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&#233; o tratamento de escolha para os CBCAR&#44; mas esse m&#233;todo requer instrumentos especiais e especialistas em cirurgia e patologia&#44; al&#233;m de ser caro&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">4&#8211;6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">A excis&#227;o em est&#225;gios com controle histopatol&#243;gico das margens &#40;EECHM&#41; &#233; um procedimento simples e acess&#237;vel&#44; com alta taxa de cura&#44; sugerido para o tratamento de tipos especiais de CBC ou para locais especiais&#44; como &#225;reas periorbitais ou nasais&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">6&#8211;10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Considerando a preval&#234;ncia muito alta de CBC&#44; o n&#250;mero relativamente alto de CBCAR e a falta de acesso &#224; CMM na maioria dos centros de cirurgia dermatol&#243;gica do mundo&#44; o presente estudo avaliou os resultados da EECHM em CBCAR na regi&#227;o da cabe&#231;a ao longo de sete anos&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Desenho e popula&#231;&#227;o do estudo</span><p id="par0040" class="elsevierStylePara elsevierViewall">Este estudo cl&#237;nico&#44; 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aquelas com invas&#227;o perineural&#44; aquelas com bordas mal definidas&#44; les&#245;es recorrentes e aquelas em pacientes com menos de 30 anos&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Procedimentos</span><p id="par0065" class="elsevierStylePara elsevierViewall">As les&#245;es de CBC foram avaliadas sob ilumina&#231;&#227;o apropriada e amplia&#231;&#227;o de 2&#44;5 na lupa&#59; suas margens foram determinadas por um marcador cir&#250;rgico&#46; No caso de les&#245;es com margem indefinida&#44; uma cureta descart&#225;vel e fina foi usada sob anestesia local para remover o tecido tumoral fr&#225;gil e anormal&#44; a fim de determinar as margens&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Ap&#243;s a determina&#231;&#227;o da margem do tumor e a aplica&#231;&#227;o de anest&#233;sicos locais&#44; os CBC foram excisados com uma margem cir&#250;rgica de 4 a 6<span class="elsevierStyleHsp" style=""></span>mm&#44; com base na quantidade de fatores de risco para CBC&#46; O tecido tumoral excisado foi marcado com fio de sutura ou uma cor de tinta diferente nas dire&#231;&#245;es superior e inferior&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">A amostra excisada e marcada foi fixada em solu&#231;&#227;o de formalde&#237;do a 10&#37; e enviada a um laborat&#243;rio de patologia&#46; O departamento de patologia foi orientado a apresentar os resultados histopatol&#243;gicos o quanto antes&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">A excis&#227;o subsequente de tecido avan&#231;ou 2 a 3<span class="elsevierStyleHsp" style=""></span>mm em cada est&#225;gio&#44; com base no relat&#243;rio histopatol&#243;gico&#44; se as margens de ressec&#231;&#227;o fossem histopatologicamente positivas&#44; ou se a margem fosse muito pequena nas &#225;reas envolvidas&#46; Os est&#225;gios cir&#250;rgicos foram espa&#231;ados por intervalos de dois a quatro dias&#46; Para prevenir infec&#231;&#227;o secund&#225;ria&#44; foram prescritos antibi&#243;ticos orais&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Finalmente&#44; quando todas as margens cir&#250;rgicas estavam livres de tumor&#44; foi estabelecida uma abordagem de reparo com base no tamanho&#44; na localiza&#231;&#227;o e em outros fatores do defeito remanescente&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">O n&#250;mero de est&#225;gios cir&#250;rgicos e as prov&#225;veis complica&#231;&#245;es durante o processo cir&#250;rgico foram registrados no question&#225;rio&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Avalia&#231;&#227;o histopatol&#243;gica</span><p id="par0095" class="elsevierStylePara elsevierViewall">As pe&#231;as cir&#250;rgicas foram fixadas em solu&#231;&#227;o de formalde&#237;do a 10&#37; e foram orientadas de acordo com as marca&#231;&#245;es&#46; Em seguida&#44; cortes finos e representativos foram obtidos da margem marcada no tecido para diagnosticar o envolvimento pela neoplasia&#46; Ap&#243;s a prepara&#231;&#227;o das l&#226;minas&#44; a colora&#231;&#227;o foi feita pelo m&#233;todo hematoxilina&#8208;eosina&#46; Se qualquer uma das margens estivesse envolvida de acordo com as marca&#231;&#245;es&#44; o local&#91;0&#93; do comprometimento era informado ao cirurgi&#227;o dermatol&#243;gico&#44; recomendava&#8208;se nova excis&#227;o at&#233; que todas as margens estivessem livres A situa&#231;&#227;o das margens foi relatada o mais rapidamente poss&#237;vel&#44; em um intervalo de no m&#225;ximo 48 horas&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Considera&#231;&#245;es &#233;ticas</span><p id="par0100" class="elsevierStylePara elsevierViewall">Este estudo foi aprovado pelo Comit&#234; de &#201;tica da Universidade de Ci&#234;ncias M&#233;dicas Kermanshah e registrado no banco de dados do IRCT &#40;IRCT201412196403N5&#41;&#46; As informa&#231;&#245;es dos pacientes foram mantidas em sigilo&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">An&#225;lise estat&#237;stica</span><p id="par0105" class="elsevierStylePara elsevierViewall">A an&#225;lise dos dados foi feita com SPSS &#40;v&#46; 16&#41;&#44; por meio de estat&#237;stica descritiva e inferencial&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Quanto &#224; estat&#237;stica descritiva&#44; foram relatadas a tend&#234;ncia central e a dispers&#227;o juntamente com as tabelas&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Quanto &#224; estat&#237;stica inferencial&#44; foram aplicados o teste do qui&#8208;quadrado e a an&#225;lise de regress&#227;o log&#237;stica m&#250;ltipla&#46; V&#225;rios modelos de regress&#227;o log&#237;stica foram criados para examinar a rela&#231;&#227;o entre as vari&#225;veis do estudo e o resultado e o n&#250;mero de etapas de excis&#227;o para fornecer a raz&#227;o de probabilidade &#40;<span class="elsevierStyleItalic">odds ratio</span>&#44; OR&#41; com um intervalo de confian&#231;a de 95&#37; &#40;IC 95&#37;&#41;&#46; O n&#237;vel de signific&#226;ncia foi definido como p &#60; 0&#44;05&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="par0120" class="elsevierStylePara elsevierViewall">Foram recrutados para este estudo 122 pacientes&#44; 47 &#40;38&#44;5&#37;&#41; do sexo feminino e 75 &#40;61&#44;5&#37;&#41; do masculino&#46; A faixa et&#225;ria dos participantes variou de 38 a 81 anos&#44; com idade m&#233;dia de 57&#44;66 &#177; 9&#44;13 anos &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">A &#225;rea nasal foi o local mais comum de tratamento &#40;49&#59; 40&#44;2&#37;&#41;&#59; a &#225;rea periorbital &#40;19&#59; 15&#44;6&#37;&#41; e a regi&#227;o frontal &#40;10&#59; 8&#44;4&#37;&#41; foram outras &#225;reas comumente tratadas &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Clinicamente&#44; 100 &#40;82&#44;0&#37;&#41;&#44; 12 &#40;9&#44;8&#37;&#41; e 10 &#40;8&#44;2&#37;&#41; CBC eram dos subtipos nodular&#44; superficial e morfeiforme&#44; respectivamente &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o histopatol&#243;gica das les&#245;es classificou 44 &#40;36&#44;1&#37;&#41; como de alto risco e 78 &#40;73&#44;9&#37;&#41; de tipo histopatol&#243;gico de baixo risco &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Setenta e sete &#40;63&#44;1&#37;&#41; pacientes