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um problema de sa&#250;de p&#250;blica em muitos pa&#237;ses&#46; A incid&#234;ncia no mundo subiu de 11&#44;8&#47;100&#46;000 habitantes em 2003&#8211;2006 para 17&#44;5 em 2011&#8211;2014&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">9&#44;10</span></a> Nos EUA&#44; o n&#250;mero pulou de menos de 10&#160;casos&#47;100&#160;mil habitantes &#40;1975&#41; para cerca de&#160;25&#160;&#40;2013&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a> Na Austr&#225;lia&#44; eram 27&#160;casos&#47;100 mil habitantes &#40;1982&#41; e 49 em 2012&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a> Um estudo recentemente publicado com dados brasileiros mostrou que a incid&#234;ncia m&#233;dia em homens aumentou de&#160;2&#44;52 para&#160;4&#44;84 e nas mulheres de&#160;1&#44;33 para 3&#44;22&#160;casos&#47;100&#46;000 habitantes de&#160;2000 a 2013 no pa&#237;s&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">11</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Na Austr&#225;lia&#44; 10&#44;2&#37; de todos os c&#226;nceres foram diagnosticados como melanoma&#44; nos EUA&#44; 4&#44;5&#37; e no Brasil&#44; menos do que 2&#44;3&#37;&#46; Novos casos de melanomas foram 13&#46;283 em&#160;2012 na Austr&#225;lia&#44; 76&#46;380 em&#160;2013 nos EUA e 5&#46;670 in 2012 no Brasil&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">4&#8211;6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">S&#227;o poucos os estudos epidemiol&#243;gicos com enfoque nas taxas de sobrevida do melanoma no Brasil&#46; Por essa raz&#227;o&#44; fizemos este projeto no Hospital das Cl&#237;nicas da FMUSP com o objetivo de analisar os dados de sobrevida doen&#231;a&#8208;espec&#237;fica dos pacientes com melanoma cut&#226;neo prim&#225;rio invasivo acompanhado no nosso servi&#231;o quanto ao sexo&#44; ao fototipo de pele&#44; ao &#237;ndice de Breslow&#44; ao tipo histol&#243;gico e &#224; presen&#231;a de les&#227;o cl&#237;nica pr&#233;&#8208;existente no local do tumor&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Este trabalho foi aprovado pelo Comit&#234; de &#201;tica do Hospital das Cl&#237;nicas da FMUSP &#40;CAAE&#58;&#160;76591317&#46;0&#46;0000&#46;0068&#41;&#46; O estudo foi desenhado para ser anal&#237;tico de coorte retrospectivo com 565&#160;casos de melanomas invasivos para testar fatores associados o pior progn&#243;stico&#46; Dados de pacientes com diagn&#243;stico de melanoma acompanhados no ambulat&#243;rio de oncologia cut&#226;nea do Hospital das Cl&#237;nicas da FMUSP&#44; entre janeiro de 1987 e maio de 2016 foram revisados e analisados&#46; Os dados de sobrevida foram obtidos atrav&#233;s da Funda&#231;&#227;o Sistema Estadual de An&#225;lise de Dados &#40;Seade&#41;&#44; que &#233; uma ag&#234;ncia governamental do Estado de S&#227;o Paulo e que&#44; gentilmente&#44; compartilhou conosco os dados de data e causa do &#243;bito dos pacientes do nosso servi&#231;o&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Os crit&#233;rios de inclus&#227;o foram&#58; melanoma invasivo diagnosticado entre janeiro de 1987 e maio de 2016&#59; 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Fototipos I&#44; II e III foram classificados como baixo e IV&#44; V e VI&#44; como alto&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Os dados coletados a partir dos laudos histopatol&#243;gicos foram&#58; &#237;ndice de Breslow&#44; tipo histol&#243;gico&#44; presen&#231;a de ulcera&#231;&#227;o e regress&#227;o&#44; n&#250;mero de mitoses &#40;medido de acordo com a recomenda&#231;&#227;o da AJCC&#58; <span class="elsevierStyleItalic">American Joint Committee on Cancer</span>&#41; e status do linfonodo sentinela&#46; Para os pacientes que apresentaram mais de um melanoma prim&#225;rio invasivo&#44; optamos pelos dados do tumor mais espesso para a an&#225;lise da sobrevida&#8208;espec&#237;fica&#46; Os dados de sobrevida da Funda&#231;&#227;o Seade foram obtidos atrav&#233;s do cruzamento das seguintes informa&#231;&#245;es&#58; nome e data de nascimento do paciente&#44; nome da m&#227;e&#44; data e causa da morte&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">A an&#225;lise de sobrevida foi usada para avaliar a sobrevida global para os pacientes com melanoma&#46; 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As an&#225;lises foram feitas nos <span class="elsevierStyleItalic">softwares</span> estat&#237;sticos SPSS v&#46;18 for Windows e Stata v&#46;11&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0050" class="elsevierStylePara elsevierViewall">A planilha do ambulat&#243;rio de oncologia cut&#226;nea do Hospital das Cl&#237;nicas da FMUSP usada para armazenar os dados dos pacientes com melanoma acompanhados no servi&#231;o contava com 906 pacientes&#44; desde seu in&#237;cio entre janeiro de&#160;1987 e maio de&#160;2016&#46; De acordo com os crit&#233;rios definidos acima&#44; exclu&#237;mos 173&#160;casos de melanoma <span class="elsevierStyleItalic">in situ</span> e 177 que&#44; apesar de invasivos&#44; n&#227;o apresentavam o &#237;ndice de Breslow reportado no laudo histopatol&#243;gico&#46; Por essa raz&#227;o&#44; nossa coorte continha 556&#160;pacientes&#46; Como nove deles tiveram dois melanomas invasivos prim&#225;rios distintos&#44; esta pesquisa incluiu 565&#160;melanomas&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Par&#226;metros cl&#237;nicos e histopatol&#243;gicos</span><p id="par0055" class="elsevierStylePara elsevierViewall">Para se ter uma ideia da robustez da popula&#231;&#227;o estudada&#44; a <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> resume todos os dados cl&#237;nicos e histopatol&#243;gicos computados&#46; De forma sucinta&#44; podemos afirmar que a nossa coorte era em sua maioria de pacientes do sexo feminino&#160;&#40;61&#37;&#41;&#59; que a maior frequ&#234;ncia do diagn&#243;stico ocorreu entre os&#160;50&#160;e&#160;80&#160;anos&#160;&#40;60&#37;&#41;&#44; com m&#233;dia de&#160;56&#44;6&#160;anos&#46; Em rela&#231;&#227;o ao fototipo de Fitzpatrick&#44; o tipo&#160;II foi o mais frequente &#40;44&#37;&#41;&#44; seguido pelo tipo&#160;III&#160;&#40;29&#37;&#41;&#46; Os locais mais frequentes de surgimento dos melanomas invasivos foram tronco com 37&#37;&#44; seguido por membros com 34&#37;&#44; cabe&#231;a e pesco&#231;o&#44; 16&#37; e extremidades &#40;p&#233;s e m&#227;os&#41; 12&#37;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">O &#237;ndice de Breslow m&#233;dio para todos os melanomas foi&#160;2&#44;01&#160;mm&#46; Melanomas &#8804;&#160;1&#44;0&#160;mm foram 51&#37; dos casos&#59; 21&#37; estavam entre 1&#44;01 e 2&#44;0&#160;mm&#59; 15&#37; entre 2&#44;01 e 4&#44;0&#160;mm e 14&#37; com espessura&#160;&#62;&#160;4&#44;0&#160;mm&#46; A ulcera&#231;&#227;o e a regress&#227;o foram identificadas em 10&#37; e 11&#37; dos tumores&#44; respectivamente&#46; O melanoma extensivo superficial contabilizou 46&#37; dos casos&#59; seguido pelo tipo nodular&#44; com 11&#37;&#44; lentiginoso acral&#44; com 9&#37;&#44; e lentigo maligno melanoma&#44; com 8&#37;&#46; Mitoses estiveram presentes em 15&#37; dos melanomas&#44; ausentes em 12&#37; deles e 73&#37; dos laudos n&#227;o especificavam essa informa&#231;&#227;o&#46; A pesquisa do linfonodo sentinela mostrou que 16&#37; foram negativos&#44; 4&#37;&#44; positivos e que nos demais 80&#37; n&#227;o havia sido feita&#46; Quanto &#224; presen&#231;a de les&#227;o cl&#237;nica pr&#233;&#8208;existente&#44; 51&#37; negaram&#44; 35&#37; confirmaram e 14&#37; n&#227;o souberam informar&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Sobrevida melanoma&#8208;espec&#237;fica</span><p id="par0065" class="elsevierStylePara elsevierViewall">Neste estudo foram inclu&#237;dos 556&#160;pacientes com melanoma&#44; dos quais 521&#160;&#40;93&#44;7&#37;&#41; tinham informa&#231;&#227;o dispon&#237;vel sobre status vital &#40;vivo ou &#243;bito&#41;&#46; Dos pacientes com informa&#231;&#227;o dispon&#237;vel&#44; 463&#160;&#40;88&#44;9&#37;&#41; estavam vivos e 58&#160;&#40;11&#44;1&#37;&#41; eram &#243;bitos&#46; A an&#225;lise de sobrevida foi considerada em meses&#44; c&#225;lculo das probabilidades de sobrevida em&#160;um&#160;ano&#44; 2&#160;anos&#44; 5&#160;anos e 10&#160;anos e foi feita pelo m&#233;todo de Kaplan&#8208;Meier&#46; Valores do tempo m&#233;dio&#44; mediano e do erro&#8208;padr&#227;o foram apresentados para o total de pacientes e segundo as vari&#225;veis &#237;ndice de Breslow&#44; sexo&#44; fototipo e tipo de les&#227;o &#40;pr&#233;&#8208;existente ou &#8220;de novo&#8221;&#41;&#46; A compara&#231;&#227;o das curvas de sobrevida apontou diferen&#231;as estatisticamente significativas entre as categorias do &#237;ndice de Breslow &#40;p&#160;&#60;&#160;0&#44;001&#41;&#59; g&#234;nero &#40;p&#160;&#61;&#160;0&#44;014&#41;&#59; fototipo &#40;p&#160;&#61;&#160;0&#44;047&#41; e tipo de les&#227;o &#40;p&#160;&#61;&#160;0&#44;005&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Conforme mostra a <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#44; a sobrevida global diminui com os anos&#46; De&#160;99&#44;6&#37; em um&#160;ano passa para 84&#44;6&#37; em 10&#160;anos&#46; Quanto maior o &#237;ndice de Breslow&#44; menores as taxas de sobrevida&#46; As mulheres apresentaram melhor sobrevida do que os homens&#44; assim como fototipos baixos em compara&#231;&#227;o com os altos e haver les&#227;o cl&#237;nica pr&#233;&#8208;existente no s&#237;tio do aparecimento do melanoma em rela&#231;&#227;o &#224;queles que apareceram &#8220;de novo&#8221;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Na avalia&#231;&#227;o dos fatores relacionados com a sobrevida global&#44; usou&#8208;se a regress&#227;o de Cox n&#227;o ajustada e ajustada&#46; Valores de <span class="elsevierStyleItalic">hazard ratio</span> &#40;HR&#41; e seus respectivos intervalos com 95&#37; de confian&#231;a foram calculados e apresentados na <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#46; O &#237;ndice de Breslow continuou fortemente significativo&#44; mostrou que tumores mais espessos&#44; especialmente maiores do que 4&#160;mm&#44; t&#234;m uma sobrevida pior do que os finos &#40;p&#160;&#61;&#160;0&#44;001&#41;&#46; Pacientes do sexo feminino mantiveram um melhor progn&#243;stico que do masculino &#40;p&#160;&#61;&#160;0&#44;018&#41;&#46; J&#225; nesta an&#225;lise&#44; o fototipo alto <span class="elsevierStyleItalic">versus</span> baixo e a presen&#231;a ou n&#227;o de les&#227;o cl&#237;nica pr&#233;&#8208;existente n&#227;o foram associados &#224; taxa de sobrevida&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">A seguir&#44; quisemos verificar o modelo de regress&#227;o de Cox e ajustamos cada uma das vari&#225;veis independentes pelo &#237;ndice de Breslow&#46; Os resultados s&#227;o apresentados na <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#46; Somente a vari&#225;vel fototipo n&#227;o resultou significativa na compara&#231;&#227;o das curvas de sobrevida ajustada pelo &#237;ndice de Breslow &#40;p&#160;&#61;&#160;0&#44;426&#41;&#46; O sexo &#40;p&#160;&#61;&#160;0&#44;025&#41; e o tipo de les&#227;o &#40;p&#160;&#61;&#160;0&#44;011&#41; apresentaram diferen&#231;as significativas nas curvas de sobrevida ajustadas pelo &#237;ndice de Breslow&#46; As mulheres e os melanomas que surgiram sobre les&#245;es cl&#237;nicas pr&#233;&#8208;existentes permaneceram com melhor sobrevida quando comparados aos homens e aos melanomas &#8220;de novo&#8221;&#44; respectivamente&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Para testar a sobrevida espec&#237;fica da doen&#231;a de acordo com o tipo histol&#243;gico&#44; testamos os quatro tipos principais&#44; classificados da seguinte forma&#58; I&#58; melanoma extensivo superficial&#59; II&#58; melanoma nodular&#59; III&#58; lentigo maligno melanoma e IV&#58; melanoma lentiginoso acral&#46; Os subtipos histol&#243;gicos mostraram diferentes curvas de sobrevida com signific&#226;ncia estat&#237;stica &#40;p&#160;&#61;&#160;0&#44;024&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabela 5</a>&#41;&#46; O subtipo extensivo superficial foi o que apresentou a maior porcentagem de pacientes vivos no fim do estudo&#44; diferenciou&#8208;se dos demais&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0030">tabela 6</a> analisa a sobrevida doen&#231;a&#8208;espec&#237;fica dos pacientes com melanoma de acordo com o tipo histol&#243;gico e o &#237;ndice de Breslow&#46; De forma univariada&#44; com HR n&#227;o ajustado&#44; vemos que os tipos histol&#243;gicos II &#40;nodular&#41; e lV &#40;lentiginoso acral&#41;&#44; assim como o Breslow&#44; apresentam diferen&#231;a significativa em rela&#231;&#227;o ao tipo extensivo superficial&#46; J&#225; na an&#225;lise multivariada&#44; com HR ajustado&#44; n&#227;o houve correla&#231;&#227;o entre tipo histol&#243;gico e sobrevida&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Discuss&#227;o</span><p id="par0095" class="elsevierStylePara elsevierViewall">Os resultados apresentados na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> confirmam a robustez da nossa amostra e apresentam muitas semelhan&#231;as com outros trabalhos publicados recentemente no Brasil&#46; Dois trabalhos demonstraram a maior incid&#234;ncia de melanoma diagnosticados em mulheres&#44;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">10&#44;11</span></a> assim como o nosso&#46; Outro estudo revelou maior frequ&#234;ncia de melanomas no tronco e do tipo extensivo superficial&#44; semelhantemente aos nossos dados&#46; No entanto&#44; foi observada maior preval&#234;ncia de tumores com &#237;ndice de Breslow intermedi&#225;rio e espesso&#44; o que difere da nossa casu&#237;stica&#44; que apresenta mais tumores finos&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">12</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">A taxa de mortalidade do melanoma tamb&#233;m tem aumentado com os anos&#46; O Brasil tinha 0&#44;06 em 1979 e 0&#44;13 por 100&#46;00 habitantes em 2014&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a> Na Austr&#225;lia&#44; um dos pa&#237;ses com maior incid&#234;ncia dessa patologia no mundo&#44; era 3&#44;3 em 1968 e 6&#44;2 por 100&#46;000&#160;habitantes em 2013&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a> Recentemente publicado&#44; um estudo brasileiro que usou um banco de dados com mais de 28&#160;mil indiv&#237;duos revelou um aumento da mortalidade de 0&#44;85 para 0&#44;9&#47;100&#46;000 habitantes em homens e uma diminui&#231;&#227;o de 0&#44;56 para 0&#44;53&#47;100&#46;000&#160;habitantes em mulheres de 2000 a 2014&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">11</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">A taxa de sobrevida em&#160;5&#160;anos do melanoma na Austr&#225;lia&#44; nos EUA e na Holanda &#233; respectivamente 90&#37;&#44; 91&#44;5&#37; e 86&#37;&#46; No nosso estudo&#44; foi de&#160;95&#44;7&#37; em&#160;5&#160;anos&#44; lembramos que inclu&#237;mos somente casos invasivos&#44; o que&#44; em tese&#44; deveria piorar a nossa estat&#237;stica de sobrevida&#46; Tamb&#233;m se deve levar em conta que perdemos o seguimento de uma parte dos pacientes&#44; por falta &#224;s consultas ou por aus&#234;ncia de dados como o &#237;ndice de Breslow&#44; que n&#227;o foi em determinado em 17&#37; dos casos e os &#243;bitos ocorridos fora do Estado de SP&#44; o que pode trazer algum vi&#233;s ao estudo&#46; Outra limita&#231;&#227;o do projeto &#233; o fato de ser retrospectivo e ter sido conduzido num centro &#250;nico terceirizado&#44; o que pode n&#227;o refletir&#44; necessariamente&#44; as condi&#231;&#245;es do pa&#237;s na sua generalidade&#44; como as taxas dos pa&#237;ses citados anteriormente&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">4&#8211;6&#44;13&#44;14</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">O &#237;ndice de Breslow &#233; um par&#226;metro aceito para estadiar os melanomas e predizer a sobrevida melanoma&#8208;espec&#237;fico&#46; Os indiv&#237;duos com tumores mais finos t&#234;m uma melhor sobrevida&#44; como pode ser observado na nossa an&#225;lise de sobrevida doen&#231;a&#8208;espec&#237;fica e em outras publica&#231;&#245;es&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">15&#44;16</span></a> Nossos dados mostram que somente&#160;7&#44;6&#37; dos tumores&#160;&#8804;&#160;1&#44;0&#160;mm morreram por melanoma em&#160;10&#160;anos contra 41&#44;8&#37; daqueles mais espessos do que&#160;4&#44;0&#160;mm no mesmo per&#237;odo&#46; A chance de morte de um paciente com melanoma com Breslow &#62;&#160;4&#44;0&#160;mm &#233; 5&#44;37&#215; do maior que um indiv&#237;duo com melanomas com Breslow &#8804;&#160;1&#44;0&#160;mm&#46; Vale a pena destacar que&#44; de toda forma&#44; mesmo tumores finos &#40;&#8804;&#160;1&#44;0&#160;mm&#41; levaram &#224; morte em 7&#44;6&#37; dos casos &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">A sobrevida na nossa casu&#237;stica se mostrou diferente de acordo com o sexo&#46; Os homens tiveram um progn&#243;stico significativamente pior do que as mulheres&#46; Ser homem aumentou a chance de morte por melanoma &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46; Nos EUA&#44; isso tamb&#233;m &#233; verdade&#58; h&#225; 4&#44;1&#160;mortes em homens e 1&#44;7 em mulheres por 100&#44;00 pessoas&#59;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">5&#44;15</span></a> no Jap&#227;o&#44; a sobrevida em 140&#160;meses foi de 70&#44;6&#37; em mulheres e 60&#37; em homens&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a> Um estudo na Inglaterra tamb&#233;m reportou que ser homem teve um impacto negativo na sobrevida&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a> Em nosso estudo&#44; mesmo ap&#243;s ajuste para o &#237;ndice de Breslow&#44; que isoladamente &#233; o par&#226;metro mais importante na sobrevida do paciente com melanoma&#44; os pacientes masculinos continuaram com um pior progn&#243;stico &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#44; o que n&#227;o havia sido testado anteriormente&#46; As raz&#245;es para isso permanecem especulativas&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Com rela&#231;&#227;o a fototipo&#47;etnia e sobrevida&#44; encontramos uma menor taxa de sobrevida&#8208;espec&#237;fica em pacientes com fototipos altos de Fitzpatrick &#40;IV&#44; V e VI&#41;&#44; mas essa diferen&#231;a n&#227;o se manteve ap&#243;s o ajuste pelo &#237;ndice de Breslow &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46; Uma explica&#231;&#227;o para esse fato pode ser que pacientes com fototipos mais altos podem estar sendo diagnosticados mais tardiamente&#44; o que acarreta um pior progn&#243;stico do que aqueles com fototipos mais baixos&#46; Problemas socioecon&#244;micos poderiam atrasar o acesso ao sistema de sa&#250;de e&#47;ou a cren&#231;a de que c&#226;ncer de pele &#233; um problema apenas para pacientes com fototipo baixo podem contribuir para essa demora&#46; A maioria dos estudos