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na aus&#234;ncia de ulcera&#231;&#227;o e de um n&#250;mero de mitoses<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>&#44; a taxa de positividade do linfonodo sentinela &#233; inferior a 6&#37;&#44; sendo de pelo menos 14&#37; para espessuras<span class="elsevierStyleHsp" style=""></span>&#62; 1&#44;0<span class="elsevierStyleHsp" style=""></span>mm&#44; pelo que&#44; neste &#250;ltimo caso&#44; est&#225; recomendado realizar a bi&#243;psia de linfonodo sentinela&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a> Al&#233;m da decis&#227;o acerca da pesquisa do linfonodo sentinela&#44; a espessura influencia tamb&#233;m a extens&#227;o das margens de resse&#231;&#227;o cir&#250;rgica&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">3&#44;5</span></a> A bi&#243;psia de uma les&#227;o suspeita de melanoma deve ser&#44; tanto quanto poss&#237;vel&#44; excisional&#44; de modo a que a decis&#227;o terap&#234;utica esteja fundamentada em par&#226;metros de estadiamento precisos&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a> As bi&#243;psias incisionais podem subvalorizar a espessura em 5 a 22&#37; dos casos&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">6</span></a> baseando&#8208;se numa colheita por amostragem que nem sempre representa a zona de maior espessura tumoral&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A dermatoscopia &#233; t&#233;cnica que permite aumentar a acuidade diagn&#243;stica no melanoma&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a> Alguns estudos evidenciaram sua capacidade de inferir caracter&#237;sticas histol&#243;gicas&#44; nomeadamente a espessura&#44; o &#237;ndice mit&#243;tico e a presen&#231;a de ulcera&#231;&#227;o&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">8&#8211;12</span></a> Por&#233;m&#44; a literatura mais recente &#233; pouco abundante nesse contexto&#44; e a aplica&#231;&#227;o concreta dos resultados &#233; pouco explorada&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Desse modo&#44; este trabalho tem como objetivo prim&#225;rio estudar a rela&#231;&#227;o entre a espessura do melanoma e as vari&#225;veis dermatosc&#243;picas e&#44; em segundo lugar&#44; entre a espessura e as vari&#225;veis demogr&#225;ficas&#44; epidemiol&#243;gicas e cl&#237;nicas&#44; procurando identificar fatores preditivos da espessura do melanoma&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material e m&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Realizou&#8208;se estudo anal&#237;tico&#44; observacional e transversal numa amostra de doentes diagnosticados com melanoma cut&#226;neo&#44; no Servi&#231;o de Dermatologia e Venereologia do Centro Hospitalar e Universit&#225;rio de Coimbra&#44; entre janeiro de 2014 e dezembro de 2017&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Para a sele&#231;&#227;o&#44; teve&#8208;se em conta os seguintes crit&#233;rios de inclus&#227;o&#58; diagn&#243;stico definitivo de melanoma cut&#226;neo localizado na cabe&#231;a e pesco&#231;o&#44; tronco&#44; membro superior&#44; m&#227;o&#44; membro inferior ou p&#233;&#44; e presen&#231;a de dados cl&#237;nicos relativos ao exame dermatosc&#243;pico e anatomopatol&#243;gico&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Consultou&#8208;se o processo cl&#237;nico dos doentes selecionados para coleta de vari&#225;veis demogr&#225;ficas &#40;idade e sexo&#41;&#44; epidemiol&#243;gicas &#40;fototipo&#44; cor dos olhos&#44; cor dos cabelos aos 18 anos&#44; presen&#231;a de ef&#233;lides&#44; presen&#231;a de lentigos solares&#44; hist&#243;ria de queimadura solar com eritema e bolhas&#44; n&#250;mero de nevos melanoc&#237;ticos de dimens&#227;o<span class="elsevierStyleHsp" style=""></span>&#62; 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vers&#227;o 25&#44; com um n&#237;vel de signific&#226;ncia definido de 0&#44;05&#46; As vari&#225;veis foram representadas por meio de sua frequ&#234;ncia relativa e absoluta&#46; O teste do Qui&#8208;Quadrado e o teste de Fisher foram usados para estabelecer associa&#231;&#245;es entre as vari&#225;veis recolhidas&#46; A regress&#227;o log&#237;stica bin&#225;ria univariada e multivariada possibilitou determinar fatores preditivos de uma espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">O estudo foi realizado de acordo com as recomenda&#231;&#245;es da Declara&#231;&#227;o de Helsinque da Organiza&#231;&#227;o Mundial da Sa&#250;de e aprovado pela Comiss&#227;o de &#201;tica do Centro Hospitalar e Universit&#225;rio de Coimbra&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Esta pesquisa n&#227;o recebeu nenhum financiamento espec&#237;fico de ag&#234;ncias p&#250;blicas&#44; privadas ou sem fins lucrativos&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0050" class="elsevierStylePara elsevierViewall">Foram diagnosticados 314 doentes com melanoma maligno cut&#226;neo no per&#237;odo temporal referido&#46; Foram exclu&#237;dos 195 casos por aus&#234;ncia de registo das vari&#225;veis dermatosc&#243;picas em estudo&#44; tendo sido inclu&#237;dos os restantes 119 casos&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">As caracter&#237;sticas demogr&#225;ficas e cl&#237;nicas dos indiv&#237;duos inclu&#237;dos est&#227;o representadas na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; A maioria dos doentes &#40;94&#44;1&#37;&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>112&#41; tinha pelo menos 40 anos &#224; &#233;poca do diagn&#243;stico e era do sexo masculino &#40;51&#44;3&#37;&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>61&#41;&#46; Os melanomas malignos estavam localizados principalmente no tronco &#40;35&#44;3&#37;&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&#41;&#46; Registaram&#8208;se frequ&#234;ncias semelhantes relativamente &#224; espessura do melanoma&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">O padr&#227;o dermatosc&#243;pico multicomponente &#40;54&#44;2&#37;&#41; esteve associado a uma espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm&#44; enquanto o padr&#227;o reticular &#40;52&#44;5&#37;&#41; foi o mais frequente em melanomas com espessura &#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; A presen&#231;a de rede&#47;pseudo&#8208;rede pigmentar at&#237;pica &#40;86&#44;4&#37;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e de rede pigmentar negativa &#40;8&#44;6&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41; esteve associada a uma espessura &#8804; 1<span class="elsevierStyleHsp" style=""></span>mm&#44; enquanto a presen&#231;a de um padr&#227;o vascular at&#237;pico &#40;65&#44;0&#37;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e de linhas brancas brilhantes &#40;18&#44;3&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41; foi mais frequente nos melanomas com espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a> compara a distribui&#231;&#227;o de vari&#225;veis demogr&#225;ficas e epidemiol&#243;gicas entre pacientes com melanoma maligno de diferentes espessuras&#46; A frequ&#234;ncia de indiv&#237;duos com mais de 40 anos &#40;98&#44;3&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;049&#41; foi significativamente superior quando a espessura era<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm&#44; e essa caracter&#237;stica esteve associada a uma menor frequ&#234;ncia de ef&#233;lides &#40;1&#44;7&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;032&#41; e de queimaduras solares pr&#233;vias &#40;42&#44;1&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;032&#41;&#46; Sexo&#44; fototipo&#44; cor dos olhos&#44; cor do cabelo&#44; presen&#231;a de lentigos solares&#44; n&#250;mero de nevos melanoc&#237;ticos e presen&#231;a de nevos at&#237;picos e queratoses act&#237;nicas n&#227;o diferiu significativamente de acordo com a espessura do melanoma&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">A aus&#234;ncia de pigmenta&#231;&#227;o &#40;melanoma amelan&#243;tico&#41; associou&#8208;se a espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm &#40;17&#44;5&#37;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; N&#227;o se observaram diferen&#231;as significativas relativamente &#224; localiza&#231;&#227;o do melanoma&#44; assimetria&#44; bordo&#44; mudan&#231;a de cor e crescimento recente em fun&#231;&#227;o da espessura &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0025">tabela 5</a> representa os resultados da regress&#227;o log&#237;stica univariada e multivariada sobre fatores preditivos de uma espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm em doentes com melanoma maligno&#46; Na an&#225;lise univariada&#44; a presen&#231;a de ef&#233;lides&#44; queimadura solar pr&#233;via e de rede&#47;pseudo&#8208;rede pigmentar at&#237;pica foram preditivos de espessura &#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm&#44; mas a presen&#231;a de padr&#227;o vascular at&#237;pico ou de linhas brancas brilhantes relacionou&#8208;se com espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm&#46; O modelo de regress&#227;o multivariado permitiu explicar 49&#44;7&#37; da vari&#226;ncia associada &#224; espessura &#40;R<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;497&#41; e