When Dave Mustaine, the long-haired, snarling founder of thrash metal band Megadeth, learned he had throat cancer in early 2019, he was not at all prepared.
He’d always had problems with his teeth, so when he felt a hard-to-describe discomfort right at the back of his mouth, he went to the dentist and figured it would be “the usual drill and fill,” the vocalist and guitarist writes in his new memoir, “In My Darkest Hour,” out Sept. 8, 2026.
But the dentist didn’t see anything wrong and sent him to an oral surgeon who poked around, took some X-rays and then delivered the news in a particularly unhelpful way, Mustaine says.
He told Mustaine that he had “the Big C,” aka throat cancer.
Hearing that, “I kind of went into a place of denial,” Mustaine tells TODAY.com. “I just walked out to my car, and I climbed inside of it. I don’t know how long I sat there, maybe five minutes. It seemed like an hour.”
He then called his wife, Pam, and made his way home.
Mustaine plays a show after his cancer diagnosis and treatment.Cameron NunezCancer Felt Different ‘Because It Scared Me’
In between tour dates, Mustaine met with specialists and learned that he had squamous cell carcinoma, a type of cancer, right at the base of his tongue.
Mustaine had already survived painful spinal fusion surgery and substance use issues. But this one felt different “because cancer scared me,” he says. “The other things that happened to me — they were just inconveniences along the way.”
Once the diagnosis became public, Mustaine started hearing from all corners of the heavy metal world, he writes. Ozzy Osbourne, Paul Stanley of KISS and even James Hetfield, Mustaine’s former Metallica bandmate, all reached out.
But it was a call with Iron Maiden vocalist Bruce Dickinson, who’d been through a battle with Stage 3 throat cancer just a few years earlier, that made the biggest impact. Dickinson helped Mustaine process his diagnosis and envision his post-treatment future.
“The one thing he said was not to rush, and to take my time with the healing,” Mustaine says, “because some people have been diagnosed in remission and they think that’s a green light to go back to singing. And in some cases, it is the wrong thing to do.”
But, “I wasn’t going to take a chance,” Mustaine says. “I just cooled out.”
Mustaine’s T-shirt reveals his thoughts on cancer.Pam Mustaine
Megadeth was still making its 16th album, “The Sick, the Dying… and the Dead,” he says, so he focused on finishing the guitar parts and took a break from singing.
Not only was the call with Dickinson a reminder not to rush, it gave him some much-needed hope, Mustaine says in his memoir, which was co-written with Joe Layden. Not just hope that he would survive the disease, but also that Mustaine could one day come back to the stage — as long as he took it slow and gave his body time to heal.
And that’s exactly what he did.
A Grueling Treatment Regimen
At age 57, Mustaine endured a grueling regimen of chemotherapy, radiation and then a combination of the two.
One particularly harrowing part of treatment was getting fitted for his radiation mask, which required him to lie perfectly still while a sheet of hot nylon mesh was stretched over his face.
Mustaine after a chemotherapy session.Pam Mustaine
The anxiety and claustrophobia, along with the weight of his diagnosis, made this an impossible task, Mustaine writes in the book. It took another two appointments — and a small dose of Valium — to get through the fitting.
(Asked if he has any advice for other people who get anxious during medical procedures, Mustaine simply replies, “Sedation.”)
The treatment took a toll on Mustaine’s teeth, he writes, particularly the radiation. While only one had to be fully extracted before treatment, he says, a few others fell out in the following years — including one that popped out while he was eating chocolate.
Finally, in January 2020, he returned to the stage with Megadeth, cancer-free.
Mustaine shows his missing tooth.Dave Mustaine
“The first show that I did after going through treatment and getting the green light — and it literally was getting a green light (from the doctors) because of what Bruce had said — and we ended up playing in Helsinki, Finland,” he recalls.
“On the outside, I guess I was being Dave,” he says, “but on the inside I was crying like a baby at how how touching it was (to see) the fans’ support and them cheering me on, and it was just just remarkable.”
Just a few months later, the COVID pandemic would force the band to postpone many of their tour dates.
Paying the Hope Forward
Since then, the band has released its final album and announced a global farewell tour.
And Mustaine’s vocal abilities continue to return.
“I’ve been able to add songs back into our live set because my voice is coming back in certain songs that I couldn’t sing before,” he says, including “This Was My Life,” “Hook in Mouth,” “Liar” and “Take No Prisoners.” Those have “a little bit of a higher register” to them, which Mustaine is now able to sing again.
Mustaine and his wife, Pam.Pam Mustaine
On the other side of everything, sharing his cancer experience now is a way of paying it forward, he tells TODAY.com.
“I met a lot of people out on the road that said they had cancer too,” Mustaine says. “And I thought, you know, I got through this. … My story is such a story of hope and how everybody rallied around me.”
The main goal was “just to give some hope to people,” he says.