avalia etnia&#46; Um artigo encontrou que pessoas negras t&#234;m uma taxa de sobrevida mais baixa&#44; mas n&#227;o ajustou para a espessura&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a> Outro mostrou que negros n&#227;o hisp&#226;nicos t&#234;m uma taxa de sobrevida melhor do que brancos n&#227;o hisp&#226;nicos&#44; o que parece contr&#225;rio aos nosso achados&#44; mas tamb&#233;m n&#227;o houve ajuste para o &#237;ndice de Breslow&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Outro achado interessante &#233; que melanomas &#8220;de novo&#8221; s&#227;o mais agressivos do que aqueles que se desenvolvem sobre les&#245;es cl&#237;nicas preexistentes &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">tabelas 2 e 4</a>&#41;&#44; o que foi corroborado em outro estudo&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a> Poder&#237;amos especular que muta&#231;&#245;es que levam &#224; ocorr&#234;ncia do melanoma &#8220;de novo&#8221; poderiam causar uma doen&#231;a mais agressiva do que outras muta&#231;&#245;es que ocorrem em les&#245;es pr&#233;&#8208;existentes&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Os tipos histol&#243;gicos apresentam diferentes probabilidades de sobrevida tamb&#233;m&#46; Em nosso estudo&#44; o melanoma extensivo superficial obteve maior probabilidade de sobrevida do que os outros tipos &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabela 5</a>&#41;&#46; Um estudo japon&#234;s revelou o melanoma nodular como tendo o pior progn&#243;stico&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a> No entanto&#44; isso pode ocorrer n&#227;o pelo subtipo de melanoma em si&#44; mas sim porque&#44; usualmente&#44; ao diagn&#243;stico&#44; o melanoma nodular &#233; mais espesso e o melanoma extensivo superficial&#44; mais fino&#46; Essa hip&#243;tese pode ser corroborada pelos nossos resultados&#44; nos quais verificamos que&#44; uma vez ajustado o &#237;ndice de Breslow para todos os tipos histol&#243;gicos de melanoma&#44; n&#227;o h&#225; diferen&#231;a estat&#237;stica entre a sobrevida deles&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Dados de sobrevida s&#227;o a grande diferen&#231;a do nosso estudo&#46; H&#225; alguns anos nosso hospital tem um acordo com a Funda&#231;&#227;o Seade&#44; uma ag&#234;ncia governamental que nos permite saber a causa e a data da morte dos pacientes&#46; Seguramente isso &#233; essencial para obter as curvas de mortalidade e sobrevida aqui apresentadas e&#44; tamb&#233;m&#44; nos habilitar a planejar pol&#237;ticas de sa&#250;de p&#250;blica para melhor tratar e prevenir mortes por melanoma&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conclus&#227;o</span><p id="par0140" class="elsevierStylePara elsevierViewall">As an&#225;lises de sobrevida dos pacientes com melanoma invasivo da nossa coorte retrospectiva mostraram associa&#231;&#227;o com espessura do tumor&#44; sexo e presen&#231;a ou n&#227;o de les&#227;o cl&#237;nica pr&#233;&#8208;existente&#46; Futuros estudos poder&#227;o verificar se h&#225; associa&#231;&#227;o entre sobrevida e subtipo histol&#243;gico ou fototipo do paciente&#44; conforme nossos resultados sugerem&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Suporte financeiro</span><p id="par0145" class="elsevierStylePara elsevierViewall">Pr&#243;prio e Funda&#231;&#227;o de Amparo &#224; Pesquisa do Estado de S&#227;o Paulo &#40;Fapesp&#41;&#44; projeto n&#250;mero&#58; 2017&#47;20928&#8208;9&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Contribui&#231;&#227;o dos autores</span><p id="par0150" class="elsevierStylePara elsevierViewall">Mara Huffenbaecher Giavina&#8208;Bianchi&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Cyro Festa Neto&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Jose Antonio Sanches Junior&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Monica La Porte Teixeira&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Bernadette Cunha Valdvogel&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflitos de interesse</span><p id="par0175" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A incid&#234;ncia e a mortalidade do melanoma t&#234;m aumentado em muitos pa&#237;ses&#44; inclusive no Brasil&#46; Estudos de sobrevida ainda s&#227;o escassos no nosso pa&#237;s&#44; mas muito necess&#225;rios para se conhecer e abordar melhor esse problema&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Analisar a sobrevida doen&#231;a&#8208;espec&#237;fica dos pacientes com melanoma invasivo e correlacion&#225;&#8208;la com vari&#225;veis cl&#237;nicas e histopatol&#243;gicas&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo anal&#237;tico de coorte retrospectiva em 565&#160;casos de melanoma invasivo num hospital terci&#225;rio com o objetivo de testar vari&#225;veis que poderiam estar associadas a pior progn&#243;stico&#44; como sexo&#44; fototipo&#44; espessura&#44; tipo histol&#243;gico e presen&#231;a de les&#227;o cl&#237;nica pr&#233;&#8208;existente no local do tumor&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">As piores taxas de sobrevida estiveram significativamente associadas com tumores espessos &#40;p&#160;&#60;&#160;0&#44;001&#41;&#44; sexo masculino &#40;p&#160;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#160;0&#44;014&#41;&#44; fototipo alto &#40;p&#160;&#61;&#160;0&#44;047&#41;&#44; melanoma nodular &#40;p&#160;&#61;&#160;0&#44;024&#41; e les&#245;es &#8220;de novo&#8221; &#40;p&#160;&#61;&#160;0&#44;005&#41;&#46; Quando ajustamos as vari&#225;veis para a espessura do melanoma&#44; os pacientes do sexo masculino &#40;p&#160;&#61;&#160;0&#44;011&#41; e os melanomas &#8220;de novo&#8221; &#40;p&#160;&#61;&#160;0&#44;025&#41; mantiveram&#8208;se associados com uma menor sobrevida&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Estudo retrospectivo e de um &#250;nico hospital terci&#225;rio&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Embora as causas sejam ainda desconhecidas&#44; a sobrevida melanoma&#8208;espec&#237;fico mostrou&#8208;se estatisticamente pior para homens e para melanomas &#8220;de novo&#8221; mesmo ap&#243;s o ajuste da espessura do tumor&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0045">Trabalho realizado no Departamento de Dermatologia&#44; Hospital das Cl&#237;nicas&#44; Faculdade de Medicina&#44; Universidade de S&#227;o Paulo&#44; S&#227;o Paulo&#44; SP&#44; Brasil&#46;</p>"
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                  \t\t\t\t">70&#8211;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III&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\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">V&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t</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">90 &#40;16&#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">Tronco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">211 &#40;37&#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">Membros&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">196 &#40;34&#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">Extremidades&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68 &#40;12&#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  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">&#205;ndice de Breslow</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8804; 1&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">279 &#40;51&#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">1&#44;01&#8211;2&#44;00&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">120 &#40;21&#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">2&#44;01&#8211;4&#44;00&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">85 &#40;15&#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">&#62;4&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81 &#40;14&#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  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ulcera&#231;&#227;o</span></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">Presente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;10&#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">Ausente&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">450 &#40;80&#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">Sem informa&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;10&#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  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Regress&#227;o</span></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">Presente&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">63 &#40;11&#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">Ausente&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">424 &#40;75&#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">Sem informa&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78 &#40;14&#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  " rowspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tipo histol&#243;gico</span></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">Extensivo 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">262 &#40;46&#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">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;11&#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">Lentigo maligno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;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">Lentiginoso 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">51 &#40;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">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">6 &#40;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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sem informa&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">139 &#40;25&#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  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mitose</span></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">Presente&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">87 &#40;15&#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">Ausente&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">66 &#40;12&#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">Sem informa&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">412 &#40;73&#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  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Linfonodo sentinela</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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 &#40;4&#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">Negativo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89 &#40;16&#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">N&#227;o realizado&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 &#40;5&#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">Sem informa&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">421 &#40;75&#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  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Les&#227;o pr&#233;&#8208;existente</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">199 &#40;35&#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">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">285 &#40;51&#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">Ignorado&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 &#40;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">Sem informa&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2296258.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
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                  \t\t\t\t">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mortes&#47;Total&#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">HR<span class="elsevierStyleInf">n&#227;oajustado</span>&#40;95&#37;IC&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Valor de p<a class="elsevierStyleCrossRef" href="#tblfn0010"><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">HR<span class="elsevierStyleInf">ajustado</span>&#40;95&#37;IC&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Valor de p<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</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-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">&#8804;&#160;1&#44;00&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#47;257 &#40;6&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="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
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&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
                  \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="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;01&#8211;2&#44;00&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&#47;112 &#40;10&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;56 &#40;0&#44;66&#8211;3&#44;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;315&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">2&#44;02 &#40;0&#44;71&#8211;5&#44;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;190&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">2&#44;01&#8211;4&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#47;78 &#40;15&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;81 &#40;0&#44;91&#8211;5&#44;20&#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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;079&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;59 &#40;0&#44;87&#8211;7&#44;71&#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
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                  \t\t\t\t">0&#44;089&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
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62; 4&#44;00&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
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                  \t\t\t\t">17&#47;74 &#40;23&#44;0&#41;&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">5&#46;13 &#40;2&#44;40&#8211;10&#44;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&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
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                  \t\t\t\t">5&#44;37 &#40;1&#44;96&#8211;14&#44;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&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">Sexo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&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-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>Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#47;312 &#40;9&#44;6&#41;&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
                  \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  " align="left" valign="\n
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                  \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="" 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>Masculino&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
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Fototipo</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Alto&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"><span class="elsevierStyleHsp" style=""></span>Baixo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tipo de les&#227;o</span>&nbsp;\t\t\t\t\t\t\n
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">p&#8208;valor ajustado pelo &#237;ndice de Breslow com o uso do modelo de regress&#227;o de Cox&#46;</p>"
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          "pt" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Sobrevida global em pacientes com melanoma ajustado para o &#237;ndice de Breslow com o uso da regress&#227;o de Cox</p>"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">EP&#44; erro&#8208;padr&#227;o&#59; LMM&#44; lentigo maligno melanoma&#59; MES&#44; melanoma extensivo superficial&#59; MLA&#44; melanoma lentiginoso acral&#59; NA&#44; n&#227;o avali&#225;vel&#59; NOD&#44; melanoma nodular&#46;</p>"
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">M&#233;dia &#40;EP&#41; &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\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">371&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">343 &#40;92&#44;5&#41;&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;7&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">394&#44;23 &#40;30&#44;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;024&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"><span class="elsevierStyleHsp" style=""></span>I &#40;MES&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">231&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
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                  \t\t\t\t">221 &#40;95&#44;7&#41;&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">10 &#40;4&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">451&#44;59 &#40;38&#44;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>II &#40;NOD&#41;&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 &#40;85&#44;7&#41;&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;14&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">236&#44;56 &#40;29&#44;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">203&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>III &#40;LMM&#41;&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&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">36 &#40;90&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;10&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">195&#44;03 &#40;30&#44;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IV &#40;MLA&#41;&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  " align="left" valign="\n
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                  \t\t\t\t">194&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Teste de compara&#231;&#227;o das curvas de sobrevida <span class="elsevierStyleItalic">log&#8208;rank</span> n&#227;o ajustado&#46;</p>"
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          "pt" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Sobrevida doen&#231;a&#8208;espec&#237;fica em pacientes com melanoma segundo tipo histol&#243;gico</p>"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">95&#37;&#160;IC&#44; intervalo de confian&#231;a de 95&#37;&#59; HR&#44; <span class="elsevierStyleItalic">hazard ratio</span>&#59; LMM&#44; lentigo maligno melanoma&#59; MES&#44; melanoma extensivo superficial&#59; MLA&#44; melanoma lentiginoso acral&#59; NOD&#44; melanoma nodular&#46;</p>"
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                  \t\t\t\t">I &#40;MES&#41;&nbsp;\t\t\t\t\t\t\n
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Investigação
Pior sobrevida do melanoma invasivo em homens e em lesões “de novo”
Mara Huffenbaecher Giavina‐Bianchia,
Autor para correspondência
marahgbianchi@gmail.com

Autor para correspondência.