identificou o padr&#227;o vascular at&#237;pico &#40;risco relativo de 6&#44;621&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; como fator preditivo independente de espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm&#46; Ao contr&#225;rio&#44; a rede&#47;pseudo&#8208;rede pigmentada at&#237;pica &#40;risco relativo de 0&#44;168&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; foi identificada como um fator preditivo de espessura &#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0080" class="elsevierStylePara elsevierViewall">Das vari&#225;veis cl&#237;nicas e epidemiol&#243;gicas estudadas&#44; apenas a presen&#231;a de ef&#233;lides e a hist&#243;ria de queimadura solar pr&#233;via foram identificadas como fatores preditivos de melanomas finos&#44; fatos n&#227;o relatados consistentemente em estudos pr&#233;vios&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> Este resultado poder&#225; ser explicado pelo reconhecimento das ef&#233;lides e de queimaduras solares como fatores de risco para desenvolvimento de neoplasias cut&#226;neas e consequente ado&#231;&#227;o de medidas de preven&#231;&#227;o secund&#225;ria&#44; como o recurso ao autoexame regular da pele&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Estudos pr&#233;vios comprovaram a exist&#234;ncia de uma associa&#231;&#227;o entre a rede&#47;pseudo&#8208;rede pigmentar at&#237;pica e melanomas finos&#44; bem como uma associa&#231;&#227;o entre o padr&#227;o vascular at&#237;pico e linhas brancas brilhantes com melanomas de maior espessura&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">8&#44;9</span></a> Contudo&#44; ao contr&#225;rio de outras s&#233;ries&#44; a presen&#231;a de v&#233;u azul&#8208;acinzentado e de estrias n&#227;o mostrou rela&#231;&#227;o com melanomas de espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">8&#8211;10</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Ap&#243;s a regress&#227;o multivariada&#44; apenas o padr&#227;o vascular at&#237;pico e a rede&#47;pseudo&#8208;rede pigmentada at&#237;pica se distinguiram respetivamente como fatores preditivos independentes de melanomas mais espessos que 1<span class="elsevierStyleHsp" style=""></span>mm e de melanomas com 1<span class="elsevierStyleHsp" style=""></span>mm ou menos de espessura&#46; Essas associa&#231;&#245;es sugerem que melanomas mais invasivos t&#234;m maior neovasculariza&#231;&#227;o&#44; representada ao dermatosc&#243;pio por vasos at&#237;picos&#44; e que melanomas com espessura &#8804; 1<span class="elsevierStyleHsp" style=""></span>mm mant&#234;m a jun&#231;&#227;o dermoepid&#233;rmica intacta&#44; j&#225; que a rede pigmentada at&#237;pica corresponde &#224; prolifera&#231;&#227;o melanoc&#237;tica at&#237;pica juncional&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Salientam&#8208;se limita&#231;&#245;es como a falta de dados relativos a algumas das vari&#225;veis estudadas e a aus&#234;ncia de correla&#231;&#227;o &#243;tima entre a an&#225;lise dermatosc&#243;pica&#44; feita num plano horizontal&#44; e o exame anatomopatol&#243;gico&#44; realizado por meio de bi&#243;psia vertical&#46; Para al&#233;m disso&#44; no futuro&#44; ser&#225; relevante realizar estudos de coorte propectivos para confirma&#231;&#227;o dos resultados obtidos&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#245;es</span><p id="par0100" class="elsevierStylePara elsevierViewall">A bi&#243;psia incisional acarreta o risco de subestimar a espessura&#44; levando a um subestadiamento e a eventuais imprecis&#245;es na defini&#231;&#227;o das margens apropriadas de excis&#227;o e na indica&#231;&#227;o da bi&#243;psia de linfonodo sentinela&#46; A dermatoscopia &#233; uma t&#233;cnica potencialmente &#250;til para a redu&#231;&#227;o dos erros de subestadiamento&#44; pois possibilita a escolha do local mais adequado para a realiza&#231;&#227;o da bi&#243;psia incisional &#8211; deve&#8208;se evitar zonas onde exista apenas rede pigmentada at&#237;pica &#40;relacionadas com espessuras tumorais mais baixas&#41; e incidir de prefer&#234;ncia em zonas onde se observem vasos at&#237;picos &#40;associadas a espessuras mais elevadas&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0105" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0110" class="elsevierStylePara elsevierViewall">Ana Rita Silva&#58; An&#225;lise estat&#237;stica&#59; conce&#231;&#227;o e planeamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Ricardo Vieira&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; conce&#231;&#227;o e planeamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica do manuscrito&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflito de interesses</span><p id="par0120" 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">A espessura do melanoma &#233; importante fator progn&#243;stico e &#233; fundamental para o estadiamento&#44; que depende do estudo histopatol&#243;gico&#46; Existe risco de subestima&#231;&#227;o da espessura numa bi&#243;psia incisional&#44; caso esta n&#227;o seja realizada na zona onde a espessura &#233; m&#225;xima&#46; Isso acarreta um claro impacto na decis&#227;o terap&#234;utica&#44; em especial quanto &#224;s margens de excis&#227;o e a realiza&#231;&#227;o ou n&#227;o de bi&#243;psia de linfonodo sentinela&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar a rela&#231;&#227;o entre a espessura e diversas vari&#225;veis dermatosc&#243;picas&#44; demogr&#225;ficas&#44; epidemiol&#243;gicas e cl&#237;nicas&#44; procurando identificar fatores preditivos de espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1 mm&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo observacional e transversal realizado em pacientes diagnosticados com melanoma num &#250;nico centro num per&#237;odo de quatro anos&#46; Foram coletadas vari&#225;veis anatomopatol&#243;gicas &#40;espessura&#41;&#44; dermatosc&#243;picas&#44; demogr&#225;ficas&#44; epidemiol&#243;gicas e cl&#237;nicas&#46; Avaliou&#8208;se a associa&#231;&#227;o das vari&#225;veis com a espessura do melanoma&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Foram inclu&#237;dos 119 doentes&#46; A presen&#231;a de vasos at&#237;picos &#224; dermatoscopia foi um fator preditivo independente de espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1 mm&#46; Ao contr&#225;rio&#44; a presen&#231;a de um padr&#227;o reticular at&#237;pico &#233; preditiva de melanomas de espessura &#60;<span class="elsevierStyleHsp" style=""></span>1 mm&#46; Na an&#225;lise univariada&#44; a presen&#231;a de ef&#233;lides e a hist&#243;ria de queimadura solar pr&#233;via associaram&#8208;se igualmente a melanomas de espessura &#60;<span class="elsevierStyleHsp" style=""></span>1 mm&#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">Falta de dados relativos a algumas vari&#225;veis e aus&#234;ncia de correla&#231;&#227;o &#243;tima entre a an&#225;lise dermatosc&#243;pica e o exame anatomopatol&#243;gico&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">O padr&#227;o vascular at&#237;pico relaciona&#8208;se com uma espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1 mm&#44; auxiliando na escolha do melhor local para a realiza&#231;&#227;o de bi&#243;psia incisional&#44; no caso de bi&#243;psia excisional impratic&#225;vel&#46;</p></span>"
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                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Idade</span></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"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>40 anos&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&#44;9 &#40;7&#41;&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"><span class="elsevierStyleHsp" style=""></span>&#8805; 40 anos&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">94&#44;1 &#40;112&#41;&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo</span></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"><span class="elsevierStyleHsp" style=""></span>Homem&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">48&#44;7 &#40;58&#41;&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"><span class="elsevierStyleHsp" style=""></span>Mulher&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&#44;3 &#40;61&#41;&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Localiza&#231;&#227;o</span></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"><span class="elsevierStyleHsp" style=""></span>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">35&#44;3 &#40;42&#41;&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"><span class="elsevierStyleHsp" style=""></span>Cabe&#231;a e pesco&#231;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">27&#44;7 &#40;33&#41;&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"><span class="elsevierStyleHsp" style=""></span>Membro inferior &#40;exceto p&#233;&#41;&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">16&#44;0 &#40;19&#41;&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"><span class="elsevierStyleHsp" style=""></span>P&#233;&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 &#40;14&#41;&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"><span class="elsevierStyleHsp" style=""></span>Membro superior &#40;exceto m&#227;o&#41;&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&#44;9 &#40;7&#41;&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"><span class="elsevierStyleHsp" style=""></span>M&#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">3&#44;4 &#40;4&#41;&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Espessura</span></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"><span class="elsevierStyleHsp" style=""></span>&#8804; 1 mm&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">49&#44;6 &#40;59&#41;&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"><span class="elsevierStyleHsp" style=""></span>&#62; 1 mm&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">50&#44;4 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Caracteriza&#231;&#227;o demogr&#225;fica e cl&#237;nica da amostra</p>"
