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Guidelines&#44; o principal objetivo do tratamento do CBC e CEC &#233; a remo&#231;&#227;o cir&#250;rgica completa do tumor e a preserva&#231;&#227;o m&#225;xima da fun&#231;&#227;o e cosm&#233;tica&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A ex&#233;rese com margem cir&#250;rgica ampla pode ocasionar desfiguramento e cicatrizes desnecess&#225;rias&#44; enquanto as ressec&#231;&#245;es conservadoras podem resultar na remo&#231;&#227;o incompleta do tumor e maior recorr&#234;ncia local&#44; especialmente em les&#245;es com alto risco de recorr&#234;ncia&#46; As caracter&#237;sticas de alto risco de CBC e CEC s&#227;o&#58; profundidade de invas&#227;o &#40;&#62; 6<span class="elsevierStyleHsp" style=""></span>mm ou invas&#227;o al&#233;m do subcut&#226;neo para CEC&#41;&#44; grau de diferencia&#231;&#227;o histol&#243;gica pouco diferenciado&#44; localiza&#231;&#227;o anat&#244;mica de alto risco &#40;face&#44; orelha&#44; pr&#233;&#47;p&#243;s&#8208;auricular&#44; genit&#225;lia&#44; m&#227;os e p&#233;s&#41;&#44; envolvimento perineural&#44; les&#245;es recorrentes ap&#243;s cirurgia e&#47;ou radioterapia&#44; imunossupress&#227;o e bordas mal definidas&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o intraoperat&#243;ria de margens cir&#250;rgicas da les&#227;o por exame de congela&#231;&#227;o vem sendo largamente utilizada para tentar assegurar margens livres de doen&#231;a&#44; e &#233; mais seguro em planejar a reconstru&#231;&#227;o definitiva&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> A cirurgia microgr&#225;fica de Mohs &#40;CMM&#41; &#233; uma das t&#233;cnicas propostas para CBC e CEC de alto risco&#44; pois propicia a an&#225;lise intraoperat&#243;ria de 100&#37; da margem de excis&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Por&#233;m&#44; &#233; importante haver uma alternativa aceit&#225;vel e segura para suprir a CMM&#44; pois essa t&#233;cnica pode ser financeiramente invi&#225;vel e limitada em sua disponibilidade&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Outra t&#233;cnica em que tamb&#233;m h&#225; uma avalia&#231;&#227;o completa de todas as margens &#233; a avalia&#231;&#227;o intraoperat&#243;ria de margens cir&#250;rgicas por congela&#231;&#227;o &#8220;<span class="elsevierStyleItalic">en face</span>&#8221;&#44; uma poss&#237;vel alternativa &#224; CMM&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">O termo &#8220;<span class="elsevierStyleItalic">en face</span>&#8221; &#233; uma express&#227;o usada para se referir que ao examinar a pe&#231;a cir&#250;rgica durante a congela&#231;&#227;o intraoperat&#243;ria&#44; as se&#231;&#245;es de margens analisadas s&#227;o processadas paralelo &#224; margem cir&#250;rgica&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Nosso objetivo &#233; relatar os resultados da t&#233;cnica de congela&#231;&#227;o &#8220;<span class="elsevierStyleItalic">en face</span>&#8221; quanto &#224; recorr&#234;ncia do tumor e a concord&#226;ncia com os cortes de parafina&#44; na rotina de uma institui&#231;&#227;o&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material e m&#233;todos</span><p id="par0035" class="elsevierStylePara elsevierViewall">An&#225;lise retrospectiva de pacientes submetidos &#224; ex&#233;rese cir&#250;rgica de CBC e CEC pelo N&#250;cleo de C&#226;ncer de Pele do A&#46;C&#46;Camargo Cancer Center&#44; S&#227;o Paulo&#47;SP &#8211; Brasil&#44; entre janeiro a dezembro de 2013&#46; Houve aprova&#231;&#227;o do Comit&#234; de &#201;tica em pesquisa local para estse estudo&#44; n&#176; 2602&#47;18&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Pacientes</span><p id="par0040" class="elsevierStylePara elsevierViewall">Foram inclu&#237;dos no estudo pacientes com CBC e&#47;ou CEC&#44; prim&#225;rio ou recorrente&#44; submetidos &#224; t&#233;cnica de congela&#231;&#227;o &#8220;<span class="elsevierStyleItalic">en face</span>&#8221;&#44; independente da topografia da les&#227;o&#46; Os crit&#233;rios de n&#227;o inclus&#227;o foram pacientes com outros tipos de neoplasia cut&#226;neas e pacientes que n&#227;o realizaram a t&#233;cnica de congela&#231;&#227;o intraoperat&#243;ria &#8220;<span class="elsevierStyleItalic">en face</span>&#8221;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Foram avaliados os seguintes dados cl&#237;nicos&#44; epidemiol&#243;gicos&#44; de anatomia patol&#243;gica e tratamento de cada paciente&#58; sexo&#44; idade&#44; tipo e subtipo de tumor&#44; tipo de reconstru&#231;&#227;o&#44; n&#250;mero de ressec&#231;&#245;es necess&#225;rias para obter margens cir&#250;rgicas livre de tumor&#44; o resultado do exame intraoperat&#243;rio de congela&#231;&#227;o &#8220;<span class="elsevierStyleItalic">en face</span>&#8221; e resultado final do anatomopatol&#243;gico ap&#243;s processamento histopatol&#243;gico convencional com confec&#231;&#227;o de blocos de parafina&#44; necessidade de tratamento complementar&#44; tempo de seguimento e recorr&#234;ncia tumoral &#40;a recorr&#234;ncia foi definida como o reaparecimento da les&#227;o no acompanhamento cl&#237;nico confirmado por exame histol&#243;gico&#41;&#46; As les&#245;es prim&#225;rias foram consideradas CBCs ou CECs rec&#233;m&#8208;diagnosticados clinicamente&#44; e as les&#245;es secund&#225;rias foram aquelas que haviam sido tratadas anteriormente em outros hospitais e recorreram&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">An&#225;lise estat&#237;stica</span><p id="par0050" class="elsevierStylePara elsevierViewall">A an&#225;lise descritiva foi realizada com a avalia&#231;&#227;o dos prontu&#225;rios&#46; Regress&#245;es log&#237;sticas simples foram utilizadas para identificar vari&#225;veis que se associaram aos desfechos estudados&#46; Todas as vari&#225;veis com valor de p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 foram inclu&#237;das nos modelos de regress&#227;o log&#237;stica m&#250;ltipla&#46; O software IBM SPSS v 20&#46;0&#174; foi utilizado para a an&#225;lise estat&#237;stica&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">T&#233;cnica de congela&#231;&#227;o intraoperat&#243;ria &#8220;en face&#8221;</span><p id="par0055" class="elsevierStylePara elsevierViewall">A t&#233;cnica de congela&#231;&#227;o &#8220;<span class="elsevierStyleItalic">en face</span>&#8221; propicia o exame de todas as margens do tumor&#46; Todas as margens perif&#233;ricas e profunda da pe&#231;a analisada na congela&#231;&#227;o &#8220;<span class="elsevierStyleItalic">en face</span>&#8221; foram enviadas para processamento histopatol&#243;gico convencional com confec&#231;&#227;o de blocos de parafina&#46; Assim&#44; foram comparados os resultados do exame intraoperat&#243;rio da congela&#231;&#227;o com o resultado final anatomopatol&#243;gico ap&#243;s processamento histopatol&#243;gico com confec&#231;&#227;o de blocos de parafina&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">O