OBSERVATION

An Inquiry Into the Nature of the Pigmented Lesion

Above Franklin Delano Roosevelt’s Left Eyebrow
A. Bernard Ackerman, MD; Steven Lomazow, MD

Background: Little note was taken when Franklin
Delano Roosevelt was alive and since his death of the
pigmented lesion above his left eyebrow that fulfilled
clinical criteria for melanoma.
Observations: On morphologic grounds alone, it is
impossible to exclude the possibility that Roosevelt had
a melanoma.
Conclusions: The failure of observers of Roosevelt,
especially his physicians, to comment on his riveting fa-
cial lesion and to identify it as a probable melanoma
speaks volumes about how flawed were clinical criteria
for diagnosis of flat and slightly raised lesions of mela-
noma in the 1930s and 1940s.
Arch Dermatol. 2008;144(4):529-532

Author Affiliations: Ackerman
Academy of Dermatopathology
(Dr Ackerman) and
Departments of Medicine and
Neurology, Mount Sinai School
of Medicine (Dr Lomazow)
New York, New York.
Dr Lomazow is also in private
practice in Belleville,
New Jersey.
B
Y VIRTUE OF A VARIETY OF
technical considerations,
such as the angle of the
head, the lighting of the
face, and the brightness
and contrast of the print, the pigmented
lesion above Franklin Delano Roosevelt’s
left eyebrow shows considerable varia-
tion in intensity in many of the photo-
graphs (Figures 1, 2, 3, 4, and 5) of
the person most photographed in the
20th century. In the photographs in
which Roosevelt’s face is captured in
profile, the pigmented lesion appears to
extend from the lower part of the fore-
head to the base of the eyebrow.
OBSERVATIONS
The criteria currently touted for diagno-
sis of a slightly raised lesion of mela-
noma, a malignant neoplasm composed
of abnormal melanocytes, are the
“ABCDEs”: Asymmetry, Border irregu-
larity, Color variability, Diameter greater
than 6 mm, and Elevation (or, for some
proponents of the mnemonic, Enlarging
or Evolving). The fully developed pig-
mented lesion above Roosevelt’s left eye-
brow 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.
MELANOMA VS SOLAR
LENTIGO/SEBORRHEIC KERATOSIS
A solar lentigo is a benign neoplasm con-
stituted of pigmented keratocytes. When
it becomes elevated and, in the process, as-
sumes an appearance more advanced his-
topathologically, the same condition then
is referred to as a seborrheic keratosis of
the reticulate type. On occasion, a solar
lentigo/seborrheic keratosis may acquire
characteristics that conform to the
ABCDEs. Roosevelt was an inveterate sailor
and had many solar lentigines, particu-
larly on the dorsum of his hands, these
contrasting strikingly with the pig-
mented lesion above his left eyebrow. De-
spite that reality, not all solar lentigines
are tiny; some may achieve a size like that
of the lesion above Roosevelt’s left eye-
brow—and even larger.
On gross morphologic grounds alone,
the pigmented lesion above Roosevelt’s left
eyebrow could be either a melanoma or a
solar lentigo/seborrheic keratosis. Only a
study of sections of tissue obtained by bi-
opsy would enable the conundrum to be
resolved conclusively. No evidence ex-
ists that the lesion ever was biopsied or
treated in any way. Sad to say, most of
Roosevelt’s medical records are missing;
none at all pertinent to the pigmented le-
sion above the left eyebrow have been
found.
The fact that the pigmented lesion was
variegate in shades of brown and very dark
brown in the arciform portion of it is more