        ]
      ]
      1 => 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:1 [
          "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;veis&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="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Espessura&#44; &#37; &#40;n&#41;</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">Valor p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</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">&#8804; 1<span class="elsevierStyleHsp" style=""></span>mm &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>59&#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"><span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>60&#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="" 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></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"><span class="elsevierStyleItalic">Padr&#227;o</span>&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span>&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"><span class="elsevierStyleHsp" style=""></span>Homog&#234;neo&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;0 &#40;0&#41;&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 &#40;4&#41;&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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"><span class="elsevierStyleHsp" style=""></span>Multicomponente&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;1 &#40;16&#41;&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&#44;2 &#40;32&#41;&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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"><span class="elsevierStyleHsp" style=""></span>Reticular&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">52&#44;5 &#40;31&#41;&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">10&#44;2 &#40;6&#41;&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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"><span class="elsevierStyleHsp" style=""></span>Paralelo das cristas&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;4 &#40;2&#41;&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&#44;1 &#40;3&#41;&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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"><span class="elsevierStyleHsp" style=""></span>Outro&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">16&#44;9 &#40;10&#41;&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&#44;7 &#40;14&#41;&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="" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Cor dos cabelos aos 18 anos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Castanho&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">9&#44;4 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">74&#44;5 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">83&#44;9 &#40;47&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;626 &#40;0&#44;244&#8208;1&#44;610&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;331&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rede&#47;pseudo&#8208;rede pigmentar at&#237;pica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;168 &#40;0&#44;068&#8208;0&#44;413&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span>&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
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                  \t\t\t\t">0&#44;168 &#40;0&#44;058&#8208;0&#44;491&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
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                  \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">Padr&#227;o vascular at&#237;pico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#44;104 &#40;3&#44;488&#8208;18&#44;828&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span>&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
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                  \t\t\t\t">6&#44;621 &#40;2&#44;462&#8208;17&#44;807&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span>&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">Linhas brancas brilhantes&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
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                  \t\t\t\t">13&#44;020 &#40;1&#44;623&#8208;104&#44;445&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;016</span>&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">7&#44;005 &#40;0&#44;682&#8208;71&#44;939&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;101&nbsp;\t\t\t\t\t\t\n
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                  """
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        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Fatores preditores da espessura<span class="elsevierStyleHsp" style=""></span>&#62;1<span class="elsevierStyleHsp" style=""></span>mm em doentes com melanoma maligno</p>"
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      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
        0 => array:2 [
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          "bibliografiaReferencia" => array:14 [
            0 => array:3 [
              "identificador" => "bib0075"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic factors for metastasis in cutaneous melanoma"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;C&#46;F&#46;P&#46; Cherobin"
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                            2 => "E&#46;A&#46; Colosimo"
                            3 => "E&#46;M&#46;A&#46; Goulart"
                            4 => "F&#46;V&#46; Bittencourt"
                          ]
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                    0 => array:2 [
                      "doi" => "10.1590/abd1806-4841.20184779"
                      "Revista" => array:6 [
                        "tituloSerie" => "An Bras Dermatol&#46;"
                        "fecha" => "2018"
                        "volumen" => "93"
                        "paginaInicial" => "19"
                        "paginaFinal" => "26"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29641692"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
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              "identificador" => "bib0080"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European consensus&#8208;based interdisciplinary guideline for melanoma"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Garbe"
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                            3 => "A&#46; Hauschild"
                            4 => "P&#46; Arenberger"
                            5 => "L&#46; Bastholt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Part 1&#58; Diagnosis &#8208; Update 2019&#46; Eur J Cancer&#46;"
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                        "volumen" => "126"
                        "paginaInicial" => "141"
                        "paginaFinal" => "158"
                      ]
                    ]
                  ]
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              "identificador" => "bib0085"
              "etiqueta" => "3"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Guidelines of care for the management of primary cutaneous melanoma"
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                          "autores" => array:3 [
                            0 => "W&#46; Group"
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                            2 => "H&#46; Tsao"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Dermatology&#46;"
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                        "paginaFinal" => "250"
                      ]
                    ]
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              "identificador" => "bib0090"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Final trial report of sentinel&#8208;node biopsy versus nodal observation in melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;L&#46; Morton"
                            1 => "J&#46;F&#46; Thompson"
                            2 => "A&#46;J&#46; Cochran"
                            3 => "N&#46; Mozzillo"
                            4 => "O&#46;E&#46; Nieweg"
                            5 => "D&#46;F&#46; Roses"
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                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1310460"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med&#46;"