procedimento cir&#250;rgico foi realizado da seguinte maneira&#58; as margens de ressec&#231;&#227;o do tumor cut&#226;neo foram demarcadas com aux&#237;lio de dermatosc&#243;pio manual utilizado pelo cirurgi&#227;o respons&#225;vel pelo procedimento&#44; com o objetivo de alcan&#231;ar margens de ressec&#231;&#227;o livres&#46; N&#227;o foi poss&#237;vel documentar a margem cir&#250;rgica utilizada para a excis&#227;o&#44; por se tratar de um estudo retrospectivo&#46; A excis&#227;o foi realizada sob anestesia geral&#44; anestesia local associada com seda&#231;&#227;o&#44; anestesia local pura ou raquianestesia associada a seda&#231;&#227;o&#44; dependendo das comorbidades do paciente&#44; do planejamento da reconstru&#231;&#227;o e do tamanho da les&#227;o&#46; A excis&#227;o da les&#227;o foi realizada com a borda circunferencial reta e a margem profunda plana&#44; diferindo da forma angulada da ressec&#231;&#227;o CMM&#46; Na <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> demonstramos o aspecto cl&#237;nico da les&#227;o antes da excis&#227;o com delimita&#231;&#227;o dermatosc&#243;pica das margens cir&#250;rgicas&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">O exame intraoperat&#243;rio para avalia&#231;&#227;o de margens cir&#250;rgicas da les&#227;o excisada se inicia com o recebimento pelo patologista do esp&#233;cime a fresco com identifica&#231;&#227;o pr&#233;via pelo cirurgi&#227;o do ponto de refer&#234;ncia do paciente de 12 horas&#46; Todas as margens laterais e profunda do esp&#233;cime s&#227;o ent&#227;o pintadas com tinta <span class="elsevierStyleItalic">nankin</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">As margens laterais do esp&#233;cime s&#227;o seccionadas em quatro setores considerando o ponto fiducial de 12 horas identificado previamente pelo cirurgi&#227;o e em cortes considerando o sentido hor&#225;rio do esp&#233;cime conforme a seguir&#58; 12&#8208;3 horas&#44; 3&#8208;6 horas&#44; 6&#8208;9 horas e 9&#8208;12 horas &#40;m&#233;todo de orienta&#231;&#227;o &#8220;face do rel&#243;gio&#8221;&#41;&#46; Essas margens s&#227;o separadas da amostra com uma incis&#227;o com a ajuda de uma l&#226;mina cir&#250;rgica no ponto inicial &#40;p&#46; ex&#46;&#44; 12 horas&#41; e uma ressec&#231;&#227;o interna de 2&#44;0 a 3&#44;0<span class="elsevierStyleHsp" style=""></span>mm de espessura da pele paralela &#224; borda circunferencial&#46; Toda a extens&#227;o lateral daquele setor &#233; considerada para avalia&#231;&#227;o microsc&#243;pica&#46; A margem profunda &#233; analisada em corte paralelo&#44; tangencial &#224; face cruenta&#46; O procedimento est&#225; ilustrado na <a class="elsevierStyleCrossRef" href="#fig0015">figura 3</a>&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Os fragmentos representativos de cada margem s&#227;o ent&#227;o individual e sequencialmente submetidos para cortes de congela&#231;&#227;o por embebi&#231;&#227;o em meio de inclus&#227;o de congela&#231;&#227;o &#40;<span class="elsevierStyleItalic">tissue tek</span><span class="elsevierStyleItalic">&#174;</span>&#41; e congelamento a &#8722;30<span class="elsevierStyleHsp" style=""></span>&#176;C em cri&#243;tomo&#44; com a face da tinta &#40;ou face externa&#41; voltada para a face de corte do aparelho&#46; S&#227;o realizados cortes de 5&#44;0<span class="elsevierStyleHsp" style=""></span>&#956;m seguidos de colora&#231;&#227;o com hematoxilina e eosina&#44; montagem das l&#226;minas e avalia&#231;&#227;o pelo patologista&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">As margens s&#227;o laudadas pelo patologista separadamente de acordo com a identifica&#231;&#227;o dos setores como margem livre de neoplasia ou margem comprometida pela neoplasia&#46; Quando uma amostra do fragmento for positiva para c&#233;lulas tumorais ap&#243;s o exame histopatol&#243;gico&#44; uma amostra adicional de tecido&#44; na &#225;rea acometida pelo tumor&#44; ser&#225; retirada e enviada novamente para an&#225;lise do patologista&#46; O procedimento &#233; repetido at&#233; que margens livres de neoplasia sejam obtidas&#44; e assim o cirurgi&#227;o realiza a reconstru&#231;&#227;o da &#225;rea acometida ap&#243;s a retirada da les&#227;o&#46; Todas as amostras analisadas na congela&#231;&#227;o &#40;margens perif&#233;ricas e profunda&#41; s&#227;o submetidas a processamento histopatol&#243;gico convencional com confec&#231;&#227;o de blocos de parafina para confirmar o diagn&#243;stico do esp&#233;cime congelado no intraoperat&#243;rio&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Resultados</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados gerais</span><p id="par0085" class="elsevierStylePara elsevierViewall">Nosso estudo foi composto por 542 carcinomas cut&#226;neos&#44; excisados de 397 pacientes &#40;201 homens e 196 mulheres&#41;&#44; com idade m&#233;dia de 64 anos&#46; As caracter&#237;sticas cl&#237;nicas e de anatomia patol&#243;gica dos casos inclu&#237;dos no estudo est&#227;o apresentadas na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; O tamanho da les&#227;o por medi&#231;&#227;o da pe&#231;a patol&#243;gica &#40;cm&#41; foi em m&#233;dia 2&#44;0 &#215; 1&#44;4 &#215; 0&#44;56 &#40;di&#226;metro maior &#215; di&#226;metro menor &#215; espessura&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">A topografia mais comum das les&#245;es ocorreu na regi&#227;o de cabe&#231;a e pesco&#231;o &#40;87&#44;8&#37;&#41;&#44; seguida por extremidades &#40;9&#44;4&#37;&#41; e tronco &#40;2&#44;8&#37;&#41;&#46; As les&#245;es acometendo as extremidades foram&#58; seis les&#245;es nas m&#227;os&#44; tr&#234;s les&#245;es nos p&#233;s&#44; cinco na regi&#227;o pr&#233;&#8208;tibial&#44; 13 nos membros superiores e 24 les&#245;es nos membros inferiores&#46; O CBC correspondeu a 79&#44;7&#37; dos casos&#44; e o CEC a 20&#44;3&#37;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">O seguimento m&#233;dio foi de 38 meses&#46; Em 53 casos tivemos perda de seguimento&#46; O tempo m&#225;ximo de seguimento foi de 74&#44;43 meses&#46; Os tipos de reconstru&#231;&#227;o ap&#243;s a ex&#233;rese cir&#250;rgica do carcinoma cut&#226;neo foram&#58; 454 retalho local &#40;83&#44;8&#37;&#41;&#44; 39 enxerto cut&#226;neo &#40;7&#44;2&#37;&#41;&#44; 34 fechamento prim&#225;rio &#40;6&#44;3&#37;&#41;&#44; 14 t&#233;cnica combinada &#40;2&#44;6&#37;&#41; e um microcir&#250;rgico &#40;0&#44;2&#37;&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Recorr&#234;ncia</span><p id="par0100" class="elsevierStylePara elsevierViewall">A recorr&#234;ncia tumoral total &#40;mediana de 38 meses&#41; foi de 1&#44;4&#37; &#8211; 0&#44;86&#37; para les&#245;es virgens de tratamento e 3&#44;7&#37; para les&#245;es secund&#225;rias&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Tamb&#233;m avaliamos as associa&#231;&#245;es entre as vari&#225;veis e a sobrevida livre de recorr&#234;ncia com a regress&#227;o COX&#44; mostrada na <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Usando a regress&#227;o de COX m&#250;ltipla&#44; a associa&#231;&#227;o com a invas&#227;o perineural positiva apresentou um aumento de 13 vezes o risco de ter recidiva tumoral&#46; O n&#250;mero de amplia&#231;&#245;es de margens cir&#250;rgicas no intraoperat&#243;rio tamb&#233;m apresentou associa&#231;&#227;o&#44; com um aumento de 1&#44;8 vez o risco de recidiva tumoral para cada amplia&#231;&#227;o de margens&#46; Ent&#227;o&#44; quanto maior o n&#250;mero de amplia&#231;&#245;es de margens&#44; maior o risco de recidiva tumoral no futuro&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Dos sete casos recidivados&#44; quatro eram CBCs&#46; Desses&#44; tr&#234;s eram do subtipo histol&#243;gico misto &#40;mais de um subtipo histol&#243;gico&#41; e um CBC superficial&#44; todos localizados na face &#40;duas les&#245;es no couro cabeludo&#44; uma na fronte e uma no nariz&#41;&#44; tr&#234;s j&#225; eram tumores previamente recidivados &#40;subtipo histol&#243;gico misto&#41; e apresentaram margens comprometidas na primeira ressec&#231;&#227;o cir&#250;rgica &#8211; uma les&#227;o foi ampliada por at&#233; quatro vezes at&#233; atingir margens cir&#250;rgicas livres de tumor&#46; Os outros tr&#234;s casos recidivados eram CECs&#44; tamb&#233;m localizados na face &#40;orelha&#44; couro cabeludo e nariz&#41;&#44; todos les&#245;es virgens de tratamento&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Todos os pacientes que recidivaram tiveram um tempo m&#237;nimo de seguimento de quatro anos&#46; As recidivas ocorreram entre cinco e 44 meses ap&#243;s o procedimento cir&#250;rgico&#46; A sobrevida mediana livre de recidiva foi de 25 meses &#40;SD 5&#8208;44&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Revisamos as les&#245;es inclu&#237;das no estudo&#44; e 536 les&#245;es foram consideradas de alto risco&#46; A taxa de recidiva tumoral total nas les&#245;es de alto risco foi de 1&#44;3&#37; &#8211; 0&#44;87&#37; recidiva em tumor prim&#225;rio e 3&#44;7&#37; em tumor recorrente&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Rela&#231;&#227;o entre a congela&#231;&#227;o intraoperat&#243;ria &#8220;en face&#8221; e o resultado do processamento histopatol&#243;gico com confec&#231;&#227;o de blocos de parafina &#40;concordante ou discordante&#41;</span><p id="par0130" class="elsevierStylePara elsevierViewall">Os resultados do processamento histopatol&#243;gico com confec&#231;&#227;o de blocos de parafina estiveram de acordo com o resultado da congela&#231;&#227;o intraoperat&#243;ria &#8220;<span class="elsevierStyleItalic">en face</span>&#8221; em 98&#37; das les&#245;es&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Avaliamos as associa&#231;&#245;es entre as vari&#225;veis do paciente e o resultado da patologia permanente &#40;parafina&#41; em rela&#231;&#227;o &#224; concord&#226;ncia com a congela&#231;&#227;o &#8220;<span class="elsevierStyleItalic">en face</span>&#8221;&#46; As vari&#225;veis qualitativas descritas na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> n&#227;o apresentaram signific&#226;ncia estat&#237;stica&#46; Por outro lado&#44; houve signific&#226;ncia estat&#237;stica em rela&#231;&#227;o &#224;s vari&#225;veis quantitativas&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Observou&#8208;se que existe uma rela&#231;&#227;o direta entre o n&#250;mero de les&#245;es operadas de um mesmo paciente e o aumento da discord&#226;ncia entre os m&#233;todos diagn&#243;sticos&#46; Cada les&#227;o operada em um mesmo paciente aumenta em 24&#37; o risco de discord&#226;ncia entre o resultado final do anatomopatol&#243;gico e a congela&#231;&#227;o intraoperat&#243;ria &#8220;<span class="elsevierStyleItalic">en face</span>&#8221;&#46; Em rela&#231;&#227;o &#224;s amplia&#231;&#245;es de margens&#44; para cada les&#227;o &#40;margem&#41; ampliada h&#225; um aumento de duas vezes no risco de haver discord&#226;ncia entre o resultado final do anatomopatol&#243;gico e a congela&#231;&#227;o intraoperat&#243;ria &#8220;<span class="elsevierStyleItalic">en</span><span class="elsevierStyleItalic">face</span>&#8221;&#46; Os resultados est&#227;o resumidos na <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">Todas as vari&#225;veis com valor de p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 foram inclu&#237;das na regress&#227;o log&#237;stica m&#250;ltipla &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discuss&#227;o</span><p id="par0150" class="elsevierStylePara elsevierViewall">Analisamos 397 pacientes&#44; com um total de 542 les&#245;es&#44; carcinomas cut&#226;neos &#40;CBC e CEC&#41;&#44; entre 1 de janeiro a 31 de dezembro de 2013 &#40;per&#237;odo de um ano&#41;&#44; em que foi realizado a congela&#231;&#227;o intraoperat&#243;ria &#8220;<span class="elsevierStyleItalic">en face</span>&#8221;&#46; Esse fato &#233; importante&#44; pois na literatura n&#227;o h&#225; estudos avaliando o uso da t&#233;cnica de congela&#231;&#227;o intraoperat&#243;ria &#8220;<span class="elsevierStyleItalic">en face</span>&#8221; com um n&#250;mero de casos similar em um per&#237;odo de tempo t&#227;o curto&#46; Na <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a> demonstramos de modo resumido algumas caracter&#237;sticas importantes de trabalhos encontrados na literatura sobre a congela&#231;&#227;o &#8220;<span class="elsevierStyleItalic">en face</span>&#8221;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">A maioria dos estudos encontrados na literatura sobre a t&#233;cnica de congela&#231;&#227;o &#8220;<span class="elsevierStyleItalic">en face</span>&#8221; &#233; restrita a uma topografia espec&#237;fica&#44; descrevendo les&#245;es em regi&#227;o periorbital e na face&#44; mas nosso estudo teve um crit&#233;rio de inclus&#227;o mais amplo em rela&#231;&#227;o &#224; localiza&#231;&#227;o&#44; demonstrando que essa t&#233;cnica de congela&#231;&#227;o pode ser utilizada em outros s&#237;tios anat&#244;micos de maneira segura&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Tivemos uma taxa de 1&#44;4&#37; de recorr&#234;ncia tumoral total &#40;7&#47;542 les&#245;es&#41;&#46; Estratificando esse resultado&#44; houve uma taxa de 0&#44;86&#37; de recidiva para o tumor prim&#225;rio e 3&#44;7&#37; para o tumor recorrente&#44; com seguimento mediano superior a tr&#234;s anos&#46; Nenhum paciente que recorreu apresentou discord&#226;ncia entre o resultado da congela&#231;&#227;o &#8220;<span class="elsevierStyleItalic">en face</span>&#8221; intraoperat&#243;rio e o resultado final do exame anatomopatol&#243;gico &#40;exame de parafina&#41;&#44; demonstrando que essa t&#233;cnica de congela&#231;&#227;o &#233; segura e n&#227;o foi o fator determinante para a recorr&#234;ncia tumoral&#44; mais relacionada com a biologia do tumor&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5&#44;8</span></a> Nossa taxa de recorr&#234;ncia tumoral total se