apresentaram CBC prim&#225;rios e 45 &#40;36&#44;9&#37;&#41; apresentaram CBC recorrentes como fator de risco&#44; uma vez que haviam sido previamente submetidos a procedimentos inadequados &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">As excis&#245;es cir&#250;rgicas em um&#44; dois&#44; tr&#234;s e quatro est&#225;gios foram feitas em nove &#40;7&#44;4&#37;&#41;&#44; 56 &#40;45&#44;9&#37;&#41;&#44; 37 &#40;30&#44;3&#37;&#41; e 20 &#40;16&#44;4&#37;&#41; les&#245;es&#44; respectivamente &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Das 122 les&#245;es&#44; 109 &#40;89&#44;3&#37;&#41; foram curadas e apenas 13 &#40;10&#44;7&#37;&#41; apresentaram recidiva durante o per&#237;odo de acompanhamento &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> apresenta as demais caracter&#237;sticas demogr&#225;ficas e cl&#237;nicas dos pacientes&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">N&#227;o foram observadas complica&#231;&#245;es&#44; inclusive infec&#231;&#227;o nos locais cir&#250;rgicos ou paracir&#250;rgicos e sangramento durante os per&#237;odos cir&#250;rgicos e de acompanhamento&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Para melhor quantificar a rela&#231;&#227;o entre as vari&#225;veis do estudo e o n&#250;mero de excis&#245;es cir&#250;rgicas e os resultados do tratamento&#44; algumas vari&#225;veis foram classificadas de maneira mais concisa &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">Os resultados da an&#225;lise de regress&#227;o log&#237;stica apontaram uma associa&#231;&#227;o significativa entre o n&#250;mero de excis&#245;es cir&#250;rgicas e localiza&#231;&#227;o do tumor&#44; multiplicidade de fatores de risco&#44; tamanho do tumor e les&#245;es recorrentes &#40;p &#60; 0&#44;05&#59; <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Os resultados da regress&#227;o log&#237;stica tamb&#233;m indicaram uma associa&#231;&#227;o significativa entre resultado do tratamento e tipo histopatol&#243;gico&#44; casos recorrentes de CBC&#44; multiplicidade de fatores de risco e dura&#231;&#227;o da doen&#231;a &#40;p &#60; 0&#44;05&#59; <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discuss&#227;o</span><p id="par0180" class="elsevierStylePara elsevierViewall">Este estudo mostrou uma taxa de cura de 89&#44;3&#37; para CBCAR ap&#243;s EECHM&#44; com uma m&#233;dia de 2&#44;63 est&#225;gios de excis&#227;o ao longo de 48 meses de acompanhamento&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Um n&#250;mero maior de excis&#245;es cir&#250;rgicas foi necess&#225;rio em pacientes com tamanho de tumor superior a 20<span class="elsevierStyleHsp" style=""></span>mm&#44; CBC nasais&#44; CBC recorrentes e aqueles com mais de dois fatores de risco&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Os resultados deste estudo indicaram que a falha da EECHM era mais prov&#225;vel nos tipos histopatol&#243;gicos de alto risco&#44; CBC recorrentes&#44; m&#250;ltiplos fatores de risco e doen&#231;as de longa data&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">No presente estudo&#44; pacientes com CBC recorrentes e mais fatores de risco exigiram maior excis&#227;o cir&#250;rgica e apresentaram maior possibilidade de falha do tratamento&#46; Portanto&#44; pacientes com as vari&#225;veis mencionadas requerem mais aten&#231;&#227;o para uma cura completa&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">V&#225;rios estudos indicaram uma taxa de cura de 95&#37; para os CBC com o uso de EECHM&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">6&#8211;9</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">O presente estudo tamb&#233;m mostrou uma taxa de tratamento bem&#8208;sucedido de quase 90&#37; para CBCAR quando EECHM foi usada&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Acredita&#8208;se que essa discrep&#226;ncia se deva &#224; presen&#231;a e multiplicidade dos fatores de risco&#44; principalmente nos CBC recorrentes&#46; Al&#233;m disso&#44; em alguns estudos anteriores&#44; a EECHM foi feita em CBC de baixo e alto risco ou em &#225;reas espec&#237;ficas como nariz ou regi&#227;o periorbital&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">7&#8211;9</span></a></p><p id="par0225" class="elsevierStylePara elsevierViewall">Os fatores que causam falha do tratamento por EECHM incluem tumores principais com &#225;reas descont&#237;nuas&#44; invas&#227;o perineural de alguns CBC de alto risco e dificuldade de comunica&#231;&#227;o entre o cirurgi&#227;o e o patologista na marca&#231;&#227;o das amostras de tecido para avalia&#231;&#227;o histopatol&#243;gica&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">11&#44;12</span></a></p><p id="par0230" class="elsevierStylePara elsevierViewall">Aparentemente&#44; os CBC recorrentes levam a crescimento e expans&#227;o irregulares das massas tumorais a partir da localiza&#231;&#227;o prim&#225;ria do tumor&#44; o que dificulta a cura por EECHM e at&#233; por CMM&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a> Muitos estudos relataram que o tratamento bem&#8208;sucedido dos CBC recorrentes &#233; menos prov&#225;vel do que o dos CBC prim&#225;rios&#44; mesmo por CMM&#44; e requer mais excis&#245;es cir&#250;rgicas&#44; o que &#233; consistente com os achados atuais&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">13&#8211;15</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">Obviamente&#44; nos casos de atraso no tratamento&#44; a les&#227;o est&#225; associada a um maior tamanho&#44; penetra&#231;&#227;o mais profunda e maior possibilidade de descontinuidade entre as massas tumorais e met&#225;stases&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">1&#44;16&#44;17</span></a> Portanto&#44; a falha no tratamento &#233; mais prov&#225;vel nos casos com evolu&#231;&#227;o prolongada&#44; principalmente naqueles submetidos a excis&#245;es cir&#250;rgicas comuns pr&#233;vias&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">No presente estudo&#44; as les&#245;es nasais apresentaram maior n&#250;mero de excis&#245;es cir&#250;rgicas&#44; o que &#233; consistente com os resultados de v&#225;rios estudos anteriores&#46; Os CBC nasais s&#227;o mais propensos a desenvolver dissemina&#231;&#227;o &#8220;em leque&#8221; e invas&#227;o perineural&#46; Eles tamb&#233;m apresentam mais casos cl&#237;nicos e histopatol&#243;gicos de alto risco&#44; que aumentam o n&#250;mero de etapas cir&#250;rgicas<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">5&#44;18&#44;19</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">Os CBC com caracter&#237;sticas histopatol&#243;gicas de alto risco &#40;inclusive os tipos morfeiforme&#44; infiltrativo e micronodular&#41; est&#227;o mais propensos a desenvolver dissemina&#231;&#227;o com &#225;reas de descontinuidade e invas&#227;o perineural&#59; portanto&#44; a recorr&#234;ncia &#233; poss&#237;vel mesmo ap&#243;s a CMM&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">2&#44;11&#8211;13&#44;16&#44;17</span></a></p><p id="par0255" class="elsevierStylePara elsevierViewall">No presente estudo&#44; os pacientes com tipos histopatol&#243;gicos de alto risco apresentaram uma taxa de recorr&#234;ncia significativamente maior do que aqueles com tipos histopatol&#243;gicos de baixo risco&#44; apesar das excis&#245;es cir&#250;rgicas estadiadas&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclus&#227;o</span><p id="par0260" class="elsevierStylePara elsevierViewall">O tratamento de CBCAR por