Clinton Skin Lesion Found to Be Cancer

WASHINGTON —  A suspicious lesion removed from President Clinton’s back during a routine physical last week was a common and generally non-life-threatening form of skin cancer, the White House announced Tuesday.

The growth, a basal cell carcinoma, is the most common form of skin cancer and usually is caused by overexposure to sunlight.

“The pathology results that were read this morning confirm that the lesion was a superficial basal cell skin cancer,” White House spokesman Jake Siewert said during his daily briefing.

“Pathologists noted that the margin of the lesion appeared clean, which indicated that the lesion had been totally removed” during the minor surgical procedure, he added. “So while the president, I guess it could be said, had skin cancer, that has been removed and he no longer has it. So that is that.”

Unlike melanoma--the most virulent and deadly form of skin cancer--basal cell cancers rarely spread and are slow-growing.

“This is not going to kill him,” said Dr. Richard Strick, a clinical professor of dermatology at the UCLA School of Medicine. “These almost never spread anywhere unless they are long neglected, and you are very unlucky.”

During Clinton’s annual medical checkup on Friday, doctors discovered what they called a “small, suspicious skin lesion” on his back. They removed tissue from the area for tests.

“At the time of the biopsy, the president elected to have the tissue around the lesion treated superficially with a technique called ‘scraping and burning’ in the event that the lesion was to be confirmed as skin cancer,” Siewert said.

The president’s physician, Rear Adm. E. Connie Mariano, said that “overall, the president is in good health. The president’s risk of recurrence of basal cell skin cancer is low, but he faces a higher risk than the population at large of developing a new lesion in the future due to his fair skin and years of sun exposure.

“The president will be seen in four to six months by a dermatologist,” he added in a statement issued by the White House. “If there is no evidence of new lesions at the time of follow-up, he will be examined annually.”

Clinton has had skin growths before. A precancerous lesion was removed from his nose in 1996, and a benign cyst was taken from his chest a year later.

The new lesion was the first time that skin cancer was suspected, Dr. David Corbett, retired chairman of Bethesda Naval Hospital’s dermatology department, said last week.

About 75% of all skin cancers are basal cell carcinomas, according to the American Cancer Society. They begin in the lowest layer of the epidermis, the basal cell layer, on areas exposed to the sun, such as the head and neck.

“The ultraviolet exposure damages the DNA of cells, which allows them to mutate and eventually become a skin cancer,” Strick said.

Basal cell cancers once were seen mostly in middle-aged or older people; now, however, these skin cancers are appearing with increasing frequency among younger people, perhaps because they are spending more time in the sun, medical experts believe.

There are an estimated 800,000 to 1 million cases of basal cell cancer or squamous cell cancer--another highly treatable skin cancer--in the United States every year.

Basal cell cancer is characterized by raised, translucent nodules that may crust, ulcerate and sometimes bleed.

President Reagan had several small basal cell cancers removed from his nose at two different times during his presidency.

Reagan’s older daughter, Maureen, is currently battling melanoma, a more deadly form of skin cancer that is extremely difficult to treat once it has spread.

Arizona GOP Sen. John McCain, who challenged President-elect George W. Bush during the primaries, also was treated for melanoma.

A basal cell cancer generally does not metastasize “or cause any serious health problems,” said Dr. Thomas Keahey, a Washington dermatologist in private practice. “It tends to be a local grower, and is usually treated with some form of minor surgery.

“The fact that he’s had one means that he’s at risk to have another within five years--so he needs to wear his sunscreen and have his skin examined yearly by a dermatologist.”

These kinds of lesions can return, even after treatment, in the same place on the skin and may need to be removed again.

And although such cancers do not spread to distant parts of the body, if left untreated they can grow into nearby areas and invade the bone or other tissues beneath the skin.

Strick said he has seen only one case in his practice--an unusual, almost unheard-of situation--where a basal cell carcinoma proved deadly.

A patient arrived “with a basal cell involving half of his face,” Strick recalled. “I asked him how long it had been growing, and he said 15 to 20 years. He’d never had any treatment. I asked him why. He said: ‘I’m a busy man--I work, and play golf three days a week.’ ”

By the time the patient sought treatment, the cancer had invaded his brain, Strick said. The man died about six months later.