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os melanomas agrupados em tr&#234;s per&#237;odos de sete anos &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#44; ajustados por sexo e idade por meio de uma regress&#227;o log&#237;stica ordinal&#44; os tumores acrais e tor&#225;cicos aumentaram sua frequ&#234;ncia&#44; assim como os tipos extensivos superficiais e os lentiginosos acrais&#46; Em contrapartida&#44; tumores localizados na cabe&#231;a e pesco&#231;o&#44; assim como os lentigos malignos&#44; reduziram sua frequ&#234;ncia&#44; entre os per&#237;odos&#46; N&#227;o houve modifica&#231;&#227;o nas propor&#231;&#245;es dos tumores de acordo com os n&#237;veis de invas&#227;o histol&#243;gica&#44; e cerca de 35&#37; dos melanomas s&#227;o diagnosticados com<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> apresenta o mapa perceptual&#44; estimado pela t&#233;cnica multivariada de an&#225;lise de correspond&#234;ncia m&#250;ltipla&#44; que ajusta simultaneamente o sexo&#44; faixa et&#225;ria&#44; tipo histol&#243;gico e espessura de Breslow&#46; O modelo multivariado composto com duas dimens&#245;es explicou 62&#37; da varia&#231;&#227;o total &#40;in&#233;rcias 32&#37; e 29&#37;&#41;&#44; possibilitando identificar rela&#231;&#245;es de proximidade entre as vari&#225;veis e de continuidade entre as categorias&#46; Melanomas de espessura intermedi&#225;ria &#40;1&#8211;3<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; formas acrais&#44; extensivas superficiais&#44; e em menores que 60 anos&#44; aproximaram&#8208;se do polo mais recente &#40;2013&#8208;2019&#41; do seguimento&#44; Enquanto o per&#237;odo mais remoto &#40;1999&#8208;2005&#41; aproximou&#8208;se de idosos&#44; lentigos malignos e tumores &#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm&#46; Formas nodulares associaram&#8208;se aos maiores n&#237;veis de invas&#227;o&#44; sem aproximar&#8208;se do tempo de seguimento&#44; sexo ou faixa et&#225;ria&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Nessa s&#233;rie&#44; o aumento percentual dos melanomas diagnosticados na institui&#231;&#227;o foi maior que o crescimento populacional da regi&#227;o&#44; sugerindo aumento de incid&#234;ncia&#46; Entretanto&#44; apesar das campanhas de conscientiza&#231;&#227;o&#44; os melanomas invasivos ainda compreendem importante fra&#231;&#227;o dos tumores diagnosticados na institui&#231;&#227;o&#44; e os resultados n&#227;o evidenciam revers&#227;o desse panorama&#46; De fato&#44; h&#225; evid&#234;ncias multifatoriais para a transi&#231;&#227;o na epidemiologia dos melanomas em diferentes s&#233;ries internacionais&#44; cuja justificativa vai desde o sobrediagn&#243;stico at&#233; perfis de fotoexposi&#231;&#227;o&#44; envelhecimento populacional&#44; miscigena&#231;&#227;o racial e as campanhas de preven&#231;&#227;o&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Nessa popula&#231;&#227;o&#44; apesar do envelhecimento populacional&#44; a redu&#231;&#227;o da propor&#231;&#227;o de melanomas em idosos e das formas lentiginosas prevalentes na cabe&#231;a&#47;pesco&#231;o podem refletir melhor padr&#227;o de fotoprote&#231;&#227;o ocupacional&#44; al&#233;m do processo de urbaniza&#231;&#227;o que o Brasil vem apresentando desde a d&#233;cada de 1970&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> Esse perfil de melanoma &#233; associado ao crescimento lento da fase horizontal&#44; com comportamento menos agressivo&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Em contrapartida&#44; o aumento das formas acrais e de tumores em adultos jovens pode refletir miscigena&#231;&#227;o da popula&#231;&#227;o&#44; j&#225; que essas formas s&#227;o mais comuns em adultos melanod&#233;rmicos e orientais&#46; Esse perfil de melanoma tem comportamento mais agressivo&#44; com fase vertical precoce&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">A fra&#231;&#227;o de melanomas nodulares na institui&#231;&#227;o permaneceu est&#225;vel durante o per&#237;odo&#44; o que j&#225; fora identificado em outros pa&#237;ses&#46; Essas formas s&#227;o precocemente invasivas&#44; contribuem para a maior parte da mortalidade espec&#237;fica e n&#227;o s&#227;o sens&#237;veis ao diagn&#243;stico precoce a partir de campanhas que valorizem aspectos pigmentares&#44; de simetria ou altera&#231;&#245;es em nevos preexistentes&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Em Goi&#226;nia &#40;Brasil&#41;&#44; tamb&#233;m se identificou aumento na incid&#234;ncia de melanomas entre 1988 e 2000&#44; em ambos os sexos&#44; apesar de maior mortalidade entre homens&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> Isso foi tamb&#233;m evidenciado em pesquisa do registro de &#243;bitos no estado de S&#227;o Paulo &#40;Brasil&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> Da mesma maneira&#44; outro estudo nacional identificou diferen&#231;as regionais para as tend&#234;ncias de mortalidade espec&#237;fica do melanoma&#44; sugerindo que fatores &#233;tnicos e ambientais &#8211; que variam grandemente atrav&#233;s do pa&#237;s &#8211; interfiram na epidemiologia da doen&#231;a&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">As campanhas de rastreamento populacional s&#227;o uma importante ferramenta adotada mundialmente&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> e o Brasil a promove&#44; anualmente&#44; h&#225; duas d&#233;cadas&#46; Estrat&#233;gias adicionais como conscientiza&#231;&#227;o de pod&#243;logos e mapeamento corporal&#44; visto que m&#250;ltiplos nevos aumentam a chance de surgimento de melanomas extensivos superficiais&#44; s&#227;o tamb&#233;m importantes no diagn&#243;stico precoce&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Este estudo apresenta limita&#231;&#245;es decorrentes da caracter&#237;stica retrospectiva&#44; da fidelidade dos registros m&#233;dicos e da falta de dados longitudinais quanto ao desfecho cl&#237;nico dos pacientes&#46; Outrossim&#44; o laborat&#243;rio de patologia da institui&#231;&#227;o n&#227;o congregou todos os casos de melanoma da regi&#227;o&#44; n&#227;o permitindo infer&#234;ncias quanto a sua incid&#234;ncia&#59; apesar disso&#44; o hospital centraliza todos os diagn&#243;sticos histopatol&#243;gicos do sistema p&#250;blico de sa&#250;de &#40;SUS&#41;&#44; possibilitando uma amostra representativa dessa popula&#231;&#227;o regional&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Melanoma cut&#226;neo prim&#225;rio apresentou mudan&#231;as no perfil epidemiol&#243;gico&#44; nos &#250;ltimos 21 anos&#44; nessa institui&#231;&#227;o&#46; As campanhas de preven&#231;&#227;o devem salientar formas acrais e localizadas no t&#243;rax&#44; especialmente em indiv&#237;duos com menos de 60 anos de idade&#44; visando o diagn&#243;stico precoce diante das caracter&#237;sticas que est&#227;o se tornando mais prevalentes&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0080" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0085" class="elsevierStylePara