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Figure 1. Franklin Delano Roosevelt in 1900 (age 18 years) with no
pigmented lesion above his left eyebrow.7
Figure 2. Franklin Delano Roosevelt in 1923 (age 41 years) with a subtle,
uniformly tan, poorly marginated macule above his left eyebrow.7
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Figure 3. Franklin Delano Roosevelt in August 1938 (age 56 years) with an
asymmetric, brown, seemingly barely raised plaque, darker in shape arciform
at the top and on the right side of it, but lighter in a central zone macular.
The plaque is larger in size than it was in 1933 (Figure 5).7
consonant with melanoma than with solar lentigo/
seborrheic keratosis. Moreover, whereas a large solar len-
tigo/seborrheic keratosis on a face usually is accompa-
nied there by other large solar lentigines/seborrheic
keratoses, melanoma presents itself conventionally as an
isolated lesion, as was the case for Roosevelt’s pig-
mented lesion. That finding, too, favors a diagnosis of
melanoma. However, melanoma, being the malignant neo-
plasm irrepressible in growth that it is, would be ex-
pected in the course of the 20 years from 1923 to 1943
to have attained a diameter greater than that of the le-
sion seen above Roosevelt’s left eyebrow (at the apogee
it was only about 2.5 cm ⫻ 2.0 cm in diameter). Fur-
thermore, for several years prior to 1943, the lesion
showed no sign of centrifugal extension or of progres-
sive elevation above the surface of the skin. That behav-
ior also militates somewhat against melanoma.
Episodically, a melanoma may undergo involution in
the form of ever-expanding hypopigmentation over the
course of several years, the process often causing the pig-
mented portion yet remaining to assume an archlike con-
figuration. Only uncommonly does a melanoma regress
entirely, leaving as residuum but a macule of hypopig-
mentation. Although the arciform character of the dark-
est pigmentation of Roosevelt’s lesion surely is in keep-
ing with the clinical appearance of partial regression of
melanoma, it would be unusual for the lesion above the
left eyebrow to have undergone complete regression in
the rather short space of 4 years (ie, in the period from
early 1940 to 1943). Biologically, such a phenomenon
is unlikely. For regression in toto of a melanoma that size
to have occurred should have taken considerably longer.
Solar lentigo/seborrheic keratosis also is known to re-
gress completely, but when that happens, almost always
the lesion is small, situated on the chest, and accompa-
nied often by signs of inflammation so noticeably viola-
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Figure 4. Franklin Delano Roosevelt in August 1940 (age 58 years) with an
asymmetric, apparently slightly raised lesion, brown in an arc at the superior
pole and hypopigmented in the lower two-thirds. No additional growth since
1938 is apparent.7
ceous that at this stage of involution it is known univer-
sally as “lichen planus–like keratosis,” lichen planus being
an eruption typified by purple papules.
If Roosevelt’s lesion did not undergo involution en-
tirely, then it must have been removed surgically or have
been camouflaged by makeup. However, there is no evi-
dence for either. No sign of a scar from a surgical exci-
sion is apparent. In short, how his pigmented lesion came
to disappear from 1940 to 1943 remains an enigma. In-
dependent of that, on the basis of all that is known pres-
ently about the morphologic aspects and biologic behav-
ior of his lesion, it is impossible, despite the imponderables,
to exclude melanoma.
ROOSEVELT’S PIGMENTED LESION
IN THE CONTEXT OF HIS HEALTH IN GENERAL
All details of Roosevelt’s health, especially during his 12
years as the 32nd President of the United States, were
shrouded in secrecy while he was alive. The most fla-
grant example of duplicity was that although Roosevelt
never was able to support his own weight without the use
of metal braces on his legs as a consequence of his having
contracted poliomyelitis in 1921, the American public was
shielded from knowledge of his extraordinary physical dis-
ability. Most Americans were unaware that he was un-
able to walk without assistance. Complicit in this “splen-
did deception” (the title of a biography of Roosevelt by
historian Hugh G. Gallagher,1 who also had contracted po-
liomyelitis) were Roosevelt’s physicians, as was the press.
Of the tens of thousands of images of Roosevelt in pho-
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A B
Figure 5. Comparison of the appearance of the skin above Franklin Delano
Roosevelt’s left eyebrow in the 10 years from 1933 to 1943. A, Roosevelt in
1933 (age 51 years) and B, in January 1943 (age 61 years), showing a very
faint residual outline of what was a pigmented lesion. Note the marked
contrast in the appearance of the skin above the left eyebrow.7
tographs and films, fewer than a handful show him com-
promised physically, despite the fact he was wheelchair
bound. Every aspect of his appearance and public per-
sona was painstakingly orchestrated.
Ross T. McIntire, MD, a career navy man who even-
tually attained the rank of Vice Admiral and Surgeon Gen-
eral of the Navy, was Roosevelt’s personal physician from
1933 until the President’s death in 1945. A specialist in
head, eye, ear, nose, and throat disease, McIntire was cho-
sen to be Roosevelt’s personal physician not only
because the President was prone to sinus disease, but be-
cause McIntire had a reputation for unwavering loyalty
and for “keeping a tight lip.” He was recommended for
that post by Roosevelt’s close friend, Cary T. Grayson,
MD, who had been physician to Woodrow Wilson and
was a central figure in the cover-up of Wilson’s devas-
tatingly disabling stroke in 1919.
After Roosevelt’s death in April 1945, persistent ru-
