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Interpretations about gender in the epidemiology of cutaneous melanoma
Anna Carolina Miola, Juliano Vilaverde Schmitt, Hélio Amante Miot
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Department of Dermatology and Radiotherapy, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil
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Dados extraídos de Castro e Souza et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Anna Carolina Miola, Juliano Vilaverde Schmitt, Hélio Amante Miot" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Anna Carolina" "apellidos" => "Miola" ] 1 => array:2 [ "nombre" => "Juliano Vilaverde" "apellidos" => "Schmitt" ] 2 => array:2 [ "nombre" => "Hélio Amante" "apellidos" => "Miot" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S036505962200040X" "doi" => "10.1016/j.abd.2022.01.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036505962200040X?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275222000534?idApp=UINPBA00008Z" "url" => "/26662752/0000009700000003/v1_202206050551/S2666275222000534/v1_202206050551/pt/main.assets" ] ] "itemAnterior" => array:18 [ "pii" => "S0365059622000381" "issn" => "03650596" "doi" => "10.1016/j.abd.2020.09.019" "estado" => "S300" "fechaPublicacion" => "2022-05-01" "aid" => "527" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "sco" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Letter</span>" "titulo" => "Uremic stomatitis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "404" "paginaFinal" => "405" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1114 "Ancho" => 1674 "Tamanyo" => 206839 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Whitish plaque with threadlike projections adhered to the left lateral border of the tongue.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Paulo Ricardo Martins Souza, Gabriela Mosena, Manuela Lima Dantas, Gerson Vettorato" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Paulo Ricardo Martins" "apellidos" => "Souza" ] 1 => array:2 [ "nombre" => "Gabriela" "apellidos" => "Mosena" ] 2 => array:2 [ "nombre" => "Manuela Lima" "apellidos" => "Dantas" ] 3 => array:2 [ "nombre" => "Gerson" "apellidos" => "Vettorato" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275222000455" "doi" => "10.1016/j.abdp.2022.03.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275222000455?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059622000381?idApp=UINPBA00008Z" "url" => "/03650596/0000009700000003/v1_202205170747/S0365059622000381/v1_202205170747/en/main.assets" ] "asociados" => array:1 [ 0 => array:19 [ "pii" => "S0365059621001604" "issn" => "03650596" "doi" => "10.1016/j.abd.2020.08.022" "estado" => "S300" "fechaPublicacion" => "2021-09-01" "aid" => "403" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "sco" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Research Letter</span>" "titulo" => "Cutaneous melanoma: a retrospective study of 18 years. Are there gender differences?" 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(A), Clark’s anatomical level (n = 267); (B), Breslow index in mm (n = 265). Data extracted from Castro e Souza et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Due to the relevance of cutaneous melanoma to the health system and the scarcity of large series of cases with longitudinal follow-up in samples from the Brazilian population, we read with great interest the article by Castro e Souza et al.,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> which showed different survival rates in males and females, in a five-year follow-up of 221 patients. In addition to congratulating the authors, we would like to propose some reflections regarding the interpretation of the results.</p><p id="par0010" class="elsevierStylePara elsevierViewall">There is consistent evidence of an increase in melanoma diagnoses worldwide in recent decades; in parallel, there is an intense discussion about factors associated with this phenomenon, such as population aging, increase in sun exposure during leisure time, use of immunosuppressants, greater population awareness, greater access to the health system, and even greater diagnostic accuracy by dermatologists and pathologists. Nevertheless, the population-specific mortality did not show any signs of decrease, further alluding to the possibility of overdiagnosis.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Shorter survival in men with melanoma have also been identified in other countries; however, the tumor biological behavior considering the hormonal differences, as defended by the authors, may not fully justify this fact, especially since the greatest divergence of mortality between the sexes occurs in old age, when sex hormones are less active.