elsevierViewall">C&#233;sar Augusto Zago Ferreira&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o de dados&#59; reda&#231;&#227;o do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final submetida&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Lais Soares Ker Marques&#58; Obten&#231;&#227;o de dados&#59; aprova&#231;&#227;o da vers&#227;o final submetida&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">H&#233;lio Amante Miot&#58; Concep&#231;&#227;o e planejamento do estudo&#59; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final submetida&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Juliano Vilaverde Schmitt&#58; Concep&#231;&#227;o e planejamento do estudo&#59; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final submetida&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0105" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Como citar este artigo&#58; Ferreira CA&#44; Marques LS&#44; Miot HA&#44; Schmitt JV&#46; Epidemiological transition of primary cutaneous melanoma in a public hospital in Brazil &#40;1999&#8211;2019&#41;&#46; An Bras Dermatol&#46; 2023&#59;98&#58;89&#8211;92&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Outro&#47;n&#227;o classificado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="17" align="left" valign="\n
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                  \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="17" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Tipo histol&#243;gico</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Extensivo superficial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Lentigo&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="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Lentiginoso acral&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Outro&#47;n&#227;o classificado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="17" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Espessura de Breslow</span></td></tr><tr title="table-row"><td class="td-with-role" title="\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8804; 1 mm&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>1&#8208;3 mm&nbsp;\t\t\t\t\t\t\n
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Principais caracter&#237;sticas quanto ao sexo e faixa et&#225;ria dos melanomas cut&#226;neos prim&#225;rios diagnosticados em hospital universit&#225;rio&#58; 1999 a 2019 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>615&#41;</p>"
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                  \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">2013&#8208;2019 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>219&#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" style="border-bottom: 2px solid black">OR<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; IC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#8208;valor<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="10" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Topografia</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><span class="elsevierStyleHsp" style=""></span>T&#243;rax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;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">1&#44;05&#8208;2&#44;08&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">0&#44;027</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><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">61&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">44&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;38&#8208;0&#44;76&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">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><span class="elsevierStyleHsp" style=""></span>Membro superior&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">24&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&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">12&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;73&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;45&#8208;1&#44;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">0&#44;189&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><span class="elsevierStyleHsp" style=""></span>Acral&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">6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">12&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&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">15&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;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">1&#44;03&#8208;2&#44;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"><span class="elsevierStyleBold">0&#44;037</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><span class="elsevierStyleHsp" style=""></span>Membro inferior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&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&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&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&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&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&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;73&#8208;2&#44;06&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;436&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><span class="elsevierStyleHsp" style=""></span>Outro&#47;n&#227;o classificado&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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="10" 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="10" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Tipo histol&#243;gico</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><span class="elsevierStyleHsp" style=""></span>Extensivo <span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>superficial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">35&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">103&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;018</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Lentigo&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Lentiginoso acral&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Nodular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Outro&#47;n&#227;o classificado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="10" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Espessura de Breslow</span></td></tr><tr title="table-row"><td class="td-with-role" title="\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8804; 1 mm&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>1&#8208;3 mm&nbsp;\t\t\t\t\t\t\n
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Journal Information
Vol. 98. Issue 1.
Pages 89-92 (1 January 2023)
Visits
4163
Vol. 98. Issue 1.
Pages 89-92 (1 January 2023)
Cartas ‐ Investigação
Open Access
Transição epidemiológica do melanoma cutâneo primário em hospital público no Brasil (1999–2019)
Visits
4163
César Augusto Zago Ferreira
Corresponding author
cazferreira94@gmail.com