                        "fecha" => "2014"
                        "volumen" => "370"
                        "paginaInicial" => "599"
                        "paginaFinal" => "609"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24521106"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0095"
              "etiqueta" => "5"
              "referencia" => array:1 [
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                    0 => array:2 [
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                        "fecha" => "2020"
                        "volumen" => "126"
                        "paginaInicial" => "159"
                        "paginaFinal" => "177"
                        "link" => array:1 [
                          0 => array:2 [
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              "identificador" => "bib0100"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Frequency of and risk factor for melanoma upstaging after wide local excision of primary cutaneous melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Etzkorn"
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                            2 => "J&#46; Grunyk"
                            3 => "T&#46; Shin"
                            4 => "J&#46; Sobanko"
                            5 => "C&#46; Miller"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2017.03.018"
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                        "tituloSerie" => "J Am Acad Dermatol&#46;"
                        "fecha" => "2017"
                        "volumen" => "77"
                        "paginaInicial" => "341"
                        "paginaFinal" => "348"
                        "link" => array:1 [
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                            "web" => "Medline"
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              "identificador" => "bib0105"
              "etiqueta" => "7"
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                    0 => array:2 [
                      "titulo" => "Diagnostic accuracy of dermoscopy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46; Kittler"
                            1 => "H&#46; Pehamberger"
                            2 => "K&#46; Wolff"
                            3 => "M&#46; Binder"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s1470-2045(02)00679-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Oncol&#46;"
                        "fecha" => "2002"
                        "volumen" => "3"
                        "paginaInicial" => "159"
                        "paginaFinal" => "165"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11902502"
                            "web" => "Medline"
                          ]
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                    ]
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            7 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical and dermatoscopic criteria for the preoperative evaluation of cutaneous melanoma thickness"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46; Argenziano"
                            1 => "G&#46; Fabbrocini"
                            2 => "P&#46; Carli"
                            3 => "V&#46; Giorgi"
                            4 => "M&#46; Delfino"
                          ]
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                      ]
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                  "host" => array:1 [
                    0 => array:2 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol&#46;"
                        "fecha" => "1999"
                        "volumen" => "40"
                        "paginaInicial" => "61"
                        "paginaFinal" => "68"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9922013"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
              ]
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              "identificador" => "bib0115"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Non&#8208;invasive analysis of melanoma thickness by means of dermoscopy&#58; a retrospective study"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Stante"
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                            2 => "P&#46; Cappugi"
                            3 => "B&#46; Giannotti"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00008390-200104000-00009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Melanoma Res&#46;"
                        "fecha" => "2001"
                        "volumen" => "11"
                        "paginaInicial" => "147"
                        "paginaFinal" => "152"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11333124"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermoscopy as a Tool for Estimating Breslow Thickness in Melanoma"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;M&#46; M&#225;rtinez-Piva"
                            1 => "A&#46;S&#46; Vacas"
                            2 => "M&#46;V&#46;R&#46; Kowalczuk"
                            3 => "F&#46; Gallo"
                            4 => "M&#46;R&#46; Vasconcelos"
                            5 => "L&#46;D&#46; Mazzuoccolo"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ad.2020.11.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas dermosifiliogr&#237;aficas &#40;Engl Ed&#41;&#46;"
                        "fecha" => "2021"
                        "volumen" => "112"
                        "paginaInicial" => "434"
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                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
                          ]
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                  ]
                ]
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            10 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermoscopic features predicting the presence of mitoses in thin melanoma"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Ribero"
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                            2 => "A&#46; Lallas"
                            3 => "E&#46; Moscarella"
                            4 => "E&#46; Benati"
                            5 => "M&#46; Raucci"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jdermsci.2017.01.013"
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                        "tituloSerie" => "J Dermatol Sci&#46;"
                        "fecha" => "2017"
                        "volumen" => "86"
                        "paginaInicial" => "158"
                        "paginaFinal" => "161"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28196618"
                            "web" => "Medline"
                          ]
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                  ]
                ]
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              "identificador" => "bib0130"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Dermoscopic characteristics of melanoma according to the criteria&#44; ulceration&#8220;and&#44; mitotic rate&#8221; of the AJCC 2009 staging system for melanoma"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Deinlein"
                            1 => "E&#46; Arzberger"
                            2 => "I&#46; Zalaudek"
                            3 => "C&#46; Massone"
                            4 => "J&#46; Garcias-Ladaria"
                            5 => "A&#46; Oliveira"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "PLoS One&#46;"
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                        "paginaInicial" => "1"
                        "paginaFinal" => "9"
                      ]
                    ]
                  ]
                ]
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            12 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "13"
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                    0 => array:2 [
                      "titulo" => "Clinicopathological analysis of 1571 cutaneous malignant melanoma in Valencia&#44; Spain&#58; factors related to tumour thickness"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; Nagore"
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                            2 => "R&#46; Botella-Estrada"
                            3 => "S&#46; Moreno-Picot"
                            4 => "C&#46; Guill&#233;n"
                            5 => "J&#46; Fortea"
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                    0 => array:2 [
                      "doi" => "10.2340/00015555-0004"
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                        "volumen" => "86"
                        "paginaInicial" => "50"
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Journal Information
Vol. 97. Issue 5.
Pages 601-605 (1 September 2022)
Visits
4587
Vol. 97. Issue 5.
Pages 601-605 (1 September 2022)
Artigo original
Open Access
Fatores preditivos da espessura do melanoma
Visits
4587
Ana Rita Carreiro Silvaa,
Corresponding author
arita.carreirosilva@gmail.com