EECHM resultou em uma alta taxa de cura&#46; Pacientes com mais de dois fatores de risco e les&#245;es recorrentes demandaram maior n&#250;mero de excis&#245;es cir&#250;rgicas e apresentaram maior possibilidade de falha do tratamento&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Pacientes com CBC maiores do que 20<span class="elsevierStyleHsp" style=""></span>mm e les&#245;es nasais demandaram maior n&#250;mero de excis&#245;es cir&#250;rgicas&#46; CBC com tipo histopatol&#243;gico de alto risco e dura&#231;&#227;o superior a 48 meses foram associados a maior possibilidade de falha do tratamento&#46; Os autores sugerem que este estudo seja repetido em v&#225;rios centros com mais casos&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Suporte financeiro</span><p id="par0270" 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="par0275" class="elsevierStylePara elsevierViewall">Reza Kavoussi&#58; 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&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">Hossein Kavoussi&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">Ali Ebrahimi&#58; Participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">Nader Salari&#58; An&#225;lise estat&#237;stica&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">Seyed Hamid Madani&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflitos de interesse</span><p id="par0300" 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">O carcinoma basocelular de alto risco corresponde a uma parcela significativa dos carcinomas basocelulares e requer cirurgia microgr&#225;fica de Mohs para tratamento definitivo&#46; A excis&#227;o em est&#225;gios com controle histopatol&#243;gico das margens &#233; um procedimento simples&#44; acess&#237;vel e curativo sugerido para o tratamento de carcinoma basocelular de alto risco&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar os resultados da excis&#227;o em est&#225;gios no carcinoma basocelular de alto risco na regi&#227;o da cabe&#231;a&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Este estudo intervencionista foi feito em pacientes com carcinoma basocelular de alto risco submetidos a excis&#227;o em est&#225;gios at&#233; que as margens estivessem livres de tumor&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Foram recrutados 122 pacientes &#40;47 mulheres e 75 homens&#41; com idade m&#233;dia de 57&#44;66 &#177; 9&#44;13 anos&#46; Os tipos nasal e nodular foram os mais comuns nas formas cl&#237;nica e patol&#243;gica&#44; respectivamente&#46; Al&#233;m disso&#44; 89&#44;3&#37; dos casos foram curados por excis&#227;o em est&#225;gios ap&#243;s quatro anos de acompanhamento&#46; Observou&#8208;se uma rela&#231;&#227;o significativa entre os resultados do tratamento e les&#245;es recorrentes&#44; multiplicidade de fatores de risco&#44; doen&#231;a de longa dura&#231;&#227;o e subtipo histopatol&#243;gico&#46; Houve tamb&#233;m uma associa&#231;&#227;o significativa entre o n&#250;mero de excis&#245;es cir&#250;rgicas e a multiplicidade de fatores de risco&#44; bem como a recorr&#234;ncia&#44; localiza&#231;&#227;o e tamanho do carcinoma basocelular&#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 foi feita avalia&#231;&#227;o por resson&#226;ncia magn&#233;tica nos casos com suspeita de invas&#227;o perineural&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">O carcinoma basocelular de alto risco teve uma alta taxa de cura por excis&#227;o em est&#225;gios&#46; Pacientes com mais fatores de risco e pacientes com carcinoma basocelular nasal e recorrente demandaram mais excis&#245;es em est&#225;gios&#46; A falha do tratamento &#233; mais prov&#225;vel em pacientes com mais fatores de risco&#44; les&#245;es de longa data e carcinomas basocelulares recorrentes e de alto risco histopatol&#243;gico&#46;</p></span>"
        "secciones" => array:6 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Fundamentos"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objetivo"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "M&#233;todos"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Limita&#231;&#245;es do estudo"
          ]
          5 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Conclus&#245;es"
          ]
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    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Kavoussi R&#44; Kavoussi H&#44; Ebrahimi A&#44; Salari N&#44; Madani AH&#46; Outcome of staged excision with pathologic margin control in high&#8208;risk basal cell carcinoma of the head region&#46; An Bras Dermatol&#46; 2020&#59;95&#58;583&#8211;8&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Trabalho realizado na Universidade de Ci&#234;ncias M&#233;dicas de Kermanshah&#44; Kermanshah&#44; Ir&#227;&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabela 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabela "
            "rol" => "short"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">CBC</span>&#44; carcinoma basocelular&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "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">Percentagem&nbsp;\t\t\t\t\t\t\n
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                  \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">Frequ&#234;ncia &#40;&#37;&#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
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                  \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">Vari&#225;veis&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">38&#44;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">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">Feminino&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sexo</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">61&#44;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">75&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">Masculino&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">58&#44;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">71&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; 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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Idade &#40;anos&#41;</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">41&#44;8&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">&#8805; 60&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">74&#44;6&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">91&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">&#8804; 20&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tamanho &#40;mm&#41;</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">25&#44;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">31&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">&#62; 20&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">53&#44;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">65&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">&#8804; 48&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dura&#231;&#227;o &#40;meses&#41;</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">46&#44;7&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">57&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">&#62; 48&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">56&#44;6&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">69&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">Negativo&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hist&#243;ria pessoal