assemelha com a da literatura&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Com base em uma revis&#227;o da literatura&#44; a taxa de recorr&#234;ncia em cinco anos para CMM foi de 0&#44;6 a 3&#37; para CBC prim&#225;rio e 6 a 10&#37; para CBC recorrente&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> Montamos um fluxograma especificando os resultados separadamente de CBC e CEC quanto aos tumores prim&#225;rios&#44; recorrentes e ao &#237;ndice de recorr&#234;ncia &#40;<a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4</a>&#41;&#46; Assim&#44; nossa taxa de recorr&#234;ncia para o CBC prim&#225;rio &#40;0&#44;3&#37;&#41; e o CBC recorrente &#40;4&#44;3&#37;&#41;&#44; com o uso da t&#233;cnica de congela&#231;&#227;o intraoperat&#243;ria &#8220;<span class="elsevierStyleItalic">en face</span>&#8221;&#44; &#233; semelhante aos resultados da CMM relatados na literatura&#46; Por&#233;m&#44; n&#227;o podemos comparar os resultados da congela&#231;&#227;o &#8220;<span class="elsevierStyleItalic">en face</span>&#8221; com a CMM&#44; pois n&#227;o h&#225; estudos na literatura comparando essas duas t&#233;cnicas&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">N&#227;o relatamos o tempo cir&#250;rgico encontrado com o uso da t&#233;cnica de congela&#231;&#227;o &#8220;<span class="elsevierStyleItalic">en face</span>&#8221;&#44; pois encontramos discord&#226;ncias entre anota&#231;&#245;es no prontu&#225;rio&#44; tornando os dados incertos&#46; Tullett et al&#46; relatam que o tempo para a prepara&#231;&#227;o das l&#226;minas na t&#233;cnica de congela&#231;&#227;o &#8220;<span class="elsevierStyleItalic">en face</span>&#8221; &#233; de 45 a 75 minutos&#44; demonstrando que o uso dessa t&#233;cnica de congela&#231;&#227;o &#233; r&#225;pida&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Todas as margens perif&#233;ricas e profunda analisadas na congela&#231;&#227;o foram enviadas para an&#225;lise com a confec&#231;&#227;o de blocos de parafina&#44; afim de revisar as l&#226;minas da congela&#231;&#227;o de modo que o resultado seja seguro e assertivo que n&#227;o tenha havido tumor residual&#46; Na confec&#231;&#227;o de blocos de parafina&#44; as estruturas ficam mais evidentes e mais claras em virtude do corte histol&#243;gico mais fino&#44; possibilitando uma an&#225;lise mais detalhada&#46; Em 98&#37; dos casos tivemos o resultado da congela&#231;&#227;o intra&#8208;operat&#243;ria concordante com o resultado final do exame anatomopatol&#243;gico da pe&#231;a cir&#250;rgica &#40;exame de parafina&#41;&#46; Na experi&#234;ncia dos patologistas do nosso servi&#231;o&#44; essa discord&#226;ncia de interpreta&#231;&#227;o&#44; gerando o resultado da congela&#231;&#227;o falso&#8208;negativo&#44; &#233; comumente relacionada a cortes histol&#243;gicos espessos&#44; prolifera&#231;&#227;o inflamat&#243;ria&#44; prolifera&#231;&#227;o folicular e les&#245;es triquelimais&#46; Uma armadilha diagn&#243;stica comum na congela&#231;&#227;o de tumores cut&#226;neo &#233; confundir fol&#237;culos capilares seccionados tangencialmente em CBC&#46; A inflama&#231;&#227;o tamb&#233;m pode ser confundida com tumor ou pode obscurecer uma malignidade subjacente&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">A t&#233;cnica de congela&#231;&#227;o intraoperat&#243;ria padr&#227;o &#40;corte em &#8220;p&#227;o de forma&#8221;&#41; normalmente envolve se&#231;&#245;es por meio de amostras em seu eixo horizontal e longitudinal&#46; De acordo com a literatura&#44; aproximadamente 44&#37; de toda a margem &#233; normalmente examinada&#44; o que explica em parte por que os tumores inicialmente relatados como &#8220;completamente excisados&#8221; ocasionalmente recorrem&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">A t&#233;cnica de avalia&#231;&#227;o intraoperat&#243;ria de margens cir&#250;rgicas por congela&#231;&#227;o &#8220;<span class="elsevierStyleItalic">en face</span>&#8221; descrita neste estudo oferece certos benef&#237;cios sobre as t&#233;cnicas de congela&#231;&#227;o padr&#227;o&#46; Um desses benef&#237;cios &#233; que essa t&#233;cnica examina todas as margens perif&#233;ricas e profunda&#44; evitando casos falso&#8208;negativos&#59; &#233; tamb&#233;m uma t&#233;cnica de r&#225;pida execu&#231;&#227;o e de f&#225;cil disponibilidade&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7&#44;8&#44;13&#8211;15</span></a> Na <a class="elsevierStyleCrossRef" href="#fig0025">figura 5</a> demonstramos um desenho esquem&#225;tico da t&#233;cnica de congela&#231;&#227;o &#8220;<span class="elsevierStyleItalic">en face</span>&#8221; e da t&#233;cnica de congela&#231;&#227;o padr&#227;o&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0190" class="elsevierStylePara elsevierViewall">Podemos&#44; no entanto&#44; citar algumas limita&#231;&#245;es do uso da t&#233;cnica de congela&#231;&#227;o &#8220;<span class="elsevierStyleItalic">en face</span>&#8221;&#58; ela n&#227;o permite determinar a dist&#226;ncia entre o tumor e a margem final da pe&#231;a&#46; Mesmo que a margem seja negativa&#44; o tumor pode estar a apenas alguns micr&#244;metros de dist&#226;ncia&#46; Assim&#44; embora uma margem cl&#237;nica livre de 4<span class="elsevierStyleHsp" style=""></span>mm n&#227;o seja necess&#225;ria&#44; ainda &#233; preferido algum grau de margem cl&#237;nica livre ao utilizar a t&#233;cnica &#8220;<span class="elsevierStyleItalic">en face</span>&#8221; para minimizar o risco de uma margem histol&#243;gica livre pequena&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;16&#44;17</span></a> De acordo com a literatura&#44; uma grande parte das recorr&#234;ncias tumorais ocorre ap&#243;s o quinto ano de tratamento&#46; Esse achado enfatiza a import&#226;ncia de um seguimento a longo prazo&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Esse fato demonstra um percal&#231;o em nosso estudo&#44; pois obtivemos um tempo de seguimento mediano de tr&#234;s anos&#46; No entanto&#44; nossos dados s&#227;o compar&#225;veis aos de outros estudos na literatura sobre uso de congela&#231;&#227;o intraoperat&#243;ria &#8220;<span class="elsevierStyleItalic">en face</span>&#8221;&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">As les&#245;es em que houve discord&#226;ncia entre o resultado da congela&#231;&#227;o intraoperat&#243;ria e o resultado do processamento histopatol&#243;gico com confec&#231;&#227;o de blocos de parafina foram submetidas a tratamento complementar &#40;nova excis&#227;o cir&#250;rgica&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclus&#227;o</span><p id="par0200" class="elsevierStylePara elsevierViewall">A t&#233;cnica de congela&#231;&#227;o intraoperat&#243;ria &#8220;<span class="elsevierStyleItalic">en face</span>&#8221; &#233; r&#225;pida&#44; segura e confi&#225;vel para garantir margens cir&#250;rgicas livres de tumor para CBC e CEC&#46; Nossa taxa de recorr&#234;ncia tumoral &#233; aceit&#225;vel&#44; de acordo