Autor para correspondência.
, Lais Soares Ker Marques, Hélio Amante Miot, Juliano Vilaverde Schmitt
Departamento de Dermatologia e Radioterapia, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brasil
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Apesar de corresponder a apenas cerca de 1% de todos os cânceres de pele, o melanoma é responsável por 90% da mortalidade por malignidades cutâneas, e o tratamento das formas avançadas inflige importante impacto orçamentário ao sistema de saúde.1 Nas últimas décadas, houve consistente aumento de sua incidência em todo o mundo; entretanto, sua mortalidade específica permaneceu estável ou sofreu leve redução na maioria das séries históricas.2

No triênio 2020–2022, o Instituto Nacional de Câncer (INCA) estimou o diagnóstico de 8.400 melanomas no Brasil (4 casos/100.000 habitantes). Como os dados epidemiológicos longitudinais brasileiros são escassos, neste trabalho objetivamos verificar a transição na epidemiologia dos melanomas cutâneos primários, em 21 anos, diagnosticados em serviço público universitário no interior do Brasil.

Conduziu‐se estudo retrospectivo e analítico de pacientes diagnosticados com melanoma in situ ou invasivos no período entre janeiro de 1999 e dezembro de 2019, no laboratório de patologia do Hospital das Clínicas da Faculdade de Medicina de Botucatu (FMB‐Unesp). Procedeu‐se a coleta de dados demográficos dos pacientes e histopatológicos, referentes às características da neoplasia. Os subgrupos foram comparados por modelos logísticos (binários ou ordinais), a dimensão do efeito foi estimada pela razão de chances (Odds Ratio) com seu intervalo de confiança de 95% (IC 95%), e a significância foi definida como p <0,05. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da instituição.

Nesse intervalo, foram diagnosticados 615 melanomas cutâneos primários em 590 pacientes, dos quais 300 (50,8%) eram mulheres e 24 (4,1%) apresentaram mais de um melanoma durante o período. A idade média (desvio‐padrão) ao diagnóstico foi de 61,3 (15,8) anos, variando entre 12 e 92 anos. A incidência de melanoma cutâneo primário, na instituição, apresentou crescimento médio anual de 4,0% (IC 95% de 2,0% a 5,7%) ao ano, nos últimos 21 anos. Não houve diferença na proporção de idosos ou quanto ao sexo, em função dos anos (p> 0,68).