, Cyro Festa‐Netoa, Jose Antonio Sanchesa, Monica La Porte Teixeirab, Bernadette Cunha Waldvogelb
a Departamento de Dermatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
b Departamento de Análise e Disseminação de Informações de Dados, Fundação Sistema Estadual de Análise de Dados, São Paulo, SP, Brasil
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um problema de sa&#250;de p&#250;blica em muitos pa&#237;ses&#46; A incid&#234;ncia no mundo subiu de 11&#44;8&#47;100&#46;000 habitantes em 2003&#8211;2006 para 17&#44;5 em 2011&#8211;2014&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">9&#44;10</span></a> Nos EUA&#44; o n&#250;mero pulou de menos de 10&#160;casos&#47;100&#160;mil habitantes &#40;1975&#41; para cerca de&#160;25&#160;&#40;2013&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a> Na Austr&#225;lia&#44; eram 27&#160;casos&#47;100 mil habitantes &#40;1982&#41; e 49 em 2012&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a> Um estudo recentemente publicado com dados brasileiros mostrou que a incid&#234;ncia m&#233;dia em homens aumentou de&#160;2&#44;52 para&#160;4&#44;84 e nas mulheres de&#160;1&#44;33 para 3&#44;22&#160;casos&#47;100&#46;000 habitantes de&#160;2000 a 2013 no pa&#237;s&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">11</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Na Austr&#225;lia&#44; 10&#44;2&#37; de todos os c&#226;nceres foram diagnosticados como melanoma&#44; nos EUA&#44; 4&#44;5&#37; e no Brasil&#44; menos do que 2&#44;3&#37;&#46; Novos casos de melanomas foram 13&#46;283 em&#160;2012 na Austr&#225;lia&#44; 76&#46;380 em&#160;2013 nos EUA e 5&#46;670 in 2012 no Brasil&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">4&#8211;6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">S&#227;o poucos os estudos epidemiol&#243;gicos com enfoque nas taxas de sobrevida do melanoma no Brasil&#46; Por essa raz&#227;o&#44; fizemos este projeto no Hospital das Cl&#237;nicas da FMUSP com o objetivo de analisar os dados de sobrevida doen&#231;a&#8208;espec&#237;fica dos pacientes com melanoma cut&#226;neo prim&#225;rio invasivo acompanhado no nosso servi&#231;o quanto ao sexo&#44; ao fototipo de pele&#44; ao &#237;ndice de Breslow&#44; ao tipo histol&#243;gico e &#224; presen&#231;a de les&#227;o cl&#237;nica pr&#233;&#8208;existente no local do tumor&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Este trabalho foi aprovado pelo Comit&#234; de &#201;tica do Hospital das Cl&#237;nicas da FMUSP &#40;CAAE&#58;&#160;76591317&#46;0&#46;0000&#46;0068&#41;&#46; O estudo foi desenhado para ser anal&#237;tico de coorte retrospectivo com 565&#160;casos de melanomas invasivos para testar fatores associados o pior progn&#243;stico&#46; Dados de pacientes com diagn&#243;stico de melanoma acompanhados no ambulat&#243;rio de oncologia cut&#226;nea do Hospital das Cl&#237;nicas da FMUSP&#44; entre janeiro de 1987 e maio de 2016 foram revisados e analisados&#46; Os dados de sobrevida foram obtidos atrav&#233;s da Funda&#231;&#227;o Sistema Estadual de An&#225;lise de Dados &#40;Seade&#41;&#44; que &#233; uma ag&#234;ncia governamental do Estado de S&#227;o Paulo e que&#44; gentilmente&#44; compartilhou conosco os dados de data e causa do &#243;bito dos pacientes do nosso servi&#231;o&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Os crit&#233;rios de inclus&#227;o foram&#58; melanoma invasivo diagnosticado entre janeiro de 1987 e maio de 2016&#59; espessura do melanoma &#40;&#237;ndice de Breslow&#41; medida e relatada no exame anatomopatol&#243;gico&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Uma planilha mantida pelos m&#233;dicos que acompanham os pacientes com melanoma foi a fonte das informa&#231;&#245;es&#44; assim como o prontu&#225;rio deles&#44; quando necess&#225;rio&#46; Os dados dos pacientes pesquisados para cada paciente foram sexo&#44; idade ao diagn&#243;stico&#44; fototipo de acordo com a classifica&#231;&#227;o de Fitzpatrick&#44; localiza&#231;&#227;o do melanoma&#44; presen&#231;a de les&#227;o cl&#237;nica pr&#233;&#8208;existente no local do tumor&#44; status vital do paciente na &#250;ltima visita conhecida&#58; vivo ou &#243;bito e&#44; nesse &#250;ltimo caso&#44; por que causa pelo C&#243;digo Internacional de Doen&#231;as &#40;CID&#41;&#46; Pacientes que fizeram seguimento por menos de&#160;3&#160;meses a partir da data do diagn&#243;stico ou que n&#227;o apresentavam a data da &#250;ltima consulta na planilha foram considerados como perdidos quanto ao seu status vital&#46; Fototipos I&#44; II e III foram classificados como baixo e IV&#44; V e VI&#44; como alto&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Os dados coletados a partir dos laudos histopatol&#243;gicos foram&#58; &#237;ndice de Breslow&#44; tipo histol&#243;gico&#44; presen&#231;a de ulcera&#231;&#227;o e regress&#227;o&#44; n&#250;mero de mitoses &#40;medido de acordo com a recomenda&#231;&#227;o da AJCC&#58; <span class="elsevierStyleItalic">American Joint Committee on Cancer</span>&#41; e status do linfonodo sentinela&#46; Para os pacientes que apresentaram mais de um melanoma prim&#225;rio invasivo&#44; optamos pelos dados do tumor mais espesso para a an&#225;lise da sobrevida&#8208;espec&#237;fica&#46; Os dados de sobrevida da Funda&#231;&#227;o Seade foram obtidos atrav&#233;s do cruzamento das seguintes informa&#231;&#245;es&#58; nome e data de nascimento do paciente&#44; nome da m&#227;e&#44; data e causa da morte&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">A an&#225;lise de sobrevida foi usada para avaliar a sobrevida global para os pacientes com melanoma&#46; Curvas de sobrevida foram constru&#237;das pelo m&#233;todo de Kaplan&#8208;Meier e comparadas pelo teste <span class="elsevierStyleItalic">log&#8208;rank</span>&#46; Os tempos m&#233;dio e mediano&#44; assim como o erro&#8208;padr&#227;o&#44; foram calculados para sobrevida global de todos os pacientes e para cada categoria das vari&#225;veis independentes&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A regress&#227;o de Cox foi usada para o c&#225;lculo dos <span class="elsevierStyleItalic">hazard ratio</span> &#40;HR&#41; e os respectivos intervalos com 95&#37; de confian&#231;a para cada uma das vari&#225;veis independentes&#46; O modelo final foi ajustado por todas as vari&#225;veis independentes&#46; Adicionalmente&#44; cada uma das vari&#225;veis &#8211; sexo&#44; fototipo e les&#227;o cl&#237;nica pr&#233;&#8208;existente ou &#8220;de novo&#8221; &#8211; foi ajustada pelo &#237;ndice de Breslow&#46; O n&#237;vel de signific&#226;ncia adotado foi de&#160;5&#37;&#46; As an&#225;lises foram feitas nos <span class="elsevierStyleItalic">softwares</span> estat&#237;sticos SPSS v&#46;18 for Windows e Stata v&#46;11&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0050" class="elsevierStylePara elsevierViewall">A planilha do ambulat&#243;rio de oncologia cut&#226;nea do Hospital das Cl&#237;nicas da FMUSP usada para armazenar os dados dos pacientes com melanoma acompanhados no servi&#231;o contava com 906 pacientes&#44; desde seu in&#237;cio entre janeiro de&#160;1987 e maio de&#160;2016&#46; De acordo com os crit&#233;rios definidos acima&#44; exclu&#237;mos 173&#160;casos de melanoma <span class="elsevierStyleItalic">in situ</span> e 177 que&#44; apesar de invasivos&#44; n&#227;o apresentavam o &#237;ndice de Breslow reportado no laudo histopatol&#243;gico&#46; Por essa raz&#227;o&#44; nossa coorte continha 556&#160;pacientes&#46; Como nove deles tiveram dois melanomas invasivos prim&#225;rios distintos&#44; esta pesquisa incluiu 565&#160;melanomas&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Par&#226;metros cl&#237;nicos e histopatol&#243;gicos</span><p id="par0055" class="elsevierStylePara elsevierViewall">Para se ter uma ideia da robustez da popula&#231;&#227;o estudada&#44; a <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> resume todos os dados cl&#237;nicos e histopatol&#243;gicos computados&#46; De forma sucinta&#44; podemos afirmar que a nossa coorte era em sua maioria de pacientes do sexo feminino&#160;&#40;61&#37;&#41;&#59; que a maior frequ&#234;ncia do diagn&#243;stico ocorreu entre os&#160;50&#160;e&#160;80&#160;anos&#160;&#40;60&#37;&#41;&#44; com m&#233;dia de&#160;56&#44;6&#160;anos&#46; Em rela&#231;&#227;o ao fototipo de Fitzpatrick&#44; o tipo&#160;II foi o mais frequente &#40;44&#37;&#41;&#44; seguido pelo tipo&#160;III&#160;&#40;29&#37;&#41;&#46; Os locais mais frequentes de surgimento dos melanomas invasivos foram tronco com 37&#37;&#44; seguido por membros com 34&#37;&#44; cabe&#231;a e pesco&#231;o&#44; 16&#37; e extremidades &#40;p&#233;s e m&#227;os&#41; 12&#37;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">O &#237;ndice de Breslow m&#233;dio para todos os melanomas foi&#160;2&#44;01&#160;mm&#46; Melanomas &#8804;&#160;1&#44;0&#160;mm foram 51&#37; dos casos&#59; 21&#37; estavam entre 1&#44;01 e 2&#44;0&#160;mm&#59; 15&#37; entre 2&#44;01 e 4&#44;0&#160;mm e 14&#37; com espessura&#160;&#62;&#160;4&#44;0&#160;mm&#46; A ulcera&#231;&#227;o e a regress&#227;o foram identificadas em 10&#37; e 11&#37; dos tumores&#44; respectivamente&#46; O melanoma extensivo superficial contabilizou 46&#37; dos casos&#59; seguido pelo tipo nodular&#44; com 11&#37;&#44; lentiginoso acral&#44; com 9&#37;&#44; e lentigo maligno melanoma&#44; com 8&#37;&#46; Mitoses estiveram presentes em 15&#37; dos melanomas&#44; ausentes em 12&#37; deles e 73&#37; dos laudos n&#227;o especificavam essa informa&#231;&#227;o&#46; A pesquisa do linfonodo sentinela mostrou que 16&#37; foram negativos&#44; 4&#37;&#44; positivos e que nos demais 80&#37; n&#227;o havia sido feita&#46; Quanto &#224; presen&#231;a de les&#227;o cl&#237;nica pr&#233;&#8208;existente&#44; 51&#37; negaram&#44; 35&#37; confirmaram e 14&#37; n&#227;o souberam informar&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Sobrevida melanoma&#8208;espec&#237;fica</span><p id="par0065" class="elsevierStylePara elsevierViewall">Neste estudo foram inclu&#237;dos 556&#160;pacientes com melanoma&#44; dos quais 521&#160;&#40;93&#44;7&#37;&#41; tinham informa&#231;&#227;o dispon&#237;vel sobre status vital &#40;vivo ou &#243;bito&#41;&#46; Dos pacientes com informa&#231;&#227;o dispon&#237;vel&#44; 463&#160;&#40;88&#44;9&#37;&#41; estavam vivos e 58&#160;&#40;11&#44;1&#37;&#41; eram &#243;bitos&#46; A an&#225;lise de sobrevida foi considerada em meses&#44; c&#225;lculo das probabilidades de sobrevida em&#160;um&#160;ano&#44; 2&#160;anos&#44; 5&#160;anos e 10&#160;anos e foi feita pelo m&#233;todo de Kaplan&#8208;Meier&#46; Valores do tempo m&#233;dio&#44; mediano e do erro&#8208;padr&#227;o foram apresentados para o total de pacientes e segundo as vari&#225;veis &#237;ndice de Breslow&#44; sexo&#44; fototipo e tipo de les&#227;o &#40;pr&#233;&#8208;existente ou &#8220;de novo&#8221;&#41;&#46; A compara&#231;&#227;o das curvas de sobrevida apontou diferen&#231;as estatisticamente significativas entre as categorias do &#237;ndice de Breslow &#40;p&#160;&#60;&#160;0&#44;001&#41;&#59; g&#234;nero &#40;p&#160;&#61;&#160;0&#44;014&#41;&#59; fototipo &#40;p&#160;&#61;&#160;0&#44;047&#41; e tipo de