com a literatura&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Suporte financeiro</span><p id="par0205" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Contribui&#231;&#227;o dos autores</span><p id="par0210" class="elsevierStylePara elsevierViewall">Ana Carolina Vasconcellos Guedes Otsuka&#58; Levantamento dos dados&#44; ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; Reda&#231;&#227;o do artigo ou revis&#227;o cr&#237;tica do conte&#250;do intelectual importante&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Eduardo Bertolli&#58; Concep&#231;&#227;o e o desenho do estudo&#44; an&#225;lise estat&#237;stica&#59; Reda&#231;&#227;o do artigo ou revis&#227;o cr&#237;tica do conte&#250;do intelectual importante&#59; Participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Mariana Petaccia de Macedo&#58; Concep&#231;&#227;o e o desenho do estudo&#59; Participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Clovis Antonio Lopes Pinto&#58; Participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; Aprova&#231;&#227;o final da vers&#227;o final do manuscrito&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Jo&#227;o Pedreira Duprat Neto&#58; Reda&#231;&#227;o do artigo ou revis&#227;o cr&#237;tica do conte&#250;do intelectual importante&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; aprova&#231;&#227;o final da vers&#227;o final do manuscrito&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflito de interesses</span><p id="par0235" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Os carcinomas cut&#226;neos dos tipos basocelular e espinocelular &#40;CBC e CEC&#41; s&#227;o os tipos mais comuns de c&#226;ncer no mundo&#46; A avalia&#231;&#227;o intraoperat&#243;ria de margens cir&#250;rgicas por congela&#231;&#227;o vem sendo largamente utilizada para assegurar margens livres de doen&#231;a&#46; A t&#233;cnica de congela&#231;&#227;o intraoperat&#243;ria &#8220;<span class="elsevierStyleItalic">en face</span>&#8221; avalia todas as margens perif&#233;ricas e profunda&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Relatar os resultados da t&#233;cnica de congela&#231;&#227;o &#8220;<span class="elsevierStyleItalic">en face</span>&#8221; em rela&#231;&#227;o &#224; recorr&#234;ncia tumoral e &#224; concord&#226;ncia com o exame histopatol&#243;gico em parafina&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">An&#225;lise retrospectiva dos pacientes submetidos &#224; ex&#233;rese cir&#250;rgica de CBC e CEC pelo N&#250;cleo de C&#226;ncer de Pele do A&#46;C&#46;Camargo Cancer Center&#44; Brasil&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Nosso estudo incluiu 542 carcinomas de pele&#44; que foram excisados de 397 pacientes &#8211; 201 do sexo masculino &#40;50&#44;6&#37;&#41;&#44; 196 do sexo feminino &#40;49&#44;4&#37;&#41;&#44; com idade m&#233;dia de 64 anos&#46; Os tumores foram localizados em sua maioria na regi&#227;o da cabe&#231;a e pesco&#231;o &#40;87&#44;8&#37;&#41;&#46; O CBC correspondeu a 79&#44;7&#37; dos casos&#46; O seguimento m&#233;dio foi de 38 meses&#46; A recidiva tumoral ocorreu em 0&#44;86&#37; para os tumores prim&#225;rios e 3&#44;7&#37; para os tumores recorrentes&#46; O resultado da congela&#231;&#227;o intraoperat&#243;ria &#8220;<span class="elsevierStyleItalic">en face</span>&#8221; foi concordante com o resultado final do exame anatomopatol&#243;gico &#40;exame em parafina&#41; em 98&#37; das les&#245;es&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">N&#227;o ter o tempo de seguimento m&#237;nimo de cinco anos em todos os pacientes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A t&#233;cnica de congela&#231;&#227;o &#8220;<span class="elsevierStyleItalic">en face</span>&#8221; &#233; uma t&#233;cnica com baixa recidiva tumoral&#44; confi&#225;vel e segura para garantir margens cir&#250;rgicas negativas de tumor&#46;</p></span>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vari&#225;vel&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Fronte&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">10&#44;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Nariz&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">199&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">36&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">L&#225;bio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Regi&#227;o malar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Regi&#227;o temporal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Regi&#227;o retroauricular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Orelha&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&#225;lpebra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Regi&#227;o cervical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tronco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dorso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Flanco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Membros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Subtipos histol&#243;gicos de carcinoma cut&#226;neo basocelular</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nodular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">104&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Superficial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esclerodermiforme&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Micronodular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Misto<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">159&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Outros<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tipo de anestesia</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Local exclusiva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Local e seda&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">192&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Geral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">329&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bloqueio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Apresenta&#231;&#227;o inicial da les&#227;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Virgem de tratamento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">463&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#44;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tumor recidivado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Invas&#227;o perineural</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">533&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#44;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resultado primeira congela&#231;&#227;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Margens livres&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">392&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#44;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Margens comprometidas<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">511&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96&#44;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tratamento complementar &#40;ap&#243;s a cirurgia&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Radioterapia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cirurgia complementar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tratamento t&#243;pico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
