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e inclui a diferencia&#231;&#227;o por sexo&#46; Quanto ao tipo histol&#243;gico&#44; o melanoma extensivo superficial respondeu pela maioria dos casos&#44; com 126 diagn&#243;sticos &#40;48&#44;5&#37;&#41;&#44; seguido pelo melanoma nodular&#44; com 58 &#40;22&#44;3&#37;&#41;&#44; lentiginoso acral com 44 &#40;16&#44;9&#37;&#41; e lentigo maligno com 32 &#40;12&#44;3&#37;&#41; diagn&#243;sticos&#46; Os homens apresentaram maior frequ&#234;ncia de melanoma nodular &#40;34&#59; 13&#44;1&#37;&#41; em rela&#231;&#227;o &#224;s mulheres &#40;9&#44;2&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;014&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Em mulheres&#44; os locais mais acometidos por melanomas foram os membros superiores&#44; em 51 casos &#40;24&#44;5&#37;&#41;&#46; Em contrapartida&#44; em homens&#44; os melanomas foram encontrados principalmente na regi&#227;o da cabe&#231;a e pesco&#231;o&#44; em 50 casos &#40;31&#44;4&#37;&#41;&#44; e no dorso&#44; com 38 casos &#40;23&#44;9&#37;&#41;&#46; A diferen&#231;a entre os sexos foi considerada estatisticamente significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Quanto ao n&#237;vel de invas&#227;o&#44; dentre pacientes do sexo feminino&#44; a maioria dos melanomas invadiu apenas ao n&#237;vel da derme papilar &#8211; Clark II&#44; 60 casos &#40;40&#44;8&#37;&#41;&#46; Em contrapartida&#44; a maioria dos melanomas apresentou n&#237;veis de Clark IV&#44; 50 casos &#40;42&#44;4&#37;&#41;&#44; no sexo masculino&#59; p &#61; 0&#46;129&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Quanto ao Breslow dos melanomas no sexo masculino&#44; a maioria apresentou espessura<span class="elsevierStyleHsp" style=""></span>&#62;3mm &#40;42 casos&#44; 38&#44;2&#37;&#41;&#44; enquanto no sexo feminino a maioria apresentou Breslow<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;75<span class="elsevierStyleHsp" style=""></span>mm &#40;58 casos&#44; 41&#44;4&#37;&#41;&#44; por&#233;m n&#227;o houve relev&#226;ncia estat&#237;stica &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;156&#41;&#46; Mitoses no componente invasivo do melanoma foram vistas em 52&#44;8&#37; dos casos&#46; Presen&#231;a de ulcera&#231;&#227;o foi relatada em 22&#44;3&#37; das mulheres e 30&#44;3&#37; dos homens &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Embora n&#227;o houvesse diferen&#231;a estat&#237;stica significativa quanto ao Breslow&#44; presen&#231;a de mitoses e ulcera&#231;&#227;o&#44; houve diferen&#231;a na sobrevida entre os sexos&#46; Conforme a <a class="elsevierStyleCrossRef" href="#fig0015">figura 3</a>&#44; 78&#44;8&#37; &#40;119 casos&#41; das mulheres sobreviveram aos primeiros cinco anos ap&#243;s o diagn&#243;stico&#44; enquanto essa porcentagem foi de apenas 64&#44;8&#37; para os homens &#40;70 casos&#41;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;012&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Com desenho semelhante ao nosso estudo e no mesmo hospital&#44; foram analisados os casos de melanomas diagnosticados entre os anos de 1963 e 1997&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> Durante esse per&#237;odo&#44; foram identificados 222 novos casos de melanoma&#44; com uma incid&#234;ncia m&#233;dia de 9&#44;25 casos&#47;ano&#46; Em nosso estudo houve uma incid&#234;ncia m&#233;dia anual de 19&#44;94 casos&#46; Esses dados s&#227;o compat&#237;veis com estudos epidemiol&#243;gicos que apontam um aumento na incid&#234;ncia do melanoma maligno nas &#250;ltimas d&#233;cadas&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Nosso estudo identificou diferen&#231;as entre os sexos no tocante ao comportamento biol&#243;gico e no progn&#243;stico do melanoma&#46; H&#225; autores que consideram o sexo um fator progn&#243;stico independente para o melanoma&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> Mesmo ap&#243;s o ajuste para vari&#225;veis que pudessem causar vieses &#40;como tipo histol&#243;gico e idade ao diagn&#243;stico&#41;&#44; o progn&#243;stico parece ser pior no sexo masculino&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> Uma das teorias envolvidas no melhor progn&#243;stico do sexo feminino envolve o fator protetor dos estrog&#234;nios&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> Entretanto&#44; o uso de contraceptivos ou a gravidez n&#227;o parecem alterar a sobrevida das mulheres&#46; Al&#233;m disso&#44; os estudos apresentam resultados conflitantes no que tange &#224; sobrevida das mulheres no