Malignant Melanoma, "FDR's Deadly Secret"

Earlier today I wrote a short article which resulted in correspondence with one of the authors of the new book, 'FDR's Deadly Secret' by Steven Lomazow and Eric Fettmann.

Dr. Steven Lomazow sent me a copy of his Archives of Dermatology article with Dr. Bernard Ackerman, this photo, and a pdf of his book which I have spent the afternoon reading.

The article goes through a series of photos of FDR from his younger days to his older ones, showing the progression and changes. From the article:

The criteria currently touted for diagnosis of a slightly raised lesion of melanoma, a malignant neoplasm composed of abnormal melanocytes, are the "ABCDEs": Asymmetry, Border irregularity, Color variability, Diameter greater than 6 mm, and Elevation (or, for some proponents of the mnemonic, Enlarging or Evolving). The fully developed pigmented lesion above Roosevelt's left eyebrow admirably fulfills those criteria. But the ABCDEs also are encountered from time to time in a disparate variety of other pigmented lesions of the skin, among them being solar lentigo/seborrheic keratosis, melanocytic nevi of different kinds, and pigmented basal cell carcinoma.

The book is a “medical biography of Franklin D. Roosevelt. It presents a strong circumstantial case, backed by surviving medical records and analysis, that Roosevelt did indeed have cancer – melanoma, to be exact, originating in the pigmented lesion above the eye – that eventually spread to his brain and his abdomen. In other words, the cerebral hemorrhage that struck him down less than a month before V-E Day was not a “bolt out of the blue,” as his doctors contended, but the inevitable result of a deadly illness, compounded by catastrophic heart problems.”

Steven Lomazow and Eric Fettmann have done a great job with their book. I have enjoyed it immensely. Anyone who likes medical history will enjoy this book. Chapter 6 is entitled “The Brown Blob” and discusses the skin lesion seen in the photo above.

Back in FDR’s time, there were only two types of treatment for melanoma: surgery and radiation.

You may also like to check out Dr Lomazow’s blog: Magazine History: A Collector’s Blog.

For those of you who need to be educated regarding melanoma:

• Melanoma is the most serious form of skin cancer. If caught early, it is curable. If not, it becomes hard to treat and can be fatal.
• Melanoma accounts for less than 5% of all skin cancers, but accounts for the approximately 74% of all deaths from skin cancers.
• Melanoma metastasizes to the brain more than any other cancer. Of all the patients who die from melanoma, 90% will have brain metastases.
• Melanoma also metastasizes to the intestinal system more than any other tumor. Three cases in five metastasize to the small intestine.
• The American Cancer Society estimates that in 2009, there will be 8,650 fatalities in the U.S. The number of new cases of invasive melanoma is estimated at 68720. Overall, the lifetime risk of getting melanoma is about 1 in 50 for whites, 1 in 1,000 for blacks, 1 in 200 for Hispanics.

For many years, the early warning signs of melanoma have been identified by the acronym "ABCDE" (A stands for Asymmetry, B stands for Border, C for Color, D for Diameter and E for Evolving or changing was recently added.).

A new concept of the “ugly duckling” has been added to pick up the melanomas that don’t fit the ABCDE rule. This new method of sight detection for skin lesions is based on the concept that these melanomas look different -- ie, "the ugly duckling" -- compared to surrounding moles.

For early detection of melanoma, look for lesions that manifest the ABCDE's AND for lesions that look different compared to surrounding moles.

For more information on malignant melanoma:
National Cancer Institute
eMedicine
The Skin Cancer Foundation

REFERENCE

An Inquiry Into the Nature of the Pigmented Lesion Above Franklin Delano Roosevelt's Left Eyebrow; Arch Dermatol, Apr 2008; 144: 529 - 532; A. Bernard Ackerman; Steven Lomazow