A tabela 1 exibe as principais características dos melanomas e sua associação com sexo e faixa etária. Houve predominância de casos no tórax e região cefálica. Os tumores dos membros foram mais frequentes em mulheres, enquanto os cefálicos foram em idosos e homens. Formas extensivas superficiais foram as mais comuns, além de serem associadas ao sexo feminino e idades <60 anos. Já os melanomas nodulares prevaleceram em homens. Pacientes <60 anos também apresentaram maiores níveis de invasão histológica (1–3mm).

Tabela 1.

Principais características quanto ao sexo e faixa etária dos melanomas cutâneos primários diagnosticados em hospital universitário: 1999 a 2019 (n=615)

  TotalFemininoMasculinoOR  95% IC  p‐valor  <6 0 anos≥ 60 anosOR  IC 95%  p‐valor 
Topografia
Tórax  202  33%  83  27%  119  39%  0,58  0,42‐0,82  0,002  107  43%  95  26%  2,10  1,50‐2,96  <0,001 
Cabeça/pescoço  193  31%  85  28%  108  35%  0,70  0,50‐0,99  0,043  50  20%  143  39%  0,38  0,27‐0,56  <0,001 
Membro superior  80  13%  53  17%  27  9%  2,16  1,33‐3,50  0,002  34  14%  46  13%  1,08  0,67‐1,74  0,742 
Acral  72  12%  38  12%  34  11%  1,13  0,69‐1,85  0,626  29  12%  43  12%  0,98  0,59‐1,61  0,922 
Membro inferior  66  11%  47  15%  19  6%  2,73  1,59‐4,69  <0,001  31  12%  35  10%  1,32  0,79‐2,21  0,281 
Outro/não classificado  0%  1%  0%  ‐  ‐  ‐  0%  1%  ‐  ‐  ‐ 
Tipo histológico
Extensivo superficial  256  42%  147  48%  109  36%  1,66  1,20‐2,29  0,002  139  55%  117  32%  2,62  1,89‐3,64  <0,001 
Lentigo  174  28%  78  25%  96  31%  0,75  0,52‐1,06  0,102  30  12%  144  40%  0,21  0,14‐0,31  <0,001 
Lentiginoso acral  64  10%  34  11%  30  10%  1,15  0,68‐1,92  0,607  23  9%  41  11%  0,79  0,46‐1,36  0,402 
Nodular  60  10%  22  7%  38  12%  0,54  0,32‐0,94  0,029  26  10%  34  9%  1,12  0,66‐1,92  0,676 
Outro/não classificado  61  10%  27  9%  34  11%  ‐  ‐  ‐  33  13%  28  8%  ‐  ‐  ‐ 
Espessura de Breslow
In situ  209  34%  106  37%  103  37%  1,00  ‐  0,644  71  28%  138  38%  1,00  ‐  0,008 
≤ 1 mm  173  28%  93  32%  80  29%  1,13  0,76‐1,69    83  33%  90  25%  1,79  1,19‐2,71   
1‐3 mm  81  13%  46  16%  35  13%  1,28  0,76‐2,14    40  16%  41  11%  1,90  1,13‐3,19   
3 mm  102  17%  43  14%  59  21%  0,71  0,44‐1,14    35  14%  67  18%  1,02  0,62‐1,67   
Não classificado  50  8%  20  7%  30  10%  ‐  ‐  ‐  22  9%  28  8%  ‐  ‐  ‐ 
Nível de Clark
209  34%  106  34%  103  34%  1,00  ‐  0,734  71  28%  138  38%  1,00  ‐  0,048 
II  96  16%  53  17%  43  14%  1,20  0,74‐1,95    46  18%  50  14%  1,79  1,09‐2,93   
III  132  21%  62  20%  70  23%  0,86  0,56‐1,33    63  25%  69  19%  1,78  1,14‐2,78   
IV  100  16%  49  16%  51  17%  0,93  0,58‐1,50    38  15%  62  17%  1,19  0,73‐1,95   
19  3%  12  4%  2%  1,67  0,63‐4,40    2%  13  4%  0,90  0,33‐2,46   
Não classificado  59  10%  26  8%  33  11%  ‐  ‐  ‐  27  11%  32  9%  ‐  ‐  ‐ 

OR, odds ratio (razão de chances).