mors surfaced about his health. McIntire, in a book
(largely ghostwritten) published in 1946,2 denied that
Roosevelt had experienced any chronic malady of sig-
nificance. Until McIntire’s death in 1959, any informa-
tion germane to Roosevelt’s health was guarded closely
and effectively.
In a volume that appeared in 1970, historian Hugh
L’Etang3 was the first to raise publicly the specter that
Roosevelt had a melanoma. His assertion was deflected
in an apparently coincidental but, more likely, a pur-
posefully timed article by Howard G. Bruenn, MD,4 a car-
diologist who was the last surviving member of the in-
ner circle of Roosevelt’s physicians and who saw Roosevelt
on a daily basis from March 1944 to April 1945. Bruenn
set forth many previously undisclosed details that came
from Roosevelt’s medical records, emphasizing those of
a cardiologic and vascular character that the President
had experienced during the last year of his life.4 No ref-
erence whatsoever was made by Bruenn to the pig-
mented skin lesion above the left eyebrow, despite it being
decidedly unsightly. That omission, the wording of an
editorial that accompanied Bruenn’s article,9 and corre-
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Figure 6. In his textbook of dermatology published in 1917, William A.
Pusey, MD,8 diagnosed this extensive lesion as a “pigmented senile patch”
but had a biopsy sample been taken and read by a competent
dermatopathologist, the findings surely would have been those of melanoma,
presumably in situ.
spondence between Bruenn and Roosevelt’s children sug-
gest a deliberate attempt to minimize the impact of
L’Etang’s assertion of melanoma.
In 1979, Harry S. Goldsmith, MD,5 a well-respected
surgeon, raised, for the first time in a peer-reviewed medi-
cal journal, the possibility that Roosevelt’s pigmented le-
sion was a melanoma. Goldsmith5 cited reports and ob-
servations of creditable and competent physicians and,
in addition, presented what he deemed to be photo-
graphic evidence of the existence and then the disap-
pearance of the lesion in question. Goldsmith’s article
gained considerable attention at the time it was pub-
lished, but the emphatic public denial by Bruenn served
to quash the hypothesis of melanoma and preserve the
prevailing idea that the cause of Roosevelt’s medical con-
ditions and ultimately his death was primarily of a car-
diovascular nature. When contacted by Time magazine,
Bruenn baldly stated: “Roosevelt did not have a cancer.
This can be stated with certainty.6(p58)” Goldsmith’s propo-
sition was reduced to mere footnote.
COMMENT
Given the fact that melanoma, solely on the basis of clini-
cal inspection, should have been the most likely suspect
for Roosevelt’s lesion, why was that possibility never
raised? How could it have gone undiagnosed by derma-
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tologists throughout the United States and the world who
regularly observed it in photographs and in films? As-
toundingly, to our knowledge, the only reference dur-
ing Roosevelt’s lifetime to that lesion was by McIntire7
in a letter written in January 1940 in response to a col-
league, Reuben Peterson, MD, in which the physician/
admiral assured that the lesion was “under observation
at all times.”
In the 1920s, 1930s, and 1940s, a lesion such as
Roosevelt’s was not diagnosed as melanoma, even by der-
matologists, but was considered to be benign—that is, a
senile pigmented patch (Figure 6)—or, at worst, a pre-
malignant neoplasm designated as a Hutchinson mela-
notic freckle or precancerous circumscribed melanosis.
Even in the late 1950s, such a lesion was deemed to be a
precursor of melanoma, not a melanoma per se.
The editorial that appeared in 1970 in the Annals
of Internal Medicine complementary to the article by
Bruenn affirmed that “there was no clinical evidence for
such a lesion [melanoma] and no autopsy was per-
formed.”9(p530) But that statement certainly is not in syn-
chrony with the attributes of Roosevelt’s lesion. On clini-
cal grounds alone—that is, gross inspection—it is
impossible to exclude melanoma. Because it seems that
the lesion described herein never was biopsied, the an-
swer to the question of the authentic character of it must
for now be couched as supposition.
Accepted for Publication: August 30, 2007.
Correspondence: A. Bernard Ackerman, MD, Acker-
man Academy of Dermatopathology, 145 E 32nd St, 10th
Floor, New York, NY 10016 (jdelarose@ameripath
.com).
Author Contributions: Study concept and design: Acker-
man and Lomazow. Acquisition of data: Ackerman and
Lomazow. Analysis and interpretation of data: Acker-
man. Drafting of the manuscript: Ackerman. Critical re-
vision of the manuscript for important intellectual content:
Ackerman and Lomazow. Study supervision: Lomazow.
Financial Disclosure: None reported.
Additional Contributions: We thank the staff of the
Franklin Roosevelt Library at Hyde Park, New York, for
its assistance.
REFERENCES
1. Gallagher HG. FDR’s Splendid Deception. New York, NY: Dodd Mead & Co; 1985.
2. McIntire RT, Creel G. White House Physician. New York, NY: G.P Putnam’s Sons;
1946.
3. L’Etang H. The Pathology of Leadership. New York, NY: Hawthorne Books; 1946:
86-102.
4. Bruenn HG. Clinical notes on the illness and death of President Franklin D. Roosevelt.
Ann Intern Med. 1970;72(4):579-591.
5. Goldsmith HS. Unanswered mysteries in the death of Franklin D. Roosevelt. Surg
Gynecol Obstet. 1979;149(6):899-908.
6. Did Roosevelt have cancer? Time. December 17, 1979;114(25):58.
7. Franklin Delano Roosevelt Library. Ross McIntire Collection, Box 4. Hyde Park,
NY: Franklin Delano Roosevelt Library.
8. Pusey WA. The Principles and Practice of Dermatology: Designed for Students
and Practitioners. New York, NY: Appleton; 1917.
9. Medicine and history. Ann Intern Med. 1970;72(4):530.
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