de CBC</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">43&#44;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">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">Positivo&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">25&#44;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">31&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">Tipo II&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  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fen&#243;tipo da pele</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">61&#44;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">75&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">Tipo III&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">13&#44;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">16&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">Tipo IV&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">40&#44;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">49&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">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  " rowspan="11" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Local</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">15&#44;6&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">19&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">Periorbital&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">8&#44;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">10&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">Testa&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">7&#44;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">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">Bochecha&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">5&#44;7&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">7&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">P&#243;s&#8208;auricular&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">4&#44;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">6&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">Orelha&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">4&#44;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">6&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">Lateral do rosto&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">3&#44;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">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">Queixo&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">3&#44;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">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">Periorificial&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">3&#44;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">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">Prega nasolabial&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">3&#44;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">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">Couro cabeludo&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">60&#44;7&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">74&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">Definida&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Borda</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">39&#44;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">48&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">Indefinida&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">63&#44;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">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">Sim&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tratamento anterior</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">36&#44;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">45&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">N&#227;o&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">82&#44;0&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">100&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">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  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tipo cl&#237;nico</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">8&#44;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">10&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">Superficial&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">9&#44;8&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">Morfeiforme&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">55&#44;7&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">68&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">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  " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tipo histopatol&#243;gico</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">17&#44;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">21&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">Infiltrativo&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">9&#44;8&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">Morfeiforme&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">9&#44;0&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">Micronodular&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">8&#44;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">10&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">Superficial&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">13&#44;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">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">I&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  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Quantidade de fatores de risco</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">47&#44;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">58&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">II&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
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III&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">13&#44;1&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\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IV&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;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
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Quantidade de est&#225;gios de excis&#227;o</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  " align="left" valign="\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\ttable-entry\n
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                  \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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IV&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
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Cura&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\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">Fracasso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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Journal Information
Vol. 95. Issue 5.
Pages 583-588 (1 September 2020)
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7410
Vol. 95. Issue 5.
Pages 583-588 (1 September 2020)
Investigação
Open Access
Resultado da excisão em estágios com controle histopatológico das margens no carcinoma basocelular de alto risco da região da cabeça
Visits
7410
Reza Kavoussia, Hossein Kavoussia,
Corresponding author
hkawosi@kums.ac.ir