per&#237;odo p&#243;s&#8208;menopausa&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Como a teoria hormonal n&#227;o explica totalmente a melhor sobrevida das mulheres com melanoma&#44; a teoria do estresse oxidativo parece promissora&#46; O aumento das esp&#233;cies reativas de oxig&#234;nio parece estar envolvido na carcinog&#234;nese do melanoma por meio de mecanismos diversos&#58; &#40;a&#41; muta&#231;&#245;es no DNA&#59; &#40;b&#41; est&#237;mulo &#224; prolifera&#231;&#227;o celular&#59; &#40;c&#41; inibi&#231;&#227;o das c&#233;lulas apresentadoras de ant&#237;geno&#46; Comparativamente&#44; o sexo masculino apresenta menores n&#237;veis de antioxidantes&#59; consequentemente&#44; maiores taxas de dano oxidativo&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Nosso estudo encontrou diferen&#231;as entre os sexos n&#227;o s&#243; na incid&#234;ncia de melanoma&#44; mas tamb&#233;m nos s&#237;tios anat&#244;micos dos tumores&#44; tipos histol&#243;gicos e na sobrevida &#40;maior em mulheres&#41;&#46; Acreditamos que fatores biol&#243;gicos &#40;influ&#234;ncia hormonal&#44; estresse oxidativo e express&#227;o g&#234;nica&#41; e comportamentais &#40;exposi&#231;&#227;o &#224; luz UV e autocuidado&#41; atuem em conjunto para explicar essas diferen&#231;as&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0060" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0065" class="elsevierStylePara elsevierViewall">Bruno de Castro e Souza&#58; 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&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Diego Henrique Morais Silva&#58; Elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Neusa Yuriko Sakai Valente&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Priscila Kakizaki&#58; Participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Maria Claudia Alves Luce&#58; Revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Luiza Groba Bandeira&#58; Revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0095" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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                  \t\t\t\t" scope="col">N&#250;mero de melanomas invasivos diagnosticados&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">79 &#40;30&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nodular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Acral&nbsp;\t\t\t\t\t\t\n
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Carta – Investigação
Melanoma cutâneo: estudo retrospectivo de 18 anos. Há diferenças entre os gêneros?
Bruno de Castro e Souza
Autor para correspondência
dhenriquems@gmail.com

Autor para correspondência.
, Diego Henrique Morais Silva, Neusa Yuriko Sakai Valente, Priscila Kakizaki, Maria Claudia Alves Luce, Luiza Groba Bandeira
Departamento de Dermatologia, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brasil
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a presen&#231;a de ulcera&#231;&#227;o e a espessura tumoral est&#227;o associadas a um pior desfecho&#44; e outros fatores de risco e progn&#243;sticos s&#227;o motivos para controv&#233;rsias&#44; incluindo o g&#234;nero masculino&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Realizamos um estudo observacional&#44; descritivo e retrospectivo de pacientes diagnosticados com melanoma entre os anos de 1998 e 2016 em um hospital da cidade de S&#227;o Paulo&#46; As caracter&#237;sticas sociodemogr&#225;ficas e clinicopatol&#243;gicas desses casos foram coletadas dos prontu&#225;rios a fim de descrever o comportamento dessa neoplasia com &#234;nfase nas diferen&#231;as entre os g&#234;neros&#46; O software utilizado na an&#225;lise dos dados foi o SPSS vers&#227;o 25&#44; e as compara&#231;&#245;es entre os grupos foram realizadas pelo teste do Qui&#8208;Quadrado com corre&#231;&#227;o para o teste exato de Fisher&#44; quando apropriado&#46; A signific&#226;ncia estat&#237;stica foi definida em 5&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Nesses 18 anos&#44; 359 melanomas foram diagnosticados&#44; dos quais 99 &#40;27&#44;6&#37;&#41; foram caracterizados como <span class="elsevierStyleItalic">in situ</span> &#40;a maioria no sexo feminino &#8211; 201 casos&#59; 57&#44;3&#37;&#41; e 260 &#40;72&#44;4&#37;&#41; como invasivos&#46; Dentre os casos de melanoma invasivo&#44; 152 ocorreram em pacientes do sexo feminino &#40;58&#44;5&#37;&#41; e 108 &#40;41&#44;5&#37;&#41; no sexo masculino&#46; A <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> exibe que a maioria dos pacientes foi diagnosticada na