          "notaPie" => array:3 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Mais de um subtipo histol&#243;gico&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Outros subtipos de CBC&#58; adenoide e basoescamoso&#46;</p>"
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            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Em 116 les&#245;es foi necess&#225;ria uma amplia&#231;&#227;o de margem cir&#250;rgica no intraoperat&#243;rio para obter margens livres de tumor&#46; Em 20 les&#245;es&#44; foram necess&#225;rias duas amplia&#231;&#245;es&#46; Em 11 les&#245;es&#44; foram necess&#225;rias tr&#234;s amplia&#231;&#245;es&#46; Em duas les&#245;es&#44; foram necess&#225;rias quatro amplia&#231;&#245;es&#59; e em uma les&#227;o&#44; foram necess&#225;rios seis amplia&#231;&#245;es de margens cir&#250;rgicas para obter margens livres&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas qualitativas dos pacientes submetidos &#224; ex&#233;rese de carcinomas cut&#226;neos basocelular &#40;CBC&#41; e espinocelular &#40;CEC&#41;&#44; no ano de 2013&#44; de janeiro a dezembro no A&#46;C&#46;Camargo Cancer Center</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabela 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">RR&#44; risco relativo&#59; 95&#37; IC&#44; intervalo de confian&#231;a&#59; CBC&#44; carcinoma basocelular&#59; CEC&#44; carcinoma espinocelular&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Vari&#225;vel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Regress&#227;o de COX simples</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Regress&#227;o de COX m&#250;ltipla</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; IC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; IC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Invas&#227;o perineural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;048&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;507&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;023&#8208;70&#46;758&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;049&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;504&#8208;113&#46;216&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#250;mero de amplia&#231;&#245;es at&#233; obter margens livres&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;841&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;170&#8208;2&#46;895&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;872&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;205&#8208;2&#46;907&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Regress&#227;o de Cox simples e m&#250;ltipla com vari&#225;veis associadas &#224; sobrevida livre de recorr&#234;ncia em pacientes submetidos a ex&#233;rese de CBC e CEC&#44; no ano de 2013&#44; de janeiro a dezembro no A&#46;C&#46;Camargo Cancer Center</p>"
        ]
      ]
      7 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabela 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">OR&#44; odds ratio&#59; 95&#37; IC&#44; intervalo de confian&#231;a&#59; CBC&#44; carcinoma basocelular&#59; CEC&#44; carcinoma espinocelular&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Vari&#225;vel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Regress&#227;o log&#237;stica simples</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Regress&#227;o log&#237;stica m&#250;ltipla</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; IC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; IC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#250;mero de les&#245;es operadas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;227&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;089&#8208;1&#46;383&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;243&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;101&#8208;1&#46;403&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#250;mero de amplia&#231;&#245;es at&#233; margens livres&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;945&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;231&#8208;3&#46;073&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;035&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;237&#8208;3&#46;347&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Regress&#227;o log&#237;stica simples e m&#250;ltipla com vari&#225;veis associadas ao resultado final do anatomopatol&#243;gico &#40;concordante e discordante&#41; em pacientes submetidos a ex&#233;rese de CBC e CEC&#44; no ano de 2013&#44; de janeiro a dezembro no A&#46;C&#46;Camargo Cancer Center</p>"
        ]
      ]
      8 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Tabela 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">CBC&#44; carcinoma basocelular&#59; CEC&#44; carcinoma espinocelular&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Autores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Per&#237;odo estudado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#250;mero de les&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Localiza&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Seguimento &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Taxa de recorr&#234;ncia &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gayre et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1985 a 2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1638&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CBC periocular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wong et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1992 a 2001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">534&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CBC periocular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;2&#37;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gill et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1997 a 2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CBC periocular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resti et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1998 a 2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">110&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CBC palpebral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kvannli et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1999 a 2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">262&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CBC e CEC periorbitais&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Menesi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2002 a 2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CBC na face&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tullett et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2003 a 2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CBC periocular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nizamoglu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2010 a 2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Carcinomas de alto risco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presente estudo<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">542&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CBC e CEC cabe&#231;a e pesco&#231;o&#44; tronco e membros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Les&#227;o prim&#225;ria&#46;</p>"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Estudo atual&#46;</p>"