Autor para correspondência.
, Ricardo José David Costa Vieiraa,b
a Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
b Unidade de Cirurgia Dermatológica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Abstract
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Resumo
Fundamentos

A espessura do melanoma é importante fator prognóstico e é fundamental para o estadiamento, que depende do estudo histopatológico. Existe risco de subestimação da espessura numa biópsia incisional, caso esta não seja realizada na zona onde a espessura é máxima. Isso acarreta um claro impacto na decisão terapêutica, em especial quanto às margens de excisão e a realização ou não de biópsia de linfonodo sentinela.

Objetivo

Avaliar a relação entre a espessura e diversas variáveis dermatoscópicas, demográficas, epidemiológicas e clínicas, procurando identificar fatores preditivos de espessura> 1 mm.

Métodos

Estudo observacional e transversal realizado em pacientes diagnosticados com melanoma num único centro num período de quatro anos. Foram coletadas variáveis anatomopatológicas (espessura), dermatoscópicas, demográficas, epidemiológicas e clínicas. Avaliou‐se a associação das variáveis com a espessura do melanoma.

Resultados

Foram incluídos 119 doentes. A presença de vasos atípicos à dermatoscopia foi um fator preditivo independente de espessura> 1 mm. Ao contrário, a presença de um padrão reticular atípico é preditiva de melanomas de espessura <1 mm. Na análise univariada, a presença de efélides e a história de queimadura solar prévia associaram‐se igualmente a melanomas de espessura <1 mm.

Limitações do estudo

Falta de dados relativos a algumas variáveis e ausência de correlação ótima entre a análise dermatoscópica e o exame anatomopatológico.

Conclusão

O padrão vascular atípico relaciona‐se com uma espessura> 1 mm, auxiliando na escolha do melhor local para a realização de biópsia incisional, no caso de biópsia excisional impraticável.

Palavras‐chave:
Biópsia de linfonodo sentinela
Dermoscopia
Melanoma
Full Text
Introdução

Um dos principais fatores de prognóstico do melanoma é a espessura do tumor primário, medida em milímetros desde a camada granulosa da epiderme ou base de uma úlcera superficial até a localização mais profunda das células malignas, excluindo a invasão folicular e com aproximação de 0,1mm.1,2 Quanto maior a espessura, maior o risco de metastização.3 Para uma espessura <1,0mm, na ausência de ulceração e de um número de mitoses> 1mm2, a taxa de positividade do linfonodo sentinela é inferior a 6%, sendo de pelo menos 14% para espessuras> 1,0mm, pelo que, neste último caso, está recomendado realizar a biópsia de linfonodo sentinela.4 Além da decisão acerca da pesquisa do linfonodo sentinela, a espessura influencia também a extensão das margens de resseção cirúrgica.3,5 A biópsia de uma lesão suspeita de melanoma deve ser, tanto quanto possível, excisional, de modo a que a decisão terapêutica esteja fundamentada em parâmetros de estadiamento precisos.2 As biópsias incisionais podem subvalorizar a espessura em 5 a 22% dos casos,6 baseando‐se numa colheita por amostragem que nem sempre representa a zona de maior espessura tumoral.

A dermatoscopia é técnica que permite aumentar a acuidade diagnóstica no melanoma.7 Alguns estudos evidenciaram sua capacidade de inferir características histológicas, nomeadamente a espessura, o índice mitótico e a presença de ulceração.8–12 Porém, a literatura mais recente é pouco abundante nesse contexto, e a aplicação concreta dos resultados é pouco explorada.