les&#227;o &#40;p&#160;&#61;&#160;0&#44;005&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Conforme mostra a <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#44; a sobrevida global diminui com os anos&#46; De&#160;99&#44;6&#37; em um&#160;ano passa para 84&#44;6&#37; em 10&#160;anos&#46; Quanto maior o &#237;ndice de Breslow&#44; menores as taxas de sobrevida&#46; As mulheres apresentaram melhor sobrevida do que os homens&#44; assim como fototipos baixos em compara&#231;&#227;o com os altos e haver les&#227;o cl&#237;nica pr&#233;&#8208;existente no s&#237;tio do aparecimento do melanoma em rela&#231;&#227;o &#224;queles que apareceram &#8220;de novo&#8221;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Na avalia&#231;&#227;o dos fatores relacionados com a sobrevida global&#44; usou&#8208;se a regress&#227;o de Cox n&#227;o ajustada e ajustada&#46; Valores de <span class="elsevierStyleItalic">hazard ratio</span> &#40;HR&#41; e seus respectivos intervalos com 95&#37; de confian&#231;a foram calculados e apresentados na <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#46; O &#237;ndice de Breslow continuou fortemente significativo&#44; mostrou que tumores mais espessos&#44; especialmente maiores do que 4&#160;mm&#44; t&#234;m uma sobrevida pior do que os finos &#40;p&#160;&#61;&#160;0&#44;001&#41;&#46; Pacientes do sexo feminino mantiveram um melhor progn&#243;stico que do masculino &#40;p&#160;&#61;&#160;0&#44;018&#41;&#46; J&#225; nesta an&#225;lise&#44; o fototipo alto <span class="elsevierStyleItalic">versus</span> baixo e a presen&#231;a ou n&#227;o de les&#227;o cl&#237;nica pr&#233;&#8208;existente n&#227;o foram associados &#224; taxa de sobrevida&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">A seguir&#44; quisemos verificar o modelo de regress&#227;o de Cox e ajustamos cada uma das vari&#225;veis independentes pelo &#237;ndice de Breslow&#46; Os resultados s&#227;o apresentados na <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#46; Somente a vari&#225;vel fototipo n&#227;o resultou significativa na compara&#231;&#227;o das curvas de sobrevida ajustada pelo &#237;ndice de Breslow &#40;p&#160;&#61;&#160;0&#44;426&#41;&#46; O sexo &#40;p&#160;&#61;&#160;0&#44;025&#41; e o tipo de les&#227;o &#40;p&#160;&#61;&#160;0&#44;011&#41; apresentaram diferen&#231;as significativas nas curvas de sobrevida ajustadas pelo &#237;ndice de Breslow&#46; As mulheres e os melanomas que surgiram sobre les&#245;es cl&#237;nicas pr&#233;&#8208;existentes permaneceram com melhor sobrevida quando comparados aos homens e aos melanomas &#8220;de novo&#8221;&#44; respectivamente&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Para testar a sobrevida espec&#237;fica da doen&#231;a de acordo com o tipo histol&#243;gico&#44; testamos os quatro tipos principais&#44; classificados da seguinte forma&#58; I&#58; melanoma extensivo superficial&#59; II&#58; melanoma nodular&#59; III&#58; lentigo maligno melanoma e IV&#58; melanoma lentiginoso acral&#46; Os subtipos histol&#243;gicos mostraram diferentes curvas de sobrevida com signific&#226;ncia estat&#237;stica &#40;p&#160;&#61;&#160;0&#44;024&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabela 5</a>&#41;&#46; O subtipo extensivo superficial foi o que apresentou a maior porcentagem de pacientes vivos no fim do estudo&#44; diferenciou&#8208;se dos demais&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0030">tabela 6</a> analisa a sobrevida doen&#231;a&#8208;espec&#237;fica dos pacientes com melanoma de acordo com o tipo histol&#243;gico e o &#237;ndice de Breslow&#46; De forma univariada&#44; com HR n&#227;o ajustado&#44; vemos que os tipos histol&#243;gicos II &#40;nodular&#41; e lV &#40;lentiginoso acral&#41;&#44; assim como o Breslow&#44; apresentam diferen&#231;a significativa em rela&#231;&#227;o ao tipo extensivo superficial&#46; J&#225; na an&#225;lise multivariada&#44; com HR ajustado&#44; n&#227;o houve correla&#231;&#227;o entre tipo histol&#243;gico e sobrevida&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Discuss&#227;o</span><p id="par0095" class="elsevierStylePara elsevierViewall">Os resultados apresentados na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> confirmam a robustez da nossa amostra e apresentam muitas semelhan&#231;as com outros trabalhos publicados recentemente no Brasil&#46; Dois trabalhos demonstraram a maior incid&#234;ncia de melanoma diagnosticados em mulheres&#44;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">10&#44;11</span></a> assim como o nosso&#46; Outro estudo revelou maior frequ&#234;ncia de melanomas no tronco e do tipo extensivo superficial&#44; semelhantemente aos nossos dados&#46; No entanto&#44; foi observada maior preval&#234;ncia de tumores com &#237;ndice de Breslow intermedi&#225;rio e espesso&#44; o que difere da nossa casu&#237;stica&#44; que apresenta mais tumores finos&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">12</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">A taxa de mortalidade do melanoma tamb&#233;m tem aumentado com os anos&#46; O Brasil tinha 0&#44;06 em 1979 e 0&#44;13 por 100&#46;00 habitantes em 2014&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a> Na Austr&#225;lia&#44; um dos pa&#237;ses com maior incid&#234;ncia dessa patologia no mundo&#44; era 3&#44;3 em 1968 e 6&#44;2 por 100&#46;000&#160;habitantes em 2013&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a> Recentemente publicado&#44; um estudo brasileiro que usou um banco de dados com mais de 28&#160;mil indiv&#237;duos revelou um aumento da mortalidade de 0&#44;85 para 0&#44;9&#47;100&#46;000 habitantes em homens e uma diminui&#231;&#227;o de 0&#44;56 para 0&#44;53&#47;100&#46;000&#160;habitantes em mulheres de 2000 a 2014&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">11</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">A taxa de sobrevida em&#160;5&#160;anos do melanoma na Austr&#225;lia&#44; nos EUA e na Holanda &#233; respectivamente 90&#37;&#44; 91&#44;5&#37; e 86&#37;&#46; No nosso estudo&#44; foi de&#160;95&#44;7&#37; em&#160;5&#160;anos&#44; lembramos que inclu&#237;mos somente casos invasivos&#44; o que&#44; em tese&#44; deveria piorar a nossa estat&#237;stica de sobrevida&#46; Tamb&#233;m se deve levar em conta que perdemos o seguimento de uma parte dos pacientes&#44; por falta &#224;s consultas ou por aus&#234;ncia de dados como o &#237;ndice de Breslow&#44; que n&#227;o foi em determinado em 17&#37; dos casos e os &#243;bitos ocorridos fora do Estado de SP&#44; o que pode trazer algum vi&#233;s ao estudo&#46; Outra limita&#231;&#227;o do projeto &#233; o fato de ser retrospectivo e ter sido conduzido num centro &#250;nico terceirizado&#44; o que pode n&#227;o refletir&#44; necessariamente&#44; as condi&#231;&#245;es do pa&#237;s na sua generalidade&#44; como as taxas dos pa&#237;ses citados anteriormente&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">4&#8211;6&#44;13&#44;14</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">O &#237;ndice de Breslow &#233; um par&#226;metro aceito para estadiar os melanomas e predizer a sobrevida melanoma&#8208;espec&#237;fico&#46; Os indiv&#237;duos com tumores mais finos t&#234;m uma melhor sobrevida&#44; como pode ser observado na nossa an&#225;lise de sobrevida doen&#231;a&#8208;espec&#237;fica e em outras publica&#231;&#245;es&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">15&#44;16</span></a> Nossos dados mostram que somente&#160;7&#44;6&#37; dos tumores&#160;&#8804;&#160;1&#44;0&#160;mm morreram por melanoma em&#160;10&#160;anos contra 41&#44;8&#37; daqueles mais espessos do que&#160;4&#44;0&#160;mm no mesmo per&#237;odo&#46; A chance de morte de um paciente com melanoma com Breslow &#62;&#160;4&#44;0&#160;mm &#233; 5&#44;37&#215; do maior que um indiv&#237;duo com melanomas com Breslow &#8804;&#160;1&#44;0&#160;mm&#46; Vale a pena destacar que&#44; de toda forma&#44; mesmo tumores finos &#40;&#8804;&#160;1&#44;0&#160;mm&#41; levaram &#224; morte em 7&#44;6&#37; dos casos &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">A sobrevida na nossa casu&#237;stica se mostrou diferente de acordo com o sexo&#46; Os homens tiveram um progn&#243;stico significativamente pior do que as mulheres&#46; Ser homem aumentou a chance de morte por melanoma &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46; Nos EUA&#44; isso tamb&#233;m &#233; verdade&#58; h&#225; 4&#44;1&#160;mortes em homens e 1&#44;7 em mulheres por 100&#44;00 pessoas&#59;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">5&#44;15</span></a> no Jap&#227;o&#44; a sobrevida em 140&#160;meses foi de 70&#44;6&#37; em mulheres e 60&#37; em homens&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a> Um estudo na Inglaterra tamb&#233;m reportou que ser homem teve um impacto negativo na sobrevida&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a> Em nosso estudo&#44; mesmo ap&#243;s ajuste para o &#237;ndice de Breslow&#44; que isoladamente &#233; o par&#226;metro mais importante na sobrevida do paciente com melanoma&#44; os pacientes masculinos continuaram com um pior progn&#243;stico &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#44; o que n&#227;o havia sido testado anteriormente&#46; As raz&#245;es para isso permanecem especulativas&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Com rela&#231;&#227;o a fototipo&#47;etnia e sobrevida&#44; encontramos uma menor taxa de sobrevida&#8208;espec&#237;fica em pacientes com fototipos altos de Fitzpatrick &#40;IV&#44; V e VI&#41;&#44; mas essa diferen&#231;a n&#227;o se manteve ap&#243;s o ajuste pelo &#237;ndice de Breslow &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46; Uma explica&#231;&#227;o para esse fato pode ser que pacientes com fototipos mais altos podem estar sendo diagnosticados mais tardiamente&#44; o que acarreta um pior progn&#243;stico do que aqueles com fototipos mais baixos&#46; Problemas socioecon&#244;micos poderiam atrasar o acesso ao sistema de sa&#250;de e&#47;ou a cren&#231;a de que c&#226;ncer de pele &#233; um problema apenas para pacientes com fototipo baixo podem contribuir para essa demora&#46; A maioria dos estudos avalia etnia&#46; Um artigo encontrou que pessoas negras t&#234;m uma taxa de sobrevida mais baixa&#44; mas n&#227;o ajustou para a espessura&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a> Outro mostrou que negros n&#227;o hisp&#226;nicos t&#234;m uma taxa de sobrevida melhor do que brancos n&#227;o hisp&#226;nicos&#44; o que parece contr&#225;rio aos nosso achados&#44; mas tamb&#233;m n&#227;o houve ajuste para o &#237;ndice de Breslow&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Outro achado interessante &#233; que melanomas &#8220;de novo&#8221; s&#227;o mais agressivos do que aqueles que se desenvolvem sobre les&#245;es cl&#237;nicas preexistentes &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">tabelas 2 e 4</a>&#41;&#44; o que foi corroborado em outro estudo&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a> Poder&#237;amos especular que muta&#231;&#245;es que levam &#224; ocorr&#234;ncia do melanoma &#8220;de novo&#8221; poderiam causar uma doen&#231;a mais agressiva do que