s&#233;tima d&#233;cada de vida &#40;90 pacientes&#44; 25&#44;6&#37;&#41;&#44; tend&#234;ncia semelhante em ambos os sexos&#46; Entretanto&#44; a partir dos 70 anos&#44; o diagn&#243;stico do melanoma foi proporcionalmente maior em mulheres&#46; A <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>A demonstra que&#44; ao longo dos anos&#44; houve leve aumento do n&#250;mero de casos de melanoma&#44; visto em ambos os sexos&#46; Apesar desse aumento&#44; observa&#8208;se uma tend&#234;ncia ao diagn&#243;stico mais precoce dos casos de melanoma&#44; diagnosticados com &#237;ndice de Breslow menores &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>B&#41;&#46; Informa&#231;&#245;es sobre a sobrevida dos pacientes foram encontradas em 221 casos&#46; Destes&#44; 178 &#40;78&#44;4&#37;&#41; sobreviveram aos primeiros cinco anos ap&#243;s o diagn&#243;stico de melanoma&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> apresenta as caracter&#237;sticas dos tumores invasivos&#44; e inclui a diferencia&#231;&#227;o por sexo&#46; Quanto ao tipo histol&#243;gico&#44; o melanoma extensivo superficial respondeu pela maioria dos casos&#44; com 126 diagn&#243;sticos &#40;48&#44;5&#37;&#41;&#44; seguido pelo melanoma nodular&#44; com 58 &#40;22&#44;3&#37;&#41;&#44; lentiginoso acral com 44 &#40;16&#44;9&#37;&#41; e lentigo maligno com 32 &#40;12&#44;3&#37;&#41; diagn&#243;sticos&#46; Os homens apresentaram maior frequ&#234;ncia de melanoma nodular &#40;34&#59; 13&#44;1&#37;&#41; em rela&#231;&#227;o &#224;s mulheres &#40;9&#44;2&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;014&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Em mulheres&#44; os locais mais acometidos por melanomas foram os membros superiores&#44; em 51 casos &#40;24&#44;5&#37;&#41;&#46; Em contrapartida&#44; em homens&#44; os melanomas foram encontrados principalmente na regi&#227;o da cabe&#231;a e pesco&#231;o&#44; em 50 casos &#40;31&#44;4&#37;&#41;&#44; e no dorso&#44; com 38 casos &#40;23&#44;9&#37;&#41;&#46; A diferen&#231;a entre os sexos foi considerada estatisticamente significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Quanto ao n&#237;vel de invas&#227;o&#44; dentre pacientes do sexo feminino&#44; a maioria dos melanomas invadiu apenas ao n&#237;vel da derme papilar &#8211; Clark II&#44; 60 casos &#40;40&#44;8&#37;&#41;&#46; Em contrapartida&#44; a maioria dos melanomas apresentou n&#237;veis de Clark IV&#44; 50 casos &#40;42&#44;4&#37;&#41;&#44; no sexo masculino&#59; p &#61; 0&#46;129&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Quanto ao Breslow dos melanomas no sexo masculino&#44; a maioria apresentou espessura<span class="elsevierStyleHsp" style=""></span>&#62;3mm &#40;42 casos&#44; 38&#44;2&#37;&#41;&#44; enquanto no sexo feminino a maioria apresentou Breslow<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;75<span class="elsevierStyleHsp" style=""></span>mm &#40;58 casos&#44; 41&#44;4&#37;&#41;&#44; por&#233;m n&#227;o houve relev&#226;ncia estat&#237;stica &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;156&#41;&#46; Mitoses no componente invasivo do melanoma foram vistas em 52&#44;8&#37; dos casos&#46; Presen&#231;a de ulcera&#231;&#227;o foi relatada em 22&#44;3&#37; das mulheres e 30&#44;3&#37; dos homens &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Embora n&#227;o houvesse diferen&#231;a estat&#237;stica significativa quanto ao Breslow&#44; presen&#231;a de mitoses e ulcera&#231;&#227;o&#44; houve diferen&#231;a na sobrevida entre os sexos&#46; Conforme a <a class="elsevierStyleCrossRef" href="#fig0015">figura 3</a>&#44; 78&#44;8&#37; &#40;119 casos&#41; das mulheres sobreviveram aos primeiros cinco anos ap&#243;s o diagn&#243;stico&#44; enquanto essa porcentagem foi de apenas 64&#44;8&#37; para os homens &#40;70 casos&#41;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;012&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Com desenho semelhante ao nosso estudo e no mesmo hospital&#44; foram analisados os casos de melanomas diagnosticados entre os anos de 1963 e 1997&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> Durante esse per&#237;odo&#44; foram identificados 222 novos casos de melanoma&#44; com uma incid&#234;ncia m&#233;dia de 9&#44;25 casos&#47;ano&#46; Em nosso estudo houve uma incid&#234;ncia m&#233;dia anual de 19&#44;94 casos&#46; Esses dados s&#227;o compat&#237;veis com estudos epidemiol&#243;gicos que apontam um aumento na incid&#234;ncia do melanoma maligno nas &#250;ltimas d&#233;cadas&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Nosso