Desse modo, este trabalho tem como objetivo primário estudar a relação entre a espessura do melanoma e as variáveis dermatoscópicas e, em segundo lugar, entre a espessura e as variáveis demográficas, epidemiológicas e clínicas, procurando identificar fatores preditivos da espessura do melanoma.

Material e métodos

Realizou‐se estudo analítico, observacional e transversal numa amostra de doentes diagnosticados com melanoma cutâneo, no Serviço de Dermatologia e Venereologia do Centro Hospitalar e Universitário de Coimbra, entre janeiro de 2014 e dezembro de 2017.

Para a seleção, teve‐se em conta os seguintes critérios de inclusão: diagnóstico definitivo de melanoma cutâneo localizado na cabeça e pescoço, tronco, membro superior, mão, membro inferior ou pé, e presença de dados clínicos relativos ao exame dermatoscópico e anatomopatológico.

Consultou‐se o processo clínico dos doentes selecionados para coleta de variáveis demográficas (idade e sexo), epidemiológicas (fototipo, cor dos olhos, cor dos cabelos aos 18 anos, presença de efélides, presença de lentigos solares, história de queimadura solar com eritema e bolhas, número de nevos melanocíticos de dimensão> 2mm segundo a definição da International Agency Research on Cancer, presença de nevos atípicos segundo os critérios do ABCDE e presença de queratoses actínicas), clínicas (localização do melanoma, assimetria, bordo, coloração, mudança de dimensão nos últimos 12 meses e mudança de coloração nos últimos 12 meses), dermatoscópicas (padrão dermatoscópico, presença de rede ou pseudo‐rede pigmentada atípica, presença de rede negativa, presença de pontos ou glóbulos irregulares, presença de hipopigmentação, presença de estrias ou pseudópodes, presença de véu azul‐acinzentado, presença de vasos atípicos e presença de linhas brancas brilhantes) e anatomopatológicas (espessura ou índice de Breslow).

A análise estatística foi realizada com recurso ao Statistical Package for the Social Sciences (SPSS®), versão 25, com um nível de significância definido de 0,05. As variáveis foram representadas por meio de sua frequência relativa e absoluta. O teste do Qui‐Quadrado e o teste de Fisher foram usados para estabelecer associações entre as variáveis recolhidas. A regressão logística binária univariada e multivariada possibilitou determinar fatores preditivos de uma espessura> 1mm.

O estudo foi realizado de acordo com as recomendações da Declaração de Helsinque da Organização Mundial da Saúde e aprovado pela Comissão de Ética do Centro Hospitalar e Universitário de Coimbra.

Esta pesquisa não recebeu nenhum financiamento específico de agências públicas, privadas ou sem fins lucrativos.

Resultados

Foram diagnosticados 314 doentes com melanoma maligno cutâneo no período temporal referido. Foram excluídos 195 casos por ausência de registo das variáveis dermatoscópicas em estudo, tendo sido incluídos os restantes 119 casos.

As características demográficas e clínicas dos indivíduos incluídos estão representadas na tabela 1. A maioria dos doentes (94,1%; n=112) tinha pelo menos 40 anos à época do diagnóstico e era do sexo masculino (51,3%; n=61). Os melanomas malignos estavam localizados principalmente no tronco (35,3%; n=42). Registaram‐se frequências semelhantes relativamente à espessura do melanoma.

Tabela 1.

Caracterização demográfica e clínica da amostra

Variável, % (n)  (n=119) 
Idade
<40 anos  5,9 (7) 
≥ 40 anos  94,1 (112) 
Sexo
Homem  48,7 (58) 
Mulher  51,3 (61) 
Localização
Tronco  35,3 (42) 
Cabeça e pescoço  27,7 (33) 
Membro inferior (exceto pé)  16,0 (19) 
Pé  11,8 (14) 
Membro superior (exceto mão)  5,9 (7) 
Mão  3,4 (4) 
Espessura
≤ 1 mm  49,6 (59) 
> 1 mm  50,4 (60) 

O padrão dermatoscópico multicomponente (54,2%) esteve associado a uma espessura> 1mm, enquanto o padrão reticular (52,5%) foi o mais frequente em melanomas com espessura <1mm (p <0,001). A presença de rede/pseudo‐rede pigmentar atípica (86,4%; p <0,001) e de rede pigmentar negativa (8,6%; p=0,027) esteve associada a uma espessura ≤ 1mm, enquanto a presença de um padrão vascular atípico (65,0%; p <0,001) e de linhas brancas brilhantes (18,3%; p=0,003) foi mais frequente nos melanomas com espessura> 1mm (tabela 2).

Tabela 2.

Associação entre espessura e variáveis dermatoscópicas em doentes com melanoma maligno

Variáveis  Espessura, % (n)Valor p 
  ≤ 1mm (n=59)  > 1mm (n=60)   
Padrão      <0,001 
Homogêneo  0,0 (0)  6,8 (4)   
Multicomponente  27,1 (16)  54,2 (32)   
Reticular  52,5 (31)  10,2 (6)   
Paralelo das cristas  3,4 (2)  5,1 (3)   
Outro  16,9 (10)  23,7 (14)   
Rede/pseudo‐rede pigmentar atípica  86,4 (51)  51,7 (31)  <0,001 
Rede pigmentar negativa  8,6 (5)  0,0 (0)  0,027 
Pontos e/ou glóbulos irregulares  40,7 (24)  36,7 (22)  0,653 
Despigmentação/hipopigmentação  27,6 (16)  26,7 (16)  0,911 
Estrias/pseudópodos  22,4 (13)  15,0 (9)  0,301 
Véu azul‐acinzentado  28,8 (17)  41,7 (25)  0,142 
Padrão vascular atípico  18,6 (11)  65,0 (39)  <0,001 
Linhas brancas brilhantes  1,7 (1)  18,3 (11)  0,003 

A tabela 3 compara a distribuição de variáveis demográficas e epidemiológicas entre pacientes com melanoma maligno de diferentes espessuras. A frequência de indivíduos com mais de 40 anos (98,3%; p=0,049) foi significativamente superior quando a espessura era> 1mm, e essa característica esteve associada a uma menor frequência de efélides (1,7%; p=0,032) e de queimaduras solares prévias (42,1%; p=0,032). Sexo, fototipo, cor dos olhos, cor do cabelo, presença de lentigos solares, número de nevos melanocíticos e presença de nevos atípicos e queratoses actínicas não diferiu significativamente de acordo com a espessura do melanoma.

