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na aus&#234;ncia de ulcera&#231;&#227;o e de um n&#250;mero de mitoses<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>&#44; a taxa de positividade do linfonodo sentinela &#233; inferior a 6&#37;&#44; sendo de pelo menos 14&#37; para espessuras<span class="elsevierStyleHsp" style=""></span>&#62; 1&#44;0<span class="elsevierStyleHsp" style=""></span>mm&#44; pelo que&#44; neste &#250;ltimo caso&#44; est&#225; recomendado realizar a bi&#243;psia de linfonodo sentinela&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a> Al&#233;m da decis&#227;o acerca da pesquisa do linfonodo sentinela&#44; a espessura influencia tamb&#233;m a extens&#227;o das margens de resse&#231;&#227;o cir&#250;rgica&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">3&#44;5</span></a> A bi&#243;psia de uma les&#227;o suspeita de melanoma deve ser&#44; tanto quanto poss&#237;vel&#44; excisional&#44; de modo a que a decis&#227;o terap&#234;utica esteja fundamentada em par&#226;metros de estadiamento precisos&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a> As bi&#243;psias incisionais podem subvalorizar a espessura em 5 a 22&#37; dos casos&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">6</span></a> baseando&#8208;se numa colheita por amostragem que nem sempre representa a zona de maior espessura tumoral&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A dermatoscopia &#233; t&#233;cnica que permite aumentar a acuidade diagn&#243;stica no melanoma&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a> Alguns estudos evidenciaram sua capacidade de inferir caracter&#237;sticas histol&#243;gicas&#44; nomeadamente a espessura&#44; o &#237;ndice mit&#243;tico e a presen&#231;a de ulcera&#231;&#227;o&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">8&#8211;12</span></a> Por&#233;m&#44; a literatura mais recente &#233; pouco abundante nesse contexto&#44; e a aplica&#231;&#227;o concreta dos resultados &#233; pouco explorada&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Desse modo&#44; este trabalho tem como objetivo prim&#225;rio estudar a rela&#231;&#227;o entre a espessura do melanoma e as vari&#225;veis dermatosc&#243;picas e&#44; em segundo lugar&#44; entre a espessura e as vari&#225;veis demogr&#225;ficas&#44; epidemiol&#243;gicas e cl&#237;nicas&#44; procurando identificar fatores preditivos da espessura do melanoma&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material e m&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Realizou&#8208;se estudo anal&#237;tico&#44; observacional e transversal numa amostra de doentes diagnosticados com melanoma cut&#226;neo&#44; no Servi&#231;o de Dermatologia e Venereologia do Centro Hospitalar e Universit&#225;rio de Coimbra&#44; entre janeiro de 2014 e dezembro de 2017&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Para a sele&#231;&#227;o&#44; teve&#8208;se em conta os seguintes crit&#233;rios de inclus&#227;o&#58; diagn&#243;stico definitivo de melanoma cut&#226;neo localizado na cabe&#231;a e pesco&#231;o&#44; tronco&#44; membro superior&#44; m&#227;o&#44; membro inferior ou p&#233;&#44; e presen&#231;a de dados cl&#237;nicos relativos ao exame dermatosc&#243;pico e anatomopatol&#243;gico&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Consultou&#8208;se o processo cl&#237;nico dos doentes selecionados para coleta de vari&#225;veis demogr&#225;ficas &#40;idade e sexo&#41;&#44; epidemiol&#243;gicas &#40;fototipo&#44; cor dos olhos&#44; cor dos cabelos aos 18 anos&#44; presen&#231;a de ef&#233;lides&#44; presen&#231;a de lentigos solares&#44; hist&#243;ria de queimadura solar com eritema e bolhas&#44; n&#250;mero de nevos melanoc&#237;ticos de dimens&#227;o<span class="elsevierStyleHsp" style=""></span>&#62; 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vers&#227;o 25&#44; com um n&#237;vel de signific&#226;ncia definido de 0&#44;05&#46; As vari&#225;veis foram representadas por meio de sua frequ&#234;ncia relativa e absoluta&#46; O teste do Qui&#8208;Quadrado e o teste de Fisher foram usados para estabelecer associa&#231;&#245;es entre as vari&#225;veis recolhidas&#46; A regress&#227;o log&#237;stica bin&#225;ria univariada e multivariada possibilitou determinar fatores preditivos de uma espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">O estudo foi realizado de acordo com as recomenda&#231;&#245;es da Declara&#231;&#227;o de Helsinque da Organiza&#231;&#227;o Mundial da Sa&#250;de e aprovado pela Comiss&#227;o de &#201;tica do Centro Hospitalar e Universit&#225;rio de Coimbra&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Esta pesquisa n&#227;o recebeu nenhum financiamento espec&#237;fico de ag&#234;ncias p&#250;blicas&#44; privadas ou sem fins lucrativos&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0050" class="elsevierStylePara elsevierViewall">Foram diagnosticados 314 doentes com melanoma maligno cut&#226;neo no per&#237;odo temporal referido&#46; Foram exclu&#237;dos 195 casos por aus&#234;ncia de registo das vari&#225;veis dermatosc&#243;picas em estudo&#44; tendo sido inclu&#237;dos os restantes 119 casos&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">As caracter&#237;sticas demogr&#225;ficas e cl&#237;nicas dos indiv&#237;duos inclu&#237;dos est&#227;o representadas