Autor para correspondência.
, Ali Ebrahimia, Nader Salarib, Seyed Hamid Madanic
a Departamento de Dermatologia, Universidade de Ciências Médicas Kermanshah, Kermanshah, Irã
b Escola de Saúde, Universidade de Ciências Médicas Kermanshah, Kermanshah, Irã
c Departamento de Patologia, Universidade de Ciências Médicas Kermanshah, Kermanshah, Irã
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Abstract
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Tables (2)
Tabela 1. Características da população estudada
Tabela 2. Análise de regressão logística univariada com base nos resultados do tratamento e na quantidade de estágios de excisão
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Resumo
Fundamentos

O carcinoma basocelular de alto risco corresponde a uma parcela significativa dos carcinomas basocelulares e requer cirurgia micrográfica de Mohs para tratamento definitivo. A excisão em estágios com controle histopatológico das margens é um procedimento simples, acessível e curativo sugerido para o tratamento de carcinoma basocelular de alto risco.

Objetivo

Avaliar os resultados da excisão em estágios no carcinoma basocelular de alto risco na região da cabeça.

Métodos

Este estudo intervencionista foi feito em pacientes com carcinoma basocelular de alto risco submetidos a excisão em estágios até que as margens estivessem livres de tumor.

Resultados

Foram recrutados 122 pacientes (47 mulheres e 75 homens) com idade média de 57,66 ± 9,13 anos. Os tipos nasal e nodular foram os mais comuns nas formas clínica e patológica, respectivamente. Além disso, 89,3% dos casos foram curados por excisão em estágios após quatro anos de acompanhamento. Observou‐se uma relação significativa entre os resultados do tratamento e lesões recorrentes, multiplicidade de fatores de risco, doença de longa duração e subtipo histopatológico. Houve também uma associação significativa entre o número de excisões cirúrgicas e a multiplicidade de fatores de risco, bem como a recorrência, localização e tamanho do carcinoma basocelular.

Limitações do estudo

Não foi feita avaliação por ressonância magnética nos casos com suspeita de invasão perineural.

Conclusões

O carcinoma basocelular de alto risco teve uma alta taxa de cura por excisão em estágios. Pacientes com mais fatores de risco e pacientes com carcinoma basocelular nasal e recorrente demandaram mais excisões em estágios. A falha do tratamento é mais provável em pacientes com mais fatores de risco, lesões de longa data e carcinomas basocelulares recorrentes e de alto risco histopatológico.

Palavras‐chave:
Cirurgia de Mohs
Neoplasias cutâneas
Patologia
Full Text
Introdução

Os carcinomas basocelulares (CBC) são a neoplasia maligna mais comum, com uma incidência global crescente nas últimas décadas. No entanto, embora a taxa de mortalidade por CBC seja muito baixa, os custos relacionados ao tratamento impõem um ônus importante ao sistema de saúde1,2

Ainda que a maioria dos CBC seja facilmente curada, os carcinomas basocelulares de alto risco (CBCAR), que representam uma proporção significativa, requerem atenção especial.2,3

A cirurgia micrográfica de Mohs (CMM) é o tratamento de escolha para os CBCAR, mas esse método requer instrumentos especiais e especialistas em cirurgia e patologia, além de ser caro.4–6

A excisão em estágios com controle histopatológico das margens (EECHM) é um procedimento simples e acessível, com alta taxa de cura, sugerido para o tratamento de tipos especiais de CBC ou para locais especiais, como áreas periorbitais ou nasais.6–10

Considerando a prevalência muito alta de CBC, o número relativamente alto de CBCAR e a falta de acesso à CMM na maioria dos centros de cirurgia dermatológica do mundo, o presente estudo avaliou os resultados da EECHM em CBCAR na região da cabeça ao longo de sete anos.