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">It is considered relevant to mention that all diseases have biological, environmental and sociocultural dimensions. In Brazil, women have a life expectancy that is 9.6% higher than men (2019: 80.1 <span class="elsevierStyleItalic">vs</span>. 73.1 years), undergo fewer hospital admissions (except for obstetric ones), and have a greater perception of their own health care, such as adherence to vaccination, regular examinations and routine outpatient consultations. In the meantime, behavioral aspects related to masculinity should be considered as possible determinants of delay in the diagnosis of melanoma, contributing to its worse prognosis.</p><p id="par0025" class="elsevierStylePara elsevierViewall">To corroborate this hypothesis, the data from Castro e Souza et al. was reanalyzed regarding the Clark and Breslow levels – considering such variables as ordinals. When analyzing them using the Chi-Square test of tendency, which considers the influence of the effect by the variable order,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> it was shown that women have better histopathological indices (p < 0.017) at the moment of diagnosis of invasive cases (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, the results of Castro e Souza et al. should be seen from the perspective of primary and secondary prevention, aiming to substantiate policies that promote early diagnosis, especially in groups at higher risk and mortality, such as men and the elderly, since the worse melanoma survival in men may also reflect the socio-cultural determinant associated to gender, leading to late diagnoses in groups less aware of the importance of the disease.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0035" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0040" class="elsevierStylePara elsevierViewall">Anna Carolina Miola: Design and planning of the study; statistical analysis; drafting and editing of the manuscript; critical review of the literature; critical review of the manuscript; approval of the final version of the manuscript.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Juliano Vilaverde Schmitt: Design and planning of the study; statistical analysis; drafting and editing of the manuscript; critical review of the literature; critical review of the manuscript; approval of the final version of the manuscript.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Hélio Amante Miot: Design and planning of the study; statistical analysis; drafting and editing of the manuscript; critical review of the literature; critical review of the manuscript; approval of the final version of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-11-10" "fechaAceptado" => "2022-01-26" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Department of Dermatology and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2500 "Ancho" => 1675 "Tamanyo" => 170355 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Percentage of cutaneous melanoma cases according to gender (M, Male; F, Female) and level of histopathological invasion. (A), Clark’s anatomical level (n = 267); (B), Breslow index in mm (n = 265). Data extracted from Castro e Souza et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous melanoma: a retrospective study of 18 years. Are there gender differences?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B. Castro e Souza" 1 => "D.H. Moraes Silva" 2 => "N.Y.S. Valente" 3 => "P. Kakizaki" 4 => "M.C.A. Luce" 5 => "L.G. 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| 2024 Junho | 141 | 88 | 229 |
| 2024 Maio | 157 | 70 | 227 |
| 2024 Abril | 135 | 81 | 216 |
| 2024 Março | 100 | 50 | 150 |
| 2024 Fevereiro | 85 | 81 | 166 |
| 2024 Janeiro | 61 | 44 | 105 |
| 2023 Dezembro | 50 | 49 | 99 |
| 2023 Novembro | 68 | 83 | 151 |
| 2023 Outubro | 57 | 67 | 124 |
| 2023 Setembro | 67 | 84 | 151 |
| 2023 Agosto | 50 | 39 | 89 |
| 2023 Julho | 76 | 25 | 101 |
| 2023 Junho | 55 | 41 | 96 |
| 2023 Maio | 40 | 33 | 73 |
| 2023 Abril | 37 | 12 | 49 |
| 2023 Março | 46 | 40 | 86 |
| 2023 Fevereiro | 30 | 24 | 54 |
| 2023 Janeiro | 47 | 36 | 83 |
| 2022 Dezembro | 46 | 22 | 68 |
| 2022 Novembro | 67 | 42 | 109 |
| 2022 Outubro | 72 | 53 | 125 |
| 2022 Setembro | 54 | 67 | 121 |
| 2022 Agosto | 50 | 35 | 85 |
| 2022 Julho | 51 | 52 | 103 |
| 2022 Junho | 119 | 61 | 180 |
| 2022 Maio | 90 | 67 | 157 |
| 2022 Abril | 45 | 71 | 116 |
| 2022 Março | 31 | 25 | 56 |
Mostrar tudo