na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; A maioria dos doentes &#40;94&#44;1&#37;&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>112&#41; tinha pelo menos 40 anos &#224; &#233;poca do diagn&#243;stico e era do sexo masculino &#40;51&#44;3&#37;&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>61&#41;&#46; Os melanomas malignos estavam localizados principalmente no tronco &#40;35&#44;3&#37;&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&#41;&#46; Registaram&#8208;se frequ&#234;ncias semelhantes relativamente &#224; espessura do melanoma&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">O padr&#227;o dermatosc&#243;pico multicomponente &#40;54&#44;2&#37;&#41; esteve associado a uma espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm&#44; enquanto o padr&#227;o reticular &#40;52&#44;5&#37;&#41; foi o mais frequente em melanomas com espessura &#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; A presen&#231;a de rede&#47;pseudo&#8208;rede pigmentar at&#237;pica &#40;86&#44;4&#37;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e de rede pigmentar negativa &#40;8&#44;6&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41; esteve associada a uma espessura &#8804; 1<span class="elsevierStyleHsp" style=""></span>mm&#44; enquanto a presen&#231;a de um padr&#227;o vascular at&#237;pico &#40;65&#44;0&#37;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e de linhas brancas brilhantes &#40;18&#44;3&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41; foi mais frequente nos melanomas com espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a> compara a distribui&#231;&#227;o de vari&#225;veis demogr&#225;ficas e epidemiol&#243;gicas entre pacientes com melanoma maligno de diferentes espessuras&#46; A frequ&#234;ncia de indiv&#237;duos com mais de 40 anos &#40;98&#44;3&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;049&#41; foi significativamente superior quando a espessura era<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm&#44; e essa caracter&#237;stica esteve associada a uma menor frequ&#234;ncia de ef&#233;lides &#40;1&#44;7&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;032&#41; e de queimaduras solares pr&#233;vias &#40;42&#44;1&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;032&#41;&#46; Sexo&#44; fototipo&#44; cor dos olhos&#44; cor do cabelo&#44; presen&#231;a de lentigos solares&#44; n&#250;mero de nevos melanoc&#237;ticos e presen&#231;a de nevos at&#237;picos e queratoses act&#237;nicas n&#227;o diferiu significativamente de acordo com a espessura do melanoma&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">A aus&#234;ncia de pigmenta&#231;&#227;o &#40;melanoma amelan&#243;tico&#41; associou&#8208;se a espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm &#40;17&#44;5&#37;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; N&#227;o se observaram diferen&#231;as significativas relativamente &#224; localiza&#231;&#227;o do melanoma&#44; assimetria&#44; bordo&#44; mudan&#231;a de cor e crescimento recente em fun&#231;&#227;o da espessura &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0025">tabela 5</a> representa os resultados da regress&#227;o log&#237;stica univariada e multivariada sobre fatores preditivos de uma espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm em doentes com melanoma maligno&#46; Na an&#225;lise univariada&#44; a presen&#231;a de ef&#233;lides&#44; queimadura solar pr&#233;via e de rede&#47;pseudo&#8208;rede pigmentar at&#237;pica foram preditivos de espessura &#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm&#44; mas a presen&#231;a de padr&#227;o vascular at&#237;pico ou de linhas brancas brilhantes relacionou&#8208;se com espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm&#46; O modelo de regress&#227;o multivariado permitiu explicar 49&#44;7&#37; da vari&#226;ncia associada &#224; espessura &#40;R<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;497&#41; e identificou o padr&#227;o vascular at&#237;pico &#40;risco relativo de 6&#44;621&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; como fator preditivo independente de espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm&#46; Ao contr&#225;rio&#44; a rede&#47;pseudo&#8208;rede pigmentada at&#237;pica &#40;risco relativo de 0&#44;168&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; foi identificada como um fator preditivo de espessura &#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0080" class="elsevierStylePara elsevierViewall">Das vari&#225;veis cl&#237;nicas e epidemiol&#243;gicas estudadas&#44; apenas a presen&#231;a de ef&#233;lides e a hist&#243;ria de queimadura solar pr&#233;via foram identificadas como fatores preditivos de melanomas finos&#44; fatos n&#227;o relatados consistentemente em estudos pr&#233;vios&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> Este resultado poder&#225; ser explicado pelo reconhecimento das ef&#233;lides e de queimaduras solares como fatores de risco para desenvolvimento de neoplasias cut&#226;neas e consequente ado&#231;&#227;o de medidas de preven&#231;&#227;o secund&#225;ria&#44; como o recurso ao autoexame regular da pele&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Estudos pr&#233;vios comprovaram a exist&#234;ncia de uma