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Dados encontrados na literatura sobre o uso da congela&#231;&#227;o intraoperat&#243;ria &#8220;<span class="elsevierStyleItalic">en face</span>&#8221;</p>"
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      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:17 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A systematic review of worldwide incidence of nonmelanoma skin cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Lomas"
                            1 => "J&#46; Leonardi-Bee"
                            2 => "F&#46; Bath-Hextall"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2012.10830.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol&#46;"
                        "fecha" => "2012"
                        "volumen" => "166"
                        "paginaInicial" => "1069"
                        "paginaFinal" => "1080"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22251204"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "nccn&#46;org &#91;Internet&#93;&#46; Pensilv&#226;nia&#58; National Comprehensive Cancer Network&#59; c2022&#46; NCCN Clinical Practice Guidelines in Oncology &#40;NCCN Guidelines&#41; Basal cell skin cancer &#40;2020&#41;&#46;"
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "inca&#46;gov &#91;Internet&#93;&#46; Minist&#233;rio da Sa&#250;de&#46; Instituto Nacional de C&#226;ncer Jos&#233; Alencar Gomes da Silva&#46; Estimativa 2020&#58; Incid&#234;ncia de c&#226;ncer no Brasil&#46; Rio de Janeiro&#58; INCA&#59; 2019&#46; Dispon&#237;vel em&#58; https&#58;&#47;&#47;www&#46;inca&#46;gov&#46;br&#47;sites&#47;ufu&#46;sti&#46;inca&#46;local&#47;files&#47;media&#47;document&#47;estimativa&#8208;2020&#8208;incidencia&#8208;de&#8208;cancer&#8208;no&#8208;brasil&#46;pdf&#46;"
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of periocular basal cell carcinoma with modified en face frozen section controlled excision"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "V&#46;A&#46; Wong"
                            1 => "J&#46;A&#46; Marshall"
                            2 => "K&#46;J&#46; Whitehead"
                            3 => "R&#46;M&#46; Williamson"
                            4 => "T&#46;J&#46; Sullivan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00002341-200211000-00008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ophthal Plast Reconstr Surg&#46;"
                        "fecha" => "2002"
                        "volumen" => "18"
                        "paginaInicial" => "430"
                        "paginaFinal" => "435"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12439056"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A reliable frozen section technique for basal cell carcinomas of the head and neck"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "W&#46; Menesi"
                            1 => "E&#46;W&#46; Buchel"
                            2 => "T&#46; Je"
                            3 => "H&#46; Md"
                            4 => "T&#46;J&#46; Hayakawa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Plast Surg&#46;"
                        "fecha" => "2014"
                        "volumen" => "22"
                        "paginaInicial" => "179"
                        "paginaFinal" => "182"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
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              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acur&#225;cia da bi&#243;psia de congela&#231;&#227;o no c&#226;ncer de pele n&#227;o&#8208;melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "K&#46;M&#46; Kiyan"
                            1 => "J&#46; Broetto"
                            2 => "R&#46; Fischler"
                            3 => "A&#46;E&#46; Sperli"
                            4 => "J&#46;O&#46;G&#46; Freitas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Bras Cir Pl&#225;st&#46;"
                        "fecha" => "2012"
                        "volumen" => "27"
                        "paginaInicial" => "472"
                        "paginaFinal" => "474"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Excision of periocular basal cell carcinoma guided by en face frozen section"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Tullett"
                            1 => "S&#46; Sagili"
                            2 => "A&#46; Barrett"
                            3 => "R&#46; Malhotra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bjoms.2012.10.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Oral Maxillofac Surg&#46;"
                        "fecha" => "2013"
                        "volumen" => "51"
                        "paginaInicial" => "520"
                        "paginaFinal" => "524"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23219018"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Frozen section of skin specimens"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;J&#46; Smith-Zagone"
                            1 => "M&#46;R&#46; Schwartz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5858/2005-129-1536-FSOSS"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Pathol Lab Med&#46;"
                        "fecha" => "2005"
                        "volumen" => "129"
                        "paginaInicial" => "1536"
                        "paginaFinal" => "1543"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16329726"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Using frozen section margin control technique to manage non&#8208;melanomatous skin lesions in high&#8208;risk sites"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Nizamoglu"
                            1 => "H&#46; Douglas"
                            2 => "C&#46; McArdle"
                            3 => "B&#46; Mathew"
                            4 => "C&#46; Vize"
                            5 => "P&#46; Matteucci"
                          ]
                        ]
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Plast Reconstr Aesthetic Surg&#46;"