Tabela 3.

Associação entre espessura e variáveis demográficas e epidemiológicas em doentes com melanoma maligno

Variáveis  Espessura, % (n)Valor p 
  ≤ 1 mm(n=59)  > 1 mm(n=60)   
Sexo      0,312 
Masculino  44,1 (26)  53,3 (32)   
Feminino  55,9 (33)  46,7 (28)   
Idade      0,049 
<40 anos  10,2 (6)  1,7 (1)   
≥ 40 anos  89,8 (53)  98,3 (59)   
Fototipo      0,320 
1,7 (1)  1,7 (1)   
II  16,9 (10)  30,5 (18)   
III  64,4 (38)  57,6 (34)   
IV  16,9 (10)  10,2 (6)   
Cor dos olhos      0,724 
Verde  18,6 (11)  20,3 (12)   
Castanho  61,0 (36)  54,2 (32)   
Azul  18,6 (11)  20,3 (12)   
Preto  1,7 (1)  5,1 (3)   
Cor dos cabelos aos 18 anos      0,592 
Loiro  10,2 (6)  18,6 (11)   
Grisalho  11,9 (7)  8,5 (5)   
Preto  22,0 (13)  20,3 (12)   
Castanho  55,9 (33)  52,5 (31)   
Efélides  13,6 (8)  1,7 (1)  0,032 
Lentigos solares  55,9 (33)  52,5 (31)  0,854 
Queimadura solar prévia  62,1 (36)  42,1 (24)  0,032 
Número de nevos melanocíticos      0,447 
<20  79,7 (47)  88,1 (52)   
20‐50  13,6 (8)  8,5 (5)   
> 50  6,8 (4)  3,4 (2)   
Nevos atípicos  13,6 (8)  6,8 (4)  0,223 
Queratoses atípicas  22,0 (13)  28,8 (17)  0,398 

A ausência de pigmentação (melanoma amelanótico) associou‐se a espessura> 1mm (17,5%; p <0,001). Não se observaram diferenças significativas relativamente à localização do melanoma, assimetria, bordo, mudança de cor e crescimento recente em função da espessura (tabela 4).

Tabela 4.

Associação entre espessura e variáveis clínicas em doentes com melanoma maligno

Variáveis  Espessura, % (n)Valor p 
  ≤ 1 mm(n=59)  > 1 mm(n=60)   
Localização      0,147 
Cabeça e pescoço  28,8 (17)  26,7 (16)   
Tronco  39,0 (23)  31,7 (19)   
Membro superior (exceto mão)  6,8 (4)  5,0 (3)   
Mão  3,4 (2)  3,3 (2)   
Membro inferior (exceto pé)  18,6 (11)  13,3 (8)   
Pé  3,4 (2)  20,0 (12)   
Assimetria      0,725 
Simétrico  11,5 (6)  9,4 (5)   
Assimétrico  88,5 (46)  90,6 (48)   
Bordo      0,810 
Regular  13,0 (7)  14,5 (8)   
Irregular  87,0 (47)  85,5 (47)   
Coloração      <0,001 
Não pigmentado  0,0 (0)  17,5 (10)   
Pigmentado  100,0 (56)  82,5 (47)   
Mudança de cor recente  58,3 (28)  59,6 (31)  0,896 
Crescimento recente  74,5 (38)  83,9 (47)  0,229 

A tabela 5 representa os resultados da regressão logística univariada e multivariada sobre fatores preditivos de uma espessura> 1mm em doentes com melanoma maligno. Na análise univariada, a presença de efélides, queimadura solar prévia e de rede/pseudo‐rede pigmentar atípica foram preditivos de espessura <1mm, mas a presença de padrão vascular atípico ou de linhas brancas brilhantes relacionou‐se com espessura> 1mm. O modelo de regressão multivariado permitiu explicar 49,7% da variância associada à espessura (R2=0,497) e identificou o padrão vascular atípico (risco relativo de 6,621; p <0,001) como fator preditivo independente de espessura> 1mm. Ao contrário, a rede/pseudo‐rede pigmentada atípica (risco relativo de 0,168; p=0,001) foi identificada como um fator preditivo de espessura <1mm.

Tabela 5.

Fatores preditores da espessura>1mm em doentes com melanoma maligno

Dimensão  Análise univariadaAnálise multivariada
  RR (95% IC)  Valor p  RR (95% IC)  Valor p 
Idade ≥ 40 anos  6,679 (0,779‐57,298)  0,083  NA/NC   
Efélides  0,110 (0,013‐0,909)  0,041  NA/NC   
Queimadura solar prévia  0,444 (0,211‐0,938)  0,033  0,626 (0,244‐1,610)  0,331 
Rede/pseudo‐rede pigmentar atípica  0,168 (0,068‐0,413)  <0,001  0,168 (0,058‐0,491)  0,001 
Padrão vascular atípico  8,104 (3,488‐18,828)  <0,001  6,621 (2,462‐17,807)  <0,001 
Linhas brancas brilhantes  13,020 (1,623‐104,445)  0,016  7,005 (0,682‐71,939)  0,101 

NA/NC, não aplicável ou calculável; RR, risco relativo; 95% IC, intervalo de confiança a 95%.

Discussão

Das variáveis clínicas e epidemiológicas estudadas, apenas a presença de efélides e a história de queimadura solar prévia foram identificadas como fatores preditivos de melanomas finos, fatos não relatados consistentemente em estudos prévios.13 Este resultado poderá ser explicado pelo reconhecimento das efélides e de queimaduras solares como fatores de risco para desenvolvimento de neoplasias cutâneas e consequente adoção de medidas de prevenção secundária, como o recurso ao autoexame regular da pele.