associa&#231;&#227;o entre a rede&#47;pseudo&#8208;rede pigmentar at&#237;pica e melanomas finos&#44; bem como uma associa&#231;&#227;o entre o padr&#227;o vascular at&#237;pico e linhas brancas brilhantes com melanomas de maior espessura&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">8&#44;9</span></a> Contudo&#44; ao contr&#225;rio de outras s&#233;ries&#44; a presen&#231;a de v&#233;u azul&#8208;acinzentado e de estrias n&#227;o mostrou rela&#231;&#227;o com melanomas de espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">8&#8211;10</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Ap&#243;s a regress&#227;o multivariada&#44; apenas o padr&#227;o vascular at&#237;pico e a rede&#47;pseudo&#8208;rede pigmentada at&#237;pica se distinguiram respetivamente como fatores preditivos independentes de melanomas mais espessos que 1<span class="elsevierStyleHsp" style=""></span>mm e de melanomas com 1<span class="elsevierStyleHsp" style=""></span>mm ou menos de espessura&#46; Essas associa&#231;&#245;es sugerem que melanomas mais invasivos t&#234;m maior neovasculariza&#231;&#227;o&#44; representada ao dermatosc&#243;pio por vasos at&#237;picos&#44; e que melanomas com espessura &#8804; 1<span class="elsevierStyleHsp" style=""></span>mm mant&#234;m a jun&#231;&#227;o dermoepid&#233;rmica intacta&#44; j&#225; que a rede pigmentada at&#237;pica corresponde &#224; prolifera&#231;&#227;o melanoc&#237;tica at&#237;pica juncional&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Salientam&#8208;se limita&#231;&#245;es como a falta de dados relativos a algumas das vari&#225;veis estudadas e a aus&#234;ncia de correla&#231;&#227;o &#243;tima entre a an&#225;lise dermatosc&#243;pica&#44; feita num plano horizontal&#44; e o exame anatomopatol&#243;gico&#44; realizado por meio de bi&#243;psia vertical&#46; Para al&#233;m disso&#44; no futuro&#44; ser&#225; relevante realizar estudos de coorte propectivos para confirma&#231;&#227;o dos resultados obtidos&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#245;es</span><p id="par0100" class="elsevierStylePara elsevierViewall">A bi&#243;psia incisional acarreta o risco de subestimar a espessura&#44; levando a um subestadiamento e a eventuais imprecis&#245;es na defini&#231;&#227;o das margens apropriadas de excis&#227;o e na indica&#231;&#227;o da bi&#243;psia de linfonodo sentinela&#46; A dermatoscopia &#233; uma t&#233;cnica potencialmente &#250;til para a redu&#231;&#227;o dos erros de subestadiamento&#44; pois possibilita a escolha do local mais adequado para a realiza&#231;&#227;o da bi&#243;psia incisional &#8211; deve&#8208;se evitar zonas onde exista apenas rede pigmentada at&#237;pica &#40;relacionadas com espessuras tumorais mais baixas&#41; e incidir de prefer&#234;ncia em zonas onde se observem vasos at&#237;picos &#40;associadas a espessuras mais elevadas&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0105" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0110" class="elsevierStylePara elsevierViewall">Ana Rita Silva&#58; An&#225;lise estat&#237;stica&#59; conce&#231;&#227;o e planeamento 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="par0115" class="elsevierStylePara elsevierViewall">Ricardo Vieira&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; conce&#231;&#227;o e planeamento 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; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica do manuscrito&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflito de interesses</span><p id="par0120" 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 espessura do melanoma &#233; importante fator progn&#243;stico e &#233; fundamental para o estadiamento&#44; que depende do estudo histopatol&#243;gico&#46; Existe risco de subestima&#231;&#227;o da espessura numa bi&#243;psia incisional&#44; caso esta n&#227;o seja realizada na zona onde a espessura &#233; m&#225;xima&#46; Isso acarreta um claro impacto na decis&#227;o terap&#234;utica&#44; em especial quanto &#224;s margens de excis&#227;o e a realiza&#231;&#227;o ou n&#227;o de bi&#243;psia de linfonodo sentinela&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar a rela&#231;&#227;o entre a espessura e diversas vari&#225;veis dermatosc&#243;picas&#44; demogr&#225;ficas&#44; epidemiol&#243;gicas e cl&#237;nicas&#44; procurando identificar fatores preditivos de espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1 mm&#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 observacional e transversal realizado em pacientes diagnosticados com melanoma num &#250;nico centro num per&#237;odo de quatro anos&#46; Foram coletadas vari&#225;veis anatomopatol&#243;gicas &#40;espessura&#41;&#44; dermatosc&#243;picas&#44; demogr&#225;ficas&#44; epidemiol&#243;gicas e cl&#237;nicas&#46; Avaliou&#8208;se a associa&#231;&#227;o das vari&#225;veis com a espessura do melanoma&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Foram inclu&#237;dos 119 doentes&#46; A presen&#231;a de vasos at&#237;picos &#224; dermatoscopia foi um fator preditivo independente de espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1 mm&#46; Ao contr&#225;rio&#44; a presen&#231;a de um padr&#227;o reticular at&#237;pico &#233; preditiva de melanomas de espessura &#60;<span class="elsevierStyleHsp" style=""></span>1 mm&#46; Na