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and the associated demographic and clinical characteristics&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">This was a retrospective cohort study analyzing medical records of cases of cutaneous melanoma treated and followed at the institution between 1999 and 2016&#44; excluding tumors <span class="elsevierStyleItalic">in situ</span>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Medical records in which the anatomopathological examination did not allow adequate staging of the initial tumor were excluded&#46; Staging exams were those performed within three months of the initial diagnosis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The results of chest radiographs &#40;CR&#41; and axial computed tomography &#40;CT&#41; of the head&#44; neck&#44; chest&#44; abdomen&#44; and pelvis were evaluated according to the radiological reports&#46; Positivity was true when histological evidence of the neoplasm was obtained&#44; or when the patient&#39;s evolution showed clinically evident recurrence&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Continuous variables were analyzed by Student&#39;s <span class="elsevierStyleItalic">t</span>-test and the Mann&#8211;Whitney test&#44; depending on the normality of the distributions as assessed by the Shapiro&#8211;Wilk test&#46; Categorical variables were compared using the chi-squared test&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The impact of radiological examination on survival from the initial diagnosis was assessed by Cox regression&#46; Two-tailed values of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 were considered significant&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">We identified 93 cases included in the study&#44; of which 57 had initial imaging tests&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the baseline characteristics of the patients and the imaging tests&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">We had a balanced sample between the sexes&#44; 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reaching 61&#46;5&#37; &#40;8&#47;13&#41; after clinical manifestation of relapse&#46; Five of the 13 cases of recurrence &#40;38&#46;5&#37;&#41; presented metastatic disease in the follow-up CRs&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Of the five patients who had findings of asymptomatic metastasis on imaging examinations&#44; three had previously progressed to stage III&#46; The median follow-up time for pre-clinical identification of distant metastatic disease at imaging examinations was 24 &#40;9&#8211;29&#41; months&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the patients&#8217; overall survival curves from the initial diagnosis&#44; according to the performance and alterations of the follow-up imaging tests&#44; adjusted for age&#44; sex&#44; Breslow thickness&#44; and ulceration&#44; where more aggressive behavior of tumors with clinically identified metastatic disease is observed &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01 &#8211; 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the results disfavored CR in the staging of asymptomatic patients&#44; except for locally very advanced cases&#46; During the follow-up&#44; the positivity increases&#44; but the tumors are usually preceded by locoregional recurrence and distant metastatic disease symptoms&#44; within the three first years of follow-up&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0100" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Author&#39;s contribution</span><p id="par0105" class="elsevierStylePara elsevierViewall">Luiza Boava Souza&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analyzing and interpreting the data&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Gabriel Peres&#58; Approval of the final version of the manuscript&#59; elaboration and writing of the manuscript&#59; critical review of the manuscript&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Juliano Vilaverde Schmitt&#58; Statistical analysis&#59; approval of the final version of the manuscript&#59; conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analyzing and interpreting the data&#59; effective participation in research orientation&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Global survival according to the performance and changes of the imaging exams during follow-up&#46; &#42;Including chest X-rays and axial tomography&#46; The exams were performed selectively&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Baseline features&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>Superficial spreading&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">44 &#40;47&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nodular&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\ttable-entry\n
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                  \t\t\t\t">18 &#40;19&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Head and neck&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">26 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">31 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">36 &#40;38&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Breslow thickness &#40;mm&#41;&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
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">13&#47;57 &#40;22&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>False positives findings&#47;exams performed&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">9&#47;57 &#40;15&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#47;51 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&#47;51 &#40;5&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">3&#47;11 &#40;27&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Preclinical&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#47;11 &#40;18&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#47;11 &#40;54&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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Research Letter
Imaging tests in cutaneous malignant melanoma staging: a retrospective cohort
Luiza Boava Souzaa, Gabriel Peresb, Juliano Vilaverde Schmittb,
Autor para correspondência
julivs@gmail.com

Corresponding author.
a Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil
b Department of Dermatology and Radiotherapy, Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil
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and the associated demographic and clinical characteristics&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">This was a retrospective cohort study analyzing medical records of cases of cutaneous melanoma treated and followed at the institution between 1999 and 2016&#44; excluding tumors <span class="elsevierStyleItalic">in situ</span>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Medical records in which the anatomopathological examination did not allow adequate staging of the initial tumor were excluded&#46; Staging exams were those performed within three months of the initial diagnosis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The results of chest radiographs &#40;CR&#41; and axial computed tomography &#40;CT&#41; of the head&#44; neck&#44; chest&#44; abdomen&#44; and pelvis were evaluated according to the radiological reports&#46; Positivity was true when histological evidence of the neoplasm was obtained&#44; or when the patient&#39;s evolution showed clinically evident recurrence&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Continuous variables were analyzed by Student&#39;s <span class="elsevierStyleItalic">t</span>-test and the Mann&#8211;Whitney test&#44; depending on the normality of the distributions as assessed by the Shapiro&#8211;Wilk test&#46; Categorical variables were compared using the chi-squared test&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The impact of radiological examination on survival from the initial diagnosis was assessed by Cox regression&#46; Two-tailed values of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 were considered significant&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">We identified 93 cases included in the study&#44; of which 57 had initial imaging tests&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the baseline characteristics of the patients and the imaging tests&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">We had a balanced sample between the sexes&#44; with lesions treated between the sixth and eighth decade of life&#44; followed-up for a median period of 4&#46;6 years&#44; and initial tumors of intermediate thickness&#44; with 32&#37; fatality during follow-up&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">There were frequent incidental findings on initial imaging exams&#44; with no truly positive findings at baseline CR&#46; However&#44; the imaging tests were performed selectively&#44; with a greater regularity for the CRs&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Regarding the initial staging exams&#44; only four of 57 patients presented findings indicating systemic metastasis of melanoma &#40;through CT&#41;&#46; All lesions were ulcerated&#44; with a median Breslow thickness of 9&#46;8 &#40;1&#46;5&#8211;15&#41;<span class="elsevierStyleHsp" style=""></span>mm&#44; one quarter of which had clinical regional lymph node involvement&#44; one quarter had bone invasion by the primary tumor&#44; and one quarter had microsatellitosis&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Patients who did or did not perform initial CR did not differ in demographic and tumor staging characteristics &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; In addition&#44; general and specific mortality adjusted for age&#44; sex&#44; Breslow thickness&#44; and ulceration were not different between these groups &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;63 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;81 &#8211; Cox regression&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Of the patients with negative baseline tests&#44; 24&#46;5&#37; &#40;13&#47;53&#41; evolved to metastatic disease identified at follow-up imaging tests&#44; reaching 61&#46;5&#37; &#40;8&#47;13&#41; after clinical manifestation of relapse&#46; Five of the 13 cases of recurrence &#40;38&#46;5&#37;&#41; presented metastatic disease in the follow-up CRs&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Of the five patients who had findings of asymptomatic metastasis on imaging examinations&#44; three had previously progressed to stage III&#46; The median follow-up time for pre-clinical identification of distant metastatic disease at imaging examinations was 24 &#40;9&#8211;29&#41; months&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the patients&#8217; overall survival curves from the initial diagnosis&#44; according to the performance and alterations of the follow-up imaging tests&#44; adjusted for age&#44; sex&#44; Breslow thickness&#44; and ulceration&#44; where more aggressive behavior of tumors with clinically identified metastatic disease is observed &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01 &#8211; Cox regression&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The results of the present study suggest that imaging tests to stage asymptomatic patients are not very productive and should be considered only for locally advanced cases with thick and ulcerated tumors&#46; The studies by Gj&#248;rup et al&#46;&#44; in 2016&#44; and Ferr&#225;ndiz et al&#46;&#44; also in 2016&#44; together identified only three positive cases between CR and CT in the staging of 913 asymptomatic patients up to stage IIC&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">At follow-up&#44; the frequency of positive findings in asymptomatic patients increased&#44; but was often preceded by regional spread of the tumor&#46; In any case&#44; clinically manifest distant metastasis indicated a disease of aggressive behavior&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Despite the limitations inherent in retrospective studies&#44; the results disfavored CR in the staging of asymptomatic patients&#44; except for locally very advanced cases&#46; During the follow-up&#44; the positivity increases&#44; but the tumors are usually preceded by locoregional recurrence and distant metastatic disease symptoms&#44; within the three first years of follow-up&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0100" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Author&#39;s contribution</span><p id="par0105" class="elsevierStylePara elsevierViewall">Luiza Boava Souza&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analyzing and interpreting the data&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Gabriel Peres&#58; Approval of the final version of the manuscript&#59; elaboration and writing of the manuscript&#59; critical review of the manuscript&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Juliano Vilaverde Schmitt&#58; Statistical analysis&#59; approval of the final version of the manuscript&#59; conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analyzing and interpreting the data&#59; effective participation in research orientation&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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                  \t\t\t\t">55 &#40;22&#8211;88&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Death in the follow-up</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;32&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Death by melanoma</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;17&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Clinical type</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>Superficial spreading&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44 &#40;47&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nodular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;16&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Acral lentiginous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;17&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lentigo maligna&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;19&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Location</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>Head and neck&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Trunk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Members&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;38&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Presence of ulceration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Breslow thickness &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;3 &#40;0&#46;6&#8211;4&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
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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  " align="char" valign="\n
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                  \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>False positives findings&#47;exams performed&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \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>True positive findings on chest X-rays&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;51 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>False positive findings on chest X-rays&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;51 &#40;5&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>True positive findings on CTs&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&#47;11 &#40;27&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Preclinical&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&#47;11 &#40;18&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>False positive findings on CTs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#47;11 &#40;54&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;72&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  " align="char" valign="\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>Male&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">26 &#40;51&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;54&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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