outras muta&#231;&#245;es que ocorrem em les&#245;es pr&#233;&#8208;existentes&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Os tipos histol&#243;gicos apresentam diferentes probabilidades de sobrevida tamb&#233;m&#46; Em nosso estudo&#44; o melanoma extensivo superficial obteve maior probabilidade de sobrevida do que os outros tipos &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabela 5</a>&#41;&#46; Um estudo japon&#234;s revelou o melanoma nodular como tendo o pior progn&#243;stico&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a> No entanto&#44; isso pode ocorrer n&#227;o pelo subtipo de melanoma em si&#44; mas sim porque&#44; usualmente&#44; ao diagn&#243;stico&#44; o melanoma nodular &#233; mais espesso e o melanoma extensivo superficial&#44; mais fino&#46; Essa hip&#243;tese pode ser corroborada pelos nossos resultados&#44; nos quais verificamos que&#44; uma vez ajustado o &#237;ndice de Breslow para todos os tipos histol&#243;gicos de melanoma&#44; n&#227;o h&#225; diferen&#231;a estat&#237;stica entre a sobrevida deles&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Dados de sobrevida s&#227;o a grande diferen&#231;a do nosso estudo&#46; H&#225; alguns anos nosso hospital tem um acordo com a Funda&#231;&#227;o Seade&#44; uma ag&#234;ncia governamental que nos permite saber a causa e a data da morte dos pacientes&#46; Seguramente isso &#233; essencial para obter as curvas de mortalidade e sobrevida aqui apresentadas e&#44; tamb&#233;m&#44; nos habilitar a planejar pol&#237;ticas de sa&#250;de p&#250;blica para melhor tratar e prevenir mortes por melanoma&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conclus&#227;o</span><p id="par0140" class="elsevierStylePara elsevierViewall">As an&#225;lises de sobrevida dos pacientes com melanoma invasivo da nossa coorte retrospectiva mostraram associa&#231;&#227;o com espessura do tumor&#44; sexo e presen&#231;a ou n&#227;o de les&#227;o cl&#237;nica pr&#233;&#8208;existente&#46; Futuros estudos poder&#227;o verificar se h&#225; associa&#231;&#227;o entre sobrevida e subtipo histol&#243;gico ou fototipo do paciente&#44; conforme nossos resultados sugerem&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Suporte financeiro</span><p id="par0145" class="elsevierStylePara elsevierViewall">Pr&#243;prio e Funda&#231;&#227;o de Amparo &#224; Pesquisa do Estado de S&#227;o Paulo &#40;Fapesp&#41;&#44; projeto n&#250;mero&#58; 2017&#47;20928&#8208;9&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Contribui&#231;&#227;o dos autores</span><p id="par0150" class="elsevierStylePara elsevierViewall">Mara Huffenbaecher Giavina&#8208;Bianchi&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Cyro Festa Neto&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Jose Antonio Sanches Junior&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Monica La Porte Teixeira&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Bernadette Cunha Valdvogel&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflitos de interesse</span><p id="par0175" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A incid&#234;ncia e a mortalidade do melanoma t&#234;m aumentado em muitos pa&#237;ses&#44; inclusive no Brasil&#46; Estudos de sobrevida ainda s&#227;o escassos no nosso pa&#237;s&#44; mas muito necess&#225;rios para se conhecer e abordar melhor esse problema&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Analisar a sobrevida doen&#231;a&#8208;espec&#237;fica dos pacientes com melanoma invasivo e correlacion&#225;&#8208;la com vari&#225;veis cl&#237;nicas e histopatol&#243;gicas&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo anal&#237;tico de coorte retrospectiva em 565&#160;casos de melanoma invasivo num hospital terci&#225;rio com o objetivo de testar vari&#225;veis que poderiam estar associadas a pior progn&#243;stico&#44; como sexo&#44; fototipo&#44; espessura&#44; tipo histol&#243;gico e presen&#231;a de les&#227;o cl&#237;nica pr&#233;&#8208;existente no local do tumor&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">As piores taxas de sobrevida estiveram significativamente associadas com tumores espessos &#40;p&#160;&#60;&#160;0&#44;001&#41;&#44; sexo masculino &#40;p&#160;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#160;0&#44;014&#41;&#44; fototipo alto &#40;p&#160;&#61;&#160;0&#44;047&#41;&#44; melanoma nodular &#40;p&#160;&#61;&#160;0&#44;024&#41; e les&#245;es &#8220;de novo&#8221; &#40;p&#160;&#61;&#160;0&#44;005&#41;&#46; Quando ajustamos as vari&#225;veis para a espessura do melanoma&#44; os pacientes do sexo masculino &#40;p&#160;&#61;&#160;0&#44;011&#41; e os melanomas &#8220;de novo&#8221; &#40;p&#160;&#61;&#160;0&#44;025&#41; mantiveram&#8208;se associados com uma menor sobrevida&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Estudo retrospectivo e de um &#250;nico hospital terci&#225;rio&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Embora as causas sejam ainda desconhecidas&#44; a sobrevida melanoma&#8208;espec&#237;fico mostrou&#8208;se estatisticamente pior para homens e para melanomas &#8220;de novo&#8221; mesmo ap&#243;s o ajuste da espessura do tumor&#46;</p></span>"
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                  \t\t\t\t">40&#8211;49&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99 &#40;18&#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">50&#8211;59&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">118 &#40;21&#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">60&#8211;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">138 &#40;25&#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">70&#8211;79&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">80 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#8211;89&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">28 &#40;5&#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">90&#8211;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sem informa&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;1&#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  " rowspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Fototipo segundo Fitzpatrick</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;4&#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">II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">247 &#40;44&#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">III&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">159 &#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">IV&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 &#40;5&#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">V&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 &#40;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">VI&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 &#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">Sem informa&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89 &#40;16&#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  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Local</span></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">Cabe&#231;a&#47;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">90 &#40;16&#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">Tronco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">211 &#40;37&#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">Membros&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">196 &#40;34&#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">Extremidades&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68 &#40;12&#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  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">&#205;ndice de Breslow</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8804; 1&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">279 &#40;51&#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">1&#44;01&#8211;2&#44;00&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">120 &#40;21&#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">2&#44;01&#8211;4&#44;00&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">85 &#40;15&#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">&#62;4&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81 &#40;14&#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  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ulcera&#231;&#227;o</span></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">Presente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;10&#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">Ausente&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">450 &#40;80&#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">Sem informa&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;10&#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  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Regress&#227;o</span></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">Presente&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">63 &#40;11&#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">Ausente&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">424 &#40;75&#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">Sem informa&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78 &#40;14&#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  " rowspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tipo histol&#243;gico</span></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">Extensivo 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">262 &#40;46&#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">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;11&#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">Lentigo maligno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;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">Lentiginoso 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">51 &#40;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">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">6 &#40;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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sem informa&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">139 &#40;25&#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  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mitose</span></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">Presente&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">87 &#40;15&#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">Ausente&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">66 &#40;12&#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">Sem informa&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">412 &#40;73&#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  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Linfonodo sentinela</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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 &#40;4&#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">Negativo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89 &#40;16&#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">N&#227;o realizado&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 &#40;5&#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">Sem informa&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">421 &#40;75&#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  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Les&#227;o pr&#233;&#8208;existente</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">199 &#40;35&#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">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">285 &#40;51&#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">Ignorado&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 &#40;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">Sem informa&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">EP&#44; erro&#8208;padr&#227;o&#59; NA&#44; n&#227;o avali&#225;vel&#46;</p>"
