City. "But it sure looks like it."

The source of the supposition is the 30-year presence of a pigmented lesion above FDR's left eyebrow--a mark that appears in innumerable photographs.

Ackerman presents his case in the April issue of the Archives of Dermatology. However, he acknowledges that proving or disproving the contention amounts to a practical impossibility, given that at FDR's death an autopsy was never conducted, and that the lesion in question was never biopsied.

"The only way to prove it is to do a biopsy," he said. "So it could be that it was a sunspot, an age spot, a liver spot- all synonyms for 'solar lentigo'. We don't know. But I will say that it is something that any competent doctor today would look at and say reflexively is melanoma."

FDR died at the age of 63 on April 12, 1945, shortly after flying a strenuous 14,000 miles to attend the now famous Yalta Conference--a key meeting held between himself, Winston Churchill and Joseph Stalin, leading up to the end of World War II.

At the time, the cause of death was declared to be a cerebral hemorrhage, most probably associated with high blood pressure.
Yet most of FDR's medical records are missing. And contemporaneous efforts taken by FDR's personal physician--Ross T. McIntire, MD--to preserve FDR's medical privacy were legendary and thorough.

Most of the American public, for one, had no idea that FDR had contracted polio in 1921, and that throughout his 12 years at the White House he was unable to walk without assistance.

That said, nothing by way of written proof has ever surfaced to suggest that FDR had melanoma or died of the disease.

But, as Ackerman points out, this is no surprise given that "no one would have ever suspected melanoma at that period in time."

"This to me is one of the most fascinating and gripping aspects of this case," said Ackerman. "Here's a man who is one of the most photographed men in the world, walking around in public daily with something that looks like a melanoma on his face. And no one says a word. Because going back to the 1930s and 40s, no one knew what it was."

Melanoma is a cancer of the thin top layer of the skin, called the epidermis, which strikes the melanocyte cells that are responsible for the brown protective pigmentation that emerges following sun exposure. According to the American Cancer Society, melanoma accounts for about 3% of all skin cancer cases in the United States, and that more than 62,000 Americans will be diagnosed with the disease this year. But it causes most skin cancer deaths--about 8,420 Americans will die of this disease this year.

Melanoma is usually curable if caught early. The appearance of new moles or freckles or visible changes in skin patterns is sometimes, but not always, an early indicator of trouble. To conduct self-screening, doctors suggest following the so-called "ABCDE" rule.

Such a self-exam focuses on several factors: Asymmetry, when one half of a mole is different from the other half; Border irregularity, when the edges are irregular; Color, when the shading is not uniform; Diameter, when the mole is larger than one-quarter of an inch in size; and Elevation, when the mole is raised or bumpy.

Ackerman and his study co-author, Steven Lomazow, MD, of the Mount Sinai School of Medicine in New York City, pointed out that FDR's mole, which was about one inch by three-quarters of an inch at its largest stage, does check off as suspicious on all aspects of the ABCDE criteria.

Nevertheless, they also admit that a range of other pigmented lesions could have accounted for the marking's characteristics.

And Vijay Trisal, MD, an assistant professor of surgical oncology at the City of Hope Cancer Center in Duarte, California, said that he was not persuaded by visual evidence that FDR had melanoma or died of the disease.

"First of all, what you have to understand is that in this country today, out of every hundred lesions we think are suspicious for melanoma, only one is a melanoma and the rest are nothing," he noted. "And with a purely visual diagnosis, in most cases we can get only a 5% accuracy."

"Specifically with respect to FDR's case," he added, "I would say given the size of the lesion and the irregular color pattern, there is a 30–40% range of accuracy in visually diagnosing it."

Such hesitancy aside, Trisal suggested that if FDR indeed had melanoma it was probably not life-threatening.

"It seems more like a less aggressive 'lentigo-maligna' type of melanoma," he said. "One that typically grows slowly, with little effect on longevity. So I don't get the feeling that they [the study authors] made a strong argument about melanoma being the cause of death," Trisal concluded.

More information
For additional information on melanoma, visit the American Cancer Society.

HealthDay News, April 25, 2008