Estudos prévios comprovaram a existência de uma associação entre a rede/pseudo‐rede pigmentar atípica e melanomas finos, bem como uma associação entre o padrão vascular atípico e linhas brancas brilhantes com melanomas de maior espessura.8,9 Contudo, ao contrário de outras séries, a presença de véu azul‐acinzentado e de estrias não mostrou relação com melanomas de espessura> 1mm.8–10

Após a regressão multivariada, apenas o padrão vascular atípico e a rede/pseudo‐rede pigmentada atípica se distinguiram respetivamente como fatores preditivos independentes de melanomas mais espessos que 1mm e de melanomas com 1mm ou menos de espessura. Essas associações sugerem que melanomas mais invasivos têm maior neovascularização, representada ao dermatoscópio por vasos atípicos, e que melanomas com espessura ≤ 1mm mantêm a junção dermoepidérmica intacta, já que a rede pigmentada atípica corresponde à proliferação melanocítica atípica juncional.14

Salientam‐se limitações como a falta de dados relativos a algumas das variáveis estudadas e a ausência de correlação ótima entre a análise dermatoscópica, feita num plano horizontal, e o exame anatomopatológico, realizado por meio de biópsia vertical. Para além disso, no futuro, será relevante realizar estudos de coorte propectivos para confirmação dos resultados obtidos.

Conclusões

A biópsia incisional acarreta o risco de subestimar a espessura, levando a um subestadiamento e a eventuais imprecisões na definição das margens apropriadas de excisão e na indicação da biópsia de linfonodo sentinela. A dermatoscopia é uma técnica potencialmente útil para a redução dos erros de subestadiamento, pois possibilita a escolha do local mais adequado para a realização da biópsia incisional – deve‐se evitar zonas onde exista apenas rede pigmentada atípica (relacionadas com espessuras tumorais mais baixas) e incidir de preferência em zonas onde se observem vasos atípicos (associadas a espessuras mais elevadas).

Suporte financeiro

Nenhum.

Contribuição dos autores

Ana Rita Silva: Análise estatística; conceção e planeamento do estudo; elaboração e redação do manuscrito; obtenção, análise e interpretação dos dados; revisão crítica da literatura.

Ricardo Vieira: Aprovação da versão final do manuscrito; conceção e planeamento do estudo; elaboração e redação do manuscrito; obtenção, análise e interpretação dos dados; participação efetiva na orientação da pesquisa; revisão crítica do manuscrito; participação intelectual em conduta propedêutica e/ou terapêutica de casos estudados.

Conflito de interesses

Nenhum.

Referências
[1]
A.C.F.P. Cherobin, A.J.A. Wainstein, E.A. Colosimo, E.M.A. Goulart, F.V. Bittencourt.
Prognostic factors for metastasis in cutaneous melanoma.
An Bras Dermatol., 93 (2018), pp. 19-26
[2]
C. Garbe, T. Amaral, K. Peris, A. Hauschild, P. Arenberger, L. Bastholt, et al.
European consensus‐based interdisciplinary guideline for melanoma.
Part 1: Diagnosis ‐ Update 2019. Eur J Cancer., 126 (2020), pp. 141-158
[3]
W. Group, S.M. Swetter, H. Tsao.
Guidelines of care for the management of primary cutaneous melanoma.
J Am Dermatology., 80 (2018), pp. 208-250
[4]
D.L. Morton, J.F. Thompson, A.J. Cochran, N. Mozzillo, O.E. Nieweg, D.F. Roses, et al.
Final trial report of sentinel‐node biopsy versus nodal observation in melanoma.
N Engl J Med., 370 (2014), pp. 599-609
[5]
C. Garbe, T. Amaral, K. Peris, A. Hauschild, P. Arenberger, L. Bastholt, et al.
Europeam consensus‐based interdisciplinary guideline for melanoma.
Part 2: Treatment ‐ Update 2019. Eur J Cancer., 126 (2020), pp. 159-177
[6]
J. Etzkorn, J. Sharkey, J. Grunyk, T. Shin, J. Sobanko, C. Miller.
Frequency of and risk factor for melanoma upstaging after wide local excision of primary cutaneous melanoma.
J Am Acad Dermatol., 77 (2017), pp. 341-348
[7]
H. Kittler, H. Pehamberger, K. Wolff, M. Binder.
Diagnostic accuracy of dermoscopy.
Lancet Oncol., 3 (2002), pp. 159-165
[8]
G. Argenziano, G. Fabbrocini, P. Carli, V. Giorgi, M. Delfino.
Clinical and dermatoscopic criteria for the preoperative evaluation of cutaneous melanoma thickness.
J Am Acad Dermatol., 40 (1999), pp. 61-68
[9]
M. Stante, V. Giorgi, P. Cappugi, B. Giannotti.
Non‐invasive analysis of melanoma thickness by means of dermoscopy: a retrospective study.
Melanoma Res., 11 (2001), pp. 147-152
[10]
M.M. Mártinez-Piva, A.S. Vacas, M.V.R. Kowalczuk, F. Gallo, M.R. Vasconcelos, L.D. Mazzuoccolo.
Dermoscopy as a Tool for Estimating Breslow Thickness in Melanoma.
Actas dermosifiliogríaficas (Engl Ed)., 112 (2021), pp. 434-440
[11]
S. Ribero, G. Argenziano, A. Lallas, E. Moscarella, E. Benati, M. Raucci, et al.
Dermoscopic features predicting the presence of mitoses in thin melanoma.
J Dermatol Sci., 86 (2017), pp. 158-161
[12]
T. Deinlein, E. Arzberger, I. Zalaudek, C. Massone, J. Garcias-Ladaria, A. Oliveira, et al.
Dermoscopic characteristics of melanoma according to the criteria, ulceration“and, mitotic rate” of the AJCC 2009 staging system for melanoma.
PLoS One., 12 (2017), pp. 1-9
[13]
E. Nagore, V. Oliver, R. Botella-Estrada, S. Moreno-Picot, C. Guillén, J. Fortea.
Clinicopathological analysis of 1571 cutaneous malignant melanoma in Valencia, Spain: factors related to tumour thickness.
Acta Derm Venereol., 86 (2006), pp. 50-56
[14]
A. Kasuya, M. Aoshima, K. Fukuchi, T. Shimauchi, T. Fujiyama, Y. Tokura.
An intuitive explanation of dermoscopic structures by digitally reconstructed pathological horizontal top‐down view images.

Como citar este artigo: Silva ARC, Vieira RJDC. Predictive factors of melanoma thickness. An Bras Dermatol. 2022;97:601–5.

Trabalho realizado no Serviço de Dermatologia e Venereologia do Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.

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