estudo identificou diferen&#231;as entre os sexos no tocante ao comportamento biol&#243;gico e no progn&#243;stico do melanoma&#46; H&#225; autores que consideram o sexo um fator progn&#243;stico independente para o melanoma&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> Mesmo ap&#243;s o ajuste para vari&#225;veis que pudessem causar vieses &#40;como tipo histol&#243;gico e idade ao diagn&#243;stico&#41;&#44; o progn&#243;stico parece ser pior no sexo masculino&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> Uma das teorias envolvidas no melhor progn&#243;stico do sexo feminino envolve o fator protetor dos estrog&#234;nios&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> Entretanto&#44; o uso de contraceptivos ou a gravidez n&#227;o parecem alterar a sobrevida das mulheres&#46; Al&#233;m disso&#44; os estudos apresentam resultados conflitantes no que tange &#224; sobrevida das mulheres no per&#237;odo p&#243;s&#8208;menopausa&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Como a teoria hormonal n&#227;o explica totalmente a melhor sobrevida das mulheres com melanoma&#44; a teoria do estresse oxidativo parece promissora&#46; O aumento das esp&#233;cies reativas de oxig&#234;nio parece estar envolvido na carcinog&#234;nese do melanoma por meio de mecanismos diversos&#58; &#40;a&#41; muta&#231;&#245;es no DNA&#59; &#40;b&#41; est&#237;mulo &#224; prolifera&#231;&#227;o celular&#59; &#40;c&#41; inibi&#231;&#227;o das c&#233;lulas apresentadoras de ant&#237;geno&#46; Comparativamente&#44; o sexo masculino apresenta menores n&#237;veis de antioxidantes&#59; consequentemente&#44; maiores taxas de dano oxidativo&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Nosso estudo encontrou diferen&#231;as entre os sexos n&#227;o s&#243; na incid&#234;ncia de melanoma&#44; mas tamb&#233;m nos s&#237;tios anat&#244;micos dos tumores&#44; tipos histol&#243;gicos e na sobrevida &#40;maior em mulheres&#41;&#46; Acreditamos que fatores biol&#243;gicos &#40;influ&#234;ncia hormonal&#44; estresse oxidativo e express&#227;o g&#234;nica&#41; e comportamentais &#40;exposi&#231;&#227;o &#224; luz UV e autocuidado&#41; atuem em conjunto para explicar essas diferen&#231;as&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0060" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0065" class="elsevierStylePara elsevierViewall">Bruno de Castro e Souza&#58; 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&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Diego Henrique Morais Silva&#58; Elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Neusa Yuriko Sakai Valente&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Priscila Kakizaki&#58; Participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Maria Claudia Alves Luce&#58; Revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Luiza Groba Bandeira&#58; Revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0095" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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                  \t\t\t\t" scope="col">N&#250;mero de melanomas invasivos diagnosticados&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">79 &#40;30&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">47 &#40;18&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;014</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lentigo maligno&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32 &#40;12&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">22 &#40;10&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nodular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">40 &#40;19&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">50 &#40;31&#44;4&#41;&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">42 &#40;11&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;6&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29 &#40;18&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dorso&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">78 &#40;21&#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">40 &#40;19&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38 &#40;23&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  """
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas dos melanomas invasivos por amostra total e por sexo</p>"
        ]
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    ]
    "bibliografia" => array:2 [
      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
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