Quando comparados, os melanomas agrupados em três períodos de sete anos (tabela 2), ajustados por sexo e idade por meio de uma regressão logística ordinal, os tumores acrais e torácicos aumentaram sua frequência, assim como os tipos extensivos superficiais e os lentiginosos acrais. Em contrapartida, tumores localizados na cabeça e pescoço, assim como os lentigos malignos, reduziram sua frequência, entre os períodos. Não houve modificação nas proporções dos tumores de acordo com os níveis de invasão histológica, e cerca de 35% dos melanomas são diagnosticados com> 1mm.

Tabela 2.

Comparação evolutiva das proporções relacionadas ao melanoma cutâneo diagnosticado em hospital universitário: 1999–2019 (n=615)

  1999‐2005 (n=140)2006‐2012 (n=256)2013‐2019 (n=219)ORa  95% IC  p‐valora 
Topografia
Tórax  33  24%  88  34%  81  37%  1,48  1,05‐2,08  0,027 
Cabeça e pescoço  61  44%  78  30%  54  25%  0,54  0,38‐0,76  0,001 
Membro superior  24  17%  31  12%  25  11%  0,73  0,45‐1,17  0,189 
Acral  6%  31  12%  32  15%  1,69  1,03‐2,75  0,037 
Membro inferior  13  9%  27  11%  26  12%  1,23  0,73‐2,06  0,436 
Outro/não classificado  0%  0%  0%  ‐  ‐  ‐ 
Tipo histológico
Extensivo superficial  49  35%  103  40%  104  47%  1,49  1,07‐2,07  0,018 
Lentigo  51  36%  77  30%  46  21%  0,55  0,38‐0,79  <0,001 
Lentiginoso acral  6%  27  11%  29  13%  1,73  1,04‐2,87  0,035 
Nodular  11  8%  26  10%  23  11%  1,19  0,71‐2,00  0,512 
Outro/não classificado  21  15%  23  9%  17  8%  ‐  ‐  ‐ 
Espessura de Breslow
In situ  38  27%  107  42%  64  29%  1,00  ‐  0,522 
≤ 1 mm  44  31%  66  26%  63  29%  0,96  0,64‐1,44   
1‐3 mm  16  11%  28  11%  37  17%  1,42  0,84‐2,41   
3 mm  25  18%  38  15%  39  18%  1,06  0,66‐1,70   
Não classificado  17  12%  17  7%  16  7%       
Nível de Clark
38  27%  107  42%  64  29%  1,00  ‐  0,960 
II  24  17%  35  14%  37  17%  1,02  0,62‐1,69   
III  31  22%  48  19%  53  24%  1,11  0,71‐1,74   
IV  29  21%  35  14%  36  16%  0,89  0,55‐1,45   
3%  4%  3%  0,97  0,38‐2,47   
Não classificado  14  10%  22  9%  23  11%  ‐  ‐  ‐ 
a

Resultados ajustados para sexo e idade,

OR, odds ratio (razão de chances).

A figura 1 apresenta o mapa perceptual, estimado pela técnica multivariada de análise de correspondência múltipla, que ajusta simultaneamente o sexo, faixa etária, tipo histológico e espessura de Breslow. O modelo multivariado composto com duas dimensões explicou 62% da variação total (inércias 32% e 29%), possibilitando identificar relações de proximidade entre as variáveis e de continuidade entre as categorias. Melanomas de espessura intermediária (1–3mm), formas acrais, extensivas superficiais, e em menores que 60 anos, aproximaram‐se do polo mais recente (2013‐2019) do seguimento, Enquanto o período mais remoto (1999‐2005) aproximou‐se de idosos, lentigos malignos e tumores <1mm. Formas nodulares associaram‐se aos maiores níveis de invasão, sem aproximar‐se do tempo de seguimento, sexo ou faixa etária.

Figura 1.

Mapa perceptual (análise de correspondência múltipla) dos casos de melanoma cutâneo diagnosticado em hospital universitário: 1999–2019 (n=615).

(0.07MB).

