Life, Running, & Medicine.
Notes on life as I see it.

Wednesday, February 6, 2008

McCain's Darn Parotid Gland

Being an ENT I can't help but notice that the recent photos of Senator John McCain shows his left parotid gland to be enlarged.  I first noticed it a few weeks ago during a news interview; I  was shocked because I thought he had a tobacco chew in...
I did a quick Dr. Google search and found that he seems to have had a melanoma of the left shoulder around 1999 or 2000 that was removed.  At that time he also had what sounds like a left neck dissection and superficial parotidectomy to remove any lymph nodes that might be involved.  He is apparently pretty hush-hush about this so there's not a lot of news out there on it.
So diagnosing through the television I hope someone is on top of that gland...  The most worrisome possibility of just what the heck that could be is recurrent melanoma.  Other more friendly things might include a second new parotid tumor (usually benign), an inflammation of the remaining parotid gland (parotitis), or possibly some "post surgical change" / scarring.
Included here are a series of photos snagged from the internet of McCain from 2004 to 2008.  It's hard to deny the left parotid is bigger now than it ever has been.  The 2006 image demonstrates the classic sunken retromandibular space where the parotid was previously removed.  Also clear here is that long up-and-down scar, that is particularly odd because it is the wrong scar for a parotidectomy.  The fatty, enlarged area in 2006 seems to be over the cheek region, not really in that retromandibular area.  There is usually some parotid tissue in that area, but not that much.  You can also see where he has a good deal of swelling below his jaw on the left.  That looks like his submandibular gland has just "slipped" or become ptotic; that happens with aging.
Hmmm.... so does anyone have the scoop?  Is someone looking into this?  Has McCain said anything that hasn't yet made it to the net?


Anonymous said...

I am also ENT and the left gland is looking lumpier every time I see him. If he has melanoma there, he won't be President very long.

Anonymous said...

I agree, the scar is not even close to a traditional parotidectomy incision site. Additionally, what is clear is that he has enlargement in the submandibular gland region. This has been driving me crazy for years. Finally, if this is melanoma recurrence, then there is no way that this would get by the media. It would be a death sentence for all intents and purposes.

Anonymous said...

This does a good job of covering the details.

Kaveh said...

It could just be poor lymph drainage; morbity of surgery.

Anonymous said...

I vote for post surgical change including poor lympn drainage. It is very difficult to be certain of change when he is closing his jaw differently and the shots are taken form different angles. I do not believe a melanoma of the shoulder, aggressively treated locally, would recur this way!

muso said...

John McCain's left cheek is obviously growing out of proportion, and I've also noticed how his Ad Campains show mainly his right cheek, concealing his left.

What's he hiding?

I seriously wonder that a US Presidential nominee with such obvious health issues is a suitable candidate for President of the USA. His longevity must surely be questionable.

Anonymous said...

Heh on the liberal site I attend someone noted he looked worse. I was googlin' photos saw yours and had this to say before I looked more thoroughly. I am not convinced its his parotid- could be. I do rheum so I see a few. I wrote the insert Lotus did from NL=Nature Lover

See this link for the NYT story
Nature Lover

Doc26.2 said...

Well, time is telling us it is probably not a parotid cancer (or any cancer) making the gland/face-area larger - he'd be dead by now. Or at least a lot worse off.

But it is NOT a normal incision or healing from a parotidectomy. Parotidectomies make the gland smaller, not larger. Often there is even a noticeable depression behind the jaw.

That noticeable depression has led some surgeons to put in a fat graft in that region for cosmesis. If he had this done, it certainly "slipped" forward because it is not where it should be.

Also note the incision in the face is a good inch in front of the ear. Maybe that's a scar from 'Nam? Parotidectomies use a facelift incision right along the ear that is hardly visible.

All I'm saying is something else happened... Viet Nam, fat graft gone awry, benign parotid mass, [outside chance of cancer but so obvious we'd surely hear something by now].

The Conservative Scientist said...

Clearly not parotid. The parotid is behind the mandible and under the ear. It is obviously either the submandibular gland, or tissue surrounding the submandibular gland.

Regarding the anonymous that said it could be melanoma and that this would be a "death sentence:"

1. Melanomas are one of the most treatable forms of cancer.
2. Unlikely that a melanoma would metastasize directly to the submandibular gland. Also, not many lymph nodes to spread to in that immediate area.

Anonymous said...

Being a parotidectomy patient myself (I had a benign pleomorphic adenoma in my left parotid gland, it was removed a year ago), I partially disagree with The Conservative Scientist. Yes, the parotid is indeed located behind the mandible and under the ear, but that's usually not where the tumor grows. These tumors are rock hard, dense and very mobile, semi-detached if you will; it's like having an avocado seed under your skin and being able to push it around slightly.

Mine was located pretty much exactly where McCain's lump is, maybe an inch higher up -- but since he's over 70 and has old, baggy and unelastic skin, I would expect gravity to pull his tumor a little further down. I'm fairly certain it's a parotid tumor, possibly an adenoma or a Warthin's.

McCain shows clear signs of parotidectomy because he has that telltale depression where the superficial lobe of the parotid gland used to be. The fact that he has already had the gland removed and still has a growing lump suggests that it's a recurring tumor. Removing it is very complicated due to the fact that all facial nerves are located there (they run straight through the parotid gland). One wrong move with the scalpel and half the face will be paralyzed. Having a semi-paralyzed face probably isn't a good idea if you want to run for president, McCain would be crossing the line between scarred POW and Frankenstein's monster.

Doc26.2 said...

To be clear Conservatie Scientiest, I too am conservative, probably liberatarian. So my comments here are in no way political.

Regarding the parotid gland: the posterior portion of it wraps around the back of the manidble, yes. But anteriorly it lies over the masseter muscles, well in front of the "back of the mandible".

Regarding melanoma: Regional nodal metastasis from melanoma drops survival to about 50% (some say 25-60%). Early melanoma is very treatable, but still the most deadly of the skin cancers and really really sucky because it spreads early.

Anonymous said...

In this picture... can see part of the parotidectomy scar, it runs vertically on the neck about an inch behind his ear. This is the one part of the S-shaped Blair incision that typically leaves a visible scar. In front of the ear it usually heals perfectly, but the lower part on the neck it seldom does.

Anonymous said...

I'm thinking it's a blocked parotid gland. I had this and there was a stone blockage. Got rid of the stone (painful process) and have been lump and pain free since.

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