MétodosDesenho e população do estudo

Este estudo clínico, intervencionista, de acompanhamento foi feito em 122 pacientes durante oito anos, de 2008 a 2016, na clínica de dermatologia Hajdaie da Universidade de Ciências Médicas Kermanshah, Irã. Pacientes com suspeita clínica de CBC foram submetidos a biópsia. Após a documentação histopatológica dos CBC e de seu tipo histológico, os pacientes com critérios de CBCAR foram escolhidos como candidatos a essa modalidade de tratamento.

Todos os participantes foram informados sobre o procedimento e assinaram um termo de consentimento livre e esclarecido. Após a assinatura, foram incluídos no estudo.

Os critérios de exclusão incluíram lesões com diâmetro maior do que 5cm, penetração de células malignas na área subcutânea profunda ou comprometimento da cartilagem, extensão do tumor a locais especiais como conjuntiva, cirurgia em mais de quatro etapas, gravidez, comorbidades como imunodeficiência e suscetibilidade genética a CBC como xeroderma pigmentoso e anormalidades de reparo.

Dados demográficos, localização do CBC, características clínicas e histopatológicas dos CBC, tipo e quantidade de fatores de risco, resultado do tratamento e complicações foram registrados nos questionários usados neste estudo.

Critérios para CBCAR

Os CBCAR foram definidos como lesões em locais de alto risco, tipos histopatológicos e clínicos, lesões maiores do que 2cm, aquelas com invasão perineural, aquelas com bordas mal definidas, lesões recorrentes e aquelas em pacientes com menos de 30 anos.

Procedimentos

As lesões de CBC foram avaliadas sob iluminação apropriada e ampliação de 2,5 na lupa; suas margens foram determinadas por um marcador cirúrgico. No caso de lesões com margem indefinida, uma cureta descartável e fina foi usada sob anestesia local para remover o tecido tumoral frágil e anormal, a fim de determinar as margens.

Após a determinação da margem do tumor e a aplicação de anestésicos locais, os CBC foram excisados com uma margem cirúrgica de 4 a 6mm, com base na quantidade de fatores de risco para CBC. O tecido tumoral excisado foi marcado com fio de sutura ou uma cor de tinta diferente nas direções superior e inferior.

A amostra excisada e marcada foi fixada em solução de formaldeído a 10% e enviada a um laboratório de patologia. O departamento de patologia foi orientado a apresentar os resultados histopatológicos o quanto antes.

A excisão subsequente de tecido avançou 2 a 3mm em cada estágio, com base no relatório histopatológico, se as margens de ressecção fossem histopatologicamente positivas, ou se a margem fosse muito pequena nas áreas envolvidas. Os estágios cirúrgicos foram espaçados por intervalos de dois a quatro dias. Para prevenir infecção secundária, foram prescritos antibióticos orais.

Finalmente, quando todas as margens cirúrgicas estavam livres de tumor, foi estabelecida uma abordagem de reparo com base no tamanho, na localização e em outros fatores do defeito remanescente.

O número de estágios cirúrgicos e as prováveis complicações durante o processo cirúrgico foram registrados no questionário.

Avaliação histopatológica

As peças cirúrgicas foram fixadas em solução de formaldeído a 10% e foram orientadas de acordo com as marcações. Em seguida, cortes finos e representativos foram obtidos da margem marcada no tecido para diagnosticar o envolvimento pela neoplasia. Após a preparação das lâminas, a coloração foi feita pelo método hematoxilina‐eosina. Se qualquer uma das margens estivesse envolvida de acordo com as marcações, o local[0] do comprometimento era informado ao cirurgião dermatológico, recomendava‐se nova excisão até que todas as margens estivessem livres A situação das margens foi relatada o mais rapidamente possível, em um intervalo de no máximo 48 horas.

Considerações éticas

Este estudo foi aprovado pelo Comitê de Ética da Universidade de Ciências Médicas Kermanshah e registrado no banco de dados do IRCT (IRCT201412196403N5). As informações dos pacientes foram mantidas em sigilo.

Análise estatística

A análise dos dados foi feita com SPSS (v. 16), por meio de estatística descritiva e inferencial.

Quanto à estatística descritiva, foram relatadas a tendência central e a dispersão juntamente com as tabelas.

Quanto à estatística inferencial, foram aplicados o teste do qui‐quadrado e a análise de regressão logística múltipla. Vários modelos de regressão logística foram criados para examinar a relação entre as variáveis do estudo e o resultado e o número de etapas de excisão para fornecer a razão de probabilidade (odds ratio, OR) com um intervalo de confiança de 95% (IC 95%). O nível de significância foi definido como p < 0,05.

Resultados

Foram recrutados para este estudo 122 pacientes, 47 (38,5%) do sexo feminino e 75 (61,5%) do masculino. A faixa etária dos participantes variou de 38 a 81 anos, com idade média de 57,66 ± 9,13 anos (tabela 1).

Tabela 1.