                        "fecha" => "2016"
                        "volumen" => "69"
                        "paginaInicial" => "657"
                        "paginaFinal" => "662"
                      ]
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              "etiqueta" => "10"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcomes of excision of 1750 eyelid and periocular skin basal cell and squamous cell carcinomas by modified en face frozen section margin&#8208;controlled technique"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;S&#46; Gayre"
                            1 => "C&#46;P&#46; Hybarger"
                            2 => "G&#46; Mannor"
                            3 => "W&#46; Meecham"
                            4 => "J&#46;B&#46; Delfanti"
                            5 => "G&#46;S&#46; Mizono"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/IIO.0b013e3181b802ee"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int Ophthalmol Clin&#46;"
                        "fecha" => "2009"
                        "volumen" => "49"
                        "paginaInicial" => "97"
                        "paginaFinal" => "110"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20348860"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The method of en face Frozen section in clearing periocular basal cell carcinoma and squamous cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46; Kvannli"
                            1 => "R&#46; Benger"
                            2 => "A&#46; Gal"
                            3 => "B&#46; Swamy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/01676830.2012.679170"
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                        "tituloSerie" => "Orbit&#46;"
                        "fecha" => "2012"
                        "volumen" => "31"
                        "paginaInicial" => "233"
                        "paginaFinal" => "237"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22671704"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcome of 110 basal cell carcinomas of the eyelid treated with frozen section&#8208;controlled excision&#58; mean follow&#8208;up over 5&#8208;years"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;G&#46; Resti"
                            1 => "R&#46; Sacconi"
                            2 => "N&#46; Baccelli"
                            3 => "F&#46; Bandello"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5301/ejo.5000405"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Ophthalmol&#46;"
                        "fecha" => "2013"
                        "volumen" => "24"
                        "paginaInicial" => "476"
                        "paginaFinal" => "482"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24338583"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eyelid margin basal cell carcinoma managed with full&#8208;thickness en&#8208;face frozen section histopathology"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46;S&#46; Gill"
                            1 => "E&#46;E&#46; Moscato"
                            2 => "S&#46;R&#46; Seiff"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/IOP.0b013e3182a74f21"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ophthal Plast Reconstr Surg&#46;"
                        "fecha" => "2014"
                        "volumen" => "30"
                        "paginaInicial" => "15"
                        "paginaFinal" => "19"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24398481"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Long&#8208;term recurrence rates in previously untreated &#40;primary&#41; basal cell carcinoma&#58; implications for patient follow&#8208;up"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;E&#46; Rowe"
                            1 => "R&#46;J&#46; Carroll"
                            2 => "C&#46;L&#46; Day Jr&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.1989.tb03166.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Dermatol Surg Oncol&#46;"
                        "fecha" => "1989"
                        "volumen" => "15"
                        "paginaInicial" => "315"
                        "paginaFinal" => "328"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2646336"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mohs surgery is the treatment of choice for recurrent &#40;previously treated&#41; basal cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
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                            1 => "R&#46;J&#46; Carroll"
                            2 => "C&#46;L&#46; Day Jr&#46;"
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                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.1989.tb03249.x"
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                        "tituloSerie" => "J Dermatol Surg Oncol&#46;"
                        "fecha" => "1989"
                        "volumen" => "15"
                        "paginaInicial" => "424"
                        "paginaFinal" => "431"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2925988"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Are en face frozen sections accurate for diagnosing margin status in melanocytic lesions&#63;"
                      "autores" => array:1 [
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46;G&#46; Prieto"
                            1 => "Z&#46;B&#46; Argenyi"
                            2 => "R&#46;L&#46; Barnhill"
                            3 => "P&#46;H&#46; Duray"
                            4 => "R&#46; Elenitsas"
                            5 => "L&#46; From"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1309/J1Q0-V35E-UTMV-R193"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Clin Pathol&#46;"
                        "fecha" => "2003"
                        "volumen" => "120"
                        "paginaInicial" => "203"
                        "paginaFinal" => "208"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12931550"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                    0 => array:2 [
                      "titulo" => "Ten Years of Experience with the Munich method of micrographic surgery&#58; a report of 93 operated cases"
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                          "etal" => false
                          "autores" => array:3 [
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                            1 => "O&#46;S&#46; Gouv&#234;a"
                            2 => "J&#46;C&#46;F&#46; Bastos"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "An Bras Dermatol&#46;"
                        "fecha" => "2005"
                        "volumen" => "80"
                        "paginaInicial" => "583"
                        "paginaFinal" => "590"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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