Nessa série, o aumento percentual dos melanomas diagnosticados na instituição foi maior que o crescimento populacional da região, sugerindo aumento de incidência. Entretanto, apesar das campanhas de conscientização, os melanomas invasivos ainda compreendem importante fração dos tumores diagnosticados na instituição, e os resultados não evidenciam reversão desse panorama. De fato, há evidências multifatoriais para a transição na epidemiologia dos melanomas em diferentes séries internacionais, cuja justificativa vai desde o sobrediagnóstico até perfis de fotoexposição, envelhecimento populacional, miscigenação racial e as campanhas de prevenção.3,4

Nessa população, apesar do envelhecimento populacional, a redução da proporção de melanomas em idosos e das formas lentiginosas prevalentes na cabeça/pescoço podem refletir melhor padrão de fotoproteção ocupacional, além do processo de urbanização que o Brasil vem apresentando desde a década de 1970.5 Esse perfil de melanoma é associado ao crescimento lento da fase horizontal, com comportamento menos agressivo.

Em contrapartida, o aumento das formas acrais e de tumores em adultos jovens pode refletir miscigenação da população, já que essas formas são mais comuns em adultos melanodérmicos e orientais. Esse perfil de melanoma tem comportamento mais agressivo, com fase vertical precoce.6

A fração de melanomas nodulares na instituição permaneceu estável durante o período, o que já fora identificado em outros países. Essas formas são precocemente invasivas, contribuem para a maior parte da mortalidade específica e não são sensíveis ao diagnóstico precoce a partir de campanhas que valorizem aspectos pigmentares, de simetria ou alterações em nevos preexistentes.7

Em Goiânia (Brasil), também se identificou aumento na incidência de melanomas entre 1988 e 2000, em ambos os sexos, apesar de maior mortalidade entre homens.8 Isso foi também evidenciado em pesquisa do registro de óbitos no estado de São Paulo (Brasil).9 Da mesma maneira, outro estudo nacional identificou diferenças regionais para as tendências de mortalidade específica do melanoma, sugerindo que fatores étnicos e ambientais – que variam grandemente através do país – interfiram na epidemiologia da doença.10

As campanhas de rastreamento populacional são uma importante ferramenta adotada mundialmente,11 e o Brasil a promove, anualmente, há duas décadas. Estratégias adicionais como conscientização de podólogos e mapeamento corporal, visto que múltiplos nevos aumentam a chance de surgimento de melanomas extensivos superficiais, são também importantes no diagnóstico precoce.

Este estudo apresenta limitações decorrentes da característica retrospectiva, da fidelidade dos registros médicos e da falta de dados longitudinais quanto ao desfecho clínico dos pacientes. Outrossim, o laboratório de patologia da instituição não congregou todos os casos de melanoma da região, não permitindo inferências quanto a sua incidência; apesar disso, o hospital centraliza todos os diagnósticos histopatológicos do sistema público de saúde (SUS), possibilitando uma amostra representativa dessa população regional.

Melanoma cutâneo primário apresentou mudanças no perfil epidemiológico, nos últimos 21 anos, nessa instituição. As campanhas de prevenção devem salientar formas acrais e localizadas no tórax, especialmente em indivíduos com menos de 60 anos de idade, visando o diagnóstico precoce diante das características que estão se tornando mais prevalentes.

Suporte financeiro

Nenhum.

Contribuição dos autores

César Augusto Zago Ferreira: Concepção e planejamento do estudo; obtenção, análise e interpretação de dados; redação do manuscrito; aprovação da versão final submetida.

Lais Soares Ker Marques: Obtenção de dados; aprovação da versão final submetida.

Hélio Amante Miot: Concepção e planejamento do estudo; análise e interpretação dos dados; revisão do manuscrito; aprovação da versão final submetida.

Juliano Vilaverde Schmitt: Concepção e planejamento do estudo; análise e interpretação dos dados; revisão do manuscrito; aprovação da versão final submetida.

Conflito de interesses

Nenhum.

Referências
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Cancer statistics, 2020.
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Trends in incidence of thick, thin and in situ melanoma in Europe.
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[8]
A.M. Sortino-Rachou, M.P. Curado, M.R.D.O. Latorre.
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[9]
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J Am Acad Dermatol., 76 (2017), pp. 129-139

Como citar este artigo: Ferreira CA, Marques LS, Miot HA, Schmitt JV. Epidemiological transition of primary cutaneous melanoma in a public hospital in Brazil (1999–2019). An Bras Dermatol. 2023;98:89–92.

Trabalho realizado no Departamento de Doenças Infecciosas, Dermatologia, Diagnóstico por Imagem e Radioterapia, Faculdade de Medicina, Universidade Estadual de São Paulo, Botucatu, SP, Brasil.

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