Características da população estudada

Percentagem  Frequência (%)    Variáveis 
38,5  47  Feminino  Sexo
61,5  75  Masculino 
58,2  71  < 60  Idade (anos)
41,8  51  ≥ 60 
74,6  91  ≤ 20  Tamanho (mm)
25,4  31  > 20 
53,3  65  ≤ 48  Duração (meses)
46,7  57  > 48 
56,6  69  Negativo  História pessoal de CBC
43,4  53  Positivo 
25,4  31  Tipo II  Fenótipo da pele
61,5  75  Tipo III 
13,1  16  Tipo IV 
40,2  49  Nariz  Local
15,6  19  Periorbital 
8,2  10  Testa 
7,4  Bochecha 
5,7  Pós‐auricular 
4,9  Orelha 
4,9  Lateral do rosto 
3,3  Queixo 
3,3  Periorificial 
3,3  Prega nasolabial 
3,3  Couro cabeludo 
60,7  74  Definida  Borda
39,3  48  Indefinida 
63,1  77  Sim  Tratamento anterior
36,9  45  Não 
82,0  100  Nodular  Tipo clínico
8,2  10  Superficial 
9,8  12  Morfeiforme 
55,7  68  Nodular  Tipo histopatológico
17,2  21  Infiltrativo 
9,8  12  Morfeiforme 
9,0  11  Micronodular 
8,2  10  Superficial 
13,9  17  Quantidade de fatores de risco
47,5  58  II 
25,4  31  III 
13,1  16  IV 
7,4  Quantidade de estágios de excisão
45,9  56  II 
30,3  37  III 
16,4  20  IV 
89,3  109  Cura  Desfecho do tratamento
10,7  13  Fracasso 

CBC, carcinoma basocelular.

A área nasal foi o local mais comum de tratamento (49; 40,2%); a área periorbital (19; 15,6%) e a região frontal (10; 8,4%) foram outras áreas comumente tratadas (tabela 1).

Clinicamente, 100 (82,0%), 12 (9,8%) e 10 (8,2%) CBC eram dos subtipos nodular, superficial e morfeiforme, respectivamente (tabela 1).

A avaliação histopatológica das lesões classificou 44 (36,1%) como de alto risco e 78 (73,9%) de tipo histopatológico de baixo risco (tabela 1).

Setenta e sete (63,1%) pacientes apresentaram CBC primários e 45 (36,9%) apresentaram CBC recorrentes como fator de risco, uma vez que haviam sido previamente submetidos a procedimentos inadequados (tabela 1).

As excisões cirúrgicas em um, dois, três e quatro estágios foram feitas em nove (7,4%), 56 (45,9%), 37 (30,3%) e 20 (16,4%) lesões, respectivamente (tabela 1)

Das 122 lesões, 109 (89,3%) foram curadas e apenas 13 (10,7%) apresentaram recidiva durante o período de acompanhamento (tabela 1).

A tabela 1 apresenta as demais características demográficas e clínicas dos pacientes.

Não foram observadas complicações, inclusive infecção nos locais cirúrgicos ou paracirúrgicos e sangramento durante os períodos cirúrgicos e de acompanhamento.

Para melhor quantificar a relação entre as variáveis do estudo e o número de excisões cirúrgicas e os resultados do tratamento, algumas variáveis foram classificadas de maneira mais concisa (tabela 2).

Tabela 2.

Análise de regressão logística univariada com base nos resultados do tratamento e na quantidade de estágios de excisão

ResultadoUnivariadaQuantidade de estágios de excisãoUnivariada 
IC 95%  OR  valor‐p  ≤2  >IC 95%  OR  valor‐p 
–  0,545  30 (63,8)  17 (36,2)  –  0,066 
0,198–2,35  0,682    35 (46,7)  40 (53,3)  0,954–4,26  0,496   
–  0,264  31 (47,7)  34 (52,3)  –  0,188 
0,602–6,37  0,510    34 (59,6)  23 (40,4)  0,301–1,26  1,62   
–  0,106  21 (42,9)  28 (57,1)  –  0,006 
0,115–1,23  2,56    44 (60,3)  29 (39,7)  0,237–1,03  2,02   
–  0,388  43 (47,3)  48 (52,7)  –  –  0,025 
0,813–8,65  1,99    22 (71,0)  9 (29,0)  1,13–6,56  2,7   
–  0,031  46 (70,8)  19 (29,2)  –  –  0,065 
0,059–0,873  0,227    19 (33,3)  38 (66,7)  0,096–0,445  0,207   
–  0,057  40 (58,0)  29 (42,0)  –  –  0,236 
0,087–1,03  0,301    25 (47,2)  28 (52,8)  0,315–1,33  0,647   
–  0,001  37 (54,4)  31 (45,6)  –  –  0,778 
0,928–11,03  0,313    28 (51,9)  26 (48,1)  0,667–1,03  1,1   
–  0,052  9 (40,9)  13 (59,1)  –  –  0,203 
0,086‐1,01  3,3    56 (56,0)  44 (44,0)  0,720–4,69  1,8   
–  0,017  62 (80,5)  15 (19,5)  –  –  0,005 
0,063–0,760  0,219    3 (6,7)  42 (93,3)  0,005–0,063  0,017   
–  0,167  41 (55,4)  33 (44,6)  –  –  0,559 
1,16–13,9  0,248    24 (50,0)  24 (50,0)  0,389–1,66  0,805   
–  0,006  48 (63,2)  28 (36,8)  –  –  0,006 
0,038–0,571  0,148    17 (37,0)  29 (63,0)  0,160–0,730  0,342   

OR, razão de probabilidade; IC 95%, intervalo de confiança de 95%.

Os resultados da análise de regressão logística apontaram uma associação significativa entre o número de excisões cirúrgicas e localização do tumor, multiplicidade de fatores de risco, tamanho do tumor e lesões recorrentes (p < 0,05; tabela 2).