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&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">M&#233;dia &#40;EP&#41;&#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">Mediana&#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Valor de p<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2anos&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
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">5anos&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">10anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Global</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="left" valign="\n
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                  \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">NA&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
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                  \t\t\t\t">99&#44;6&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">98&#44;6&#37;&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">95&#44;7&#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
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                  \t\t\t\t">84&#44;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="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">&#205;ndice de Breslow</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#44;001&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>&#8804;&#160;1&#46;00 mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">459&#44;28 &#40;27&#44;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#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">99&#44;5&#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">98&#44;7&#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">92&#44;4&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1&#44;01&#8211;2&#44;00 mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">252&#44;32 &#40;22&#44;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#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">100&#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">96&#44;8&#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">91&#44;7&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&#44;01&#8211;4&#44;00 mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">272&#44;96 &#40;20&#44;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#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">98&#44;4&#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">93&#44;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">75&#44;1&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;&#160;4&#44;00 mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">154&#44;71 &#40;14&#44;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">164&#44;00&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">97&#44;1&#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">93&#44;7&#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">86&#44;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">58&#44;2&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;014&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>Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">439&#44;87 &#40;27&#44;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&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">99&#44;3&#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">98&#44;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95&#44;7&#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">87&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Masculino&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">216&#44;11 &#40;17&#44;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">194&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#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">98&#44;8&#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">95&#44;7&#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">79&#44;2&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Fototipo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;047&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>Baixo&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">419&#44;73 &#40;30&#44;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#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">99&#44;4&#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">97&#44;5&#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">90&#44;8&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Alto&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">181&#44;42 &#40;22&#44;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">194&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#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">100&#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">95&#44;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">62&#44;4&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>III &#40;LMM&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;10&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">195&#44;03 &#40;30&#44;14&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
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            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Sobrevida doen&#231;a&#8208;espec&#237;fica em pacientes com melanoma segundo tipo histol&#243;gico</p>"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">95&#37;&#160;IC&#44; intervalo de confian&#231;a de 95&#37;&#59; HR&#44; <span class="elsevierStyleItalic">hazard ratio</span>&#59; LMM&#44; lentigo maligno melanoma&#59; MES&#44; melanoma extensivo superficial&#59; MLA&#44; melanoma lentiginoso acral&#59; NOD&#44; melanoma nodular&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vari&#225;vel&nbsp;\t\t\t\t\t\t\n
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Valor de p do modelo ajustado pelo Breslow com o uso da regress&#227;o de Cox&#46;</p>"
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          "pt" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Regress&#227;o de Cox univariada e m&#250;ltipla para a sobrevida doen&#231;a espec&#237;fica em pacientes com melanoma segundo tipo histol&#243;gico</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:19 [
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Sex Differences in Age at Primary Melanoma Diagnosis in a Population&#8208;Based Analysis &#40;US Surveillance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;S&#46; Najita"
                            1 => "S&#46;M&#46; Swetter"
                            2 => "A&#46;C&#46; Geller"
                            3 => "J&#46;E&#46; Gershenwald"
                            4 => "M&#46; Zelen"
                            5 => "S&#46;J&#46; Lee"
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                      ]
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                      "doi" => "10.1016/j.jid.2016.03.044"
                      "Revista" => array:7 [
                        "tituloSerie" => "Epidemiology&#44; and End Results&#44; 2005&#8208;2011&#41;&#46; J Invest Dermatol&#46;"
                        "fecha" => "2016"
                        "volumen" => "136"
                        "paginaInicial" => "1894"
                        "paginaFinal" => "1897"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27251792"
                            "web" => "Medline"
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                        "itemHostRev" => array:3 [
                          "pii" => "S009042951301176X"
                          "estado" => "S300"
                          "issn" => "00904295"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The blockade of immune checkpoints in cancer immunotherapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46;M&#46; Pardoll"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/nrc3239"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Rev Cancer&#46;"
                        "fecha" => "2012"
                        "volumen" => "12"
                        "paginaInicial" => "252"
                        "paginaFinal" => "264"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22437870"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
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                ]
              ]
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            2 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Targeted therapy and immunotherapy in advanced melanoma&#58; an evolving paradigm"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Khattak"
                            1 => "R&#46; Fisher"
                            2 => "S&#46; Turajlic"
                            3 => "J&#46; Larkin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ther Adv Med Oncol&#46;"
                        "fecha" => "2013"
                        "volumen" => "5"
                        "paginaInicial" => "105"
                        "paginaFinal" => "118"
                      ]
                    ]
                  ]
                ]
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            3 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "INCA &#91;Internet&#93;&#46; C&#226;ncer de pele melanoma &#91;acesso 10&#47;07&#47;2018&#93;&#46; Dispon&#237;vel em&#58; www&#46;inca&#46;gov&#46;br&#47;wps&#47;wcm&#47;connect&#47;tiposdecancer&#47;site&#47;home&#47;pele&#95;melanoma&#46;"
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              ]
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            4 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "SEER &#91;Internet&#93;&#46; SEER Stat Facts Sheets&#58; Melanoma of the Skin &#91;acesso 10&#47;07&#47;2018&#41;&#46; Available from&#58; www&#46;seer&#46;cancer&#46;gov&#47;statfacts&#47;htlm&#47;melan&#46;htlm&#46;"
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Australian Government&#47;Cancer Australia &#91;Internet&#93;&#46; Melanoma statistics Australia 2016 &#91;acesso 10&#47;07&#47;2018&#93;&#46; Dispon&#237;vel em&#58; https&#58;&#47;&#47;melanoma&#46;canceraustralia&#46;gov&#46;au&#47;statistics&#46;"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
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