Os resultados da regressão logística também indicaram uma associação significativa entre resultado do tratamento e tipo histopatológico, casos recorrentes de CBC, multiplicidade de fatores de risco e duração da doença (p < 0,05; tabela 2).

Discussão

Este estudo mostrou uma taxa de cura de 89,3% para CBCAR após EECHM, com uma média de 2,63 estágios de excisão ao longo de 48 meses de acompanhamento.

Um número maior de excisões cirúrgicas foi necessário em pacientes com tamanho de tumor superior a 20mm, CBC nasais, CBC recorrentes e aqueles com mais de dois fatores de risco.

Os resultados deste estudo indicaram que a falha da EECHM era mais provável nos tipos histopatológicos de alto risco, CBC recorrentes, múltiplos fatores de risco e doenças de longa data.

No presente estudo, pacientes com CBC recorrentes e mais fatores de risco exigiram maior excisão cirúrgica e apresentaram maior possibilidade de falha do tratamento. Portanto, pacientes com as variáveis mencionadas requerem mais atenção para uma cura completa.

Vários estudos indicaram uma taxa de cura de 95% para os CBC com o uso de EECHM.6–9

O presente estudo também mostrou uma taxa de tratamento bem‐sucedido de quase 90% para CBCAR quando EECHM foi usada.

Acredita‐se que essa discrepância se deva à presença e multiplicidade dos fatores de risco, principalmente nos CBC recorrentes. Além disso, em alguns estudos anteriores, a EECHM foi feita em CBC de baixo e alto risco ou em áreas específicas como nariz ou região periorbital.7–9

Os fatores que causam falha do tratamento por EECHM incluem tumores principais com áreas descontínuas, invasão perineural de alguns CBC de alto risco e dificuldade de comunicação entre o cirurgião e o patologista na marcação das amostras de tecido para avaliação histopatológica.11,12

Aparentemente, os CBC recorrentes levam a crescimento e expansão irregulares das massas tumorais a partir da localização primária do tumor, o que dificulta a cura por EECHM e até por CMM.10 Muitos estudos relataram que o tratamento bem‐sucedido dos CBC recorrentes é menos provável do que o dos CBC primários, mesmo por CMM, e requer mais excisões cirúrgicas, o que é consistente com os achados atuais.13–15

Obviamente, nos casos de atraso no tratamento, a lesão está associada a um maior tamanho, penetração mais profunda e maior possibilidade de descontinuidade entre as massas tumorais e metástases.1,16,17 Portanto, a falha no tratamento é mais provável nos casos com evolução prolongada, principalmente naqueles submetidos a excisões cirúrgicas comuns prévias.

No presente estudo, as lesões nasais apresentaram maior número de excisões cirúrgicas, o que é consistente com os resultados de vários estudos anteriores. Os CBC nasais são mais propensos a desenvolver disseminação “em leque” e invasão perineural. Eles também apresentam mais casos clínicos e histopatológicos de alto risco, que aumentam o número de etapas cirúrgicas5,18,19

Os CBC com características histopatológicas de alto risco (inclusive os tipos morfeiforme, infiltrativo e micronodular) estão mais propensos a desenvolver disseminação com áreas de descontinuidade e invasão perineural; portanto, a recorrência é possível mesmo após a CMM.2,11–13,16,17

No presente estudo, os pacientes com tipos histopatológicos de alto risco apresentaram uma taxa de recorrência significativamente maior do que aqueles com tipos histopatológicos de baixo risco, apesar das excisões cirúrgicas estadiadas.

Conclusão

O tratamento de CBCAR por EECHM resultou em uma alta taxa de cura. Pacientes com mais de dois fatores de risco e lesões recorrentes demandaram maior número de excisões cirúrgicas e apresentaram maior possibilidade de falha do tratamento.

Pacientes com CBC maiores do que 20mm e lesões nasais demandaram maior número de excisões cirúrgicas. CBC com tipo histopatológico de alto risco e duração superior a 48 meses foram associados a maior possibilidade de falha do tratamento. Os autores sugerem que este estudo seja repetido em vários centros com mais casos.

Suporte financeiro

Nenhum.

Contribuição dos autores

Reza Kavoussi: Elaboração e redação do manuscrito; obtenção, análise e interpretação dos dados.

Hossein Kavoussi: Aprovação da versão final do manuscrito; concepção e planejamento do estudo; participação efetiva na orientação da pesquisa.

Ali Ebrahimi: Participação efetiva na orientação da pesquisa; participação intelectual em conduta propedêutica e/ou terapêutica de casos estudados; revisão crítica da literatura; revisão crítica do manuscrito.

Nader Salari: Análise estatística; revisão crítica do manuscrito.

Seyed Hamid Madani: Concepção e planejamento do estudo; obtenção, análise e interpretação dos dados.

Conflitos de interesse

Nenhum.

Referências
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Como citar este artigo: Kavoussi R, Kavoussi H, Ebrahimi A, Salari N, Madani AH. Outcome of staged excision with pathologic margin control in high‐risk basal cell carcinoma of the head region. An Bras Dermatol. 2020;95:583–8.

Trabalho realizado na Universidade de Ciências Médicas de Kermanshah, Kermanshah, Irã.

Copyright © 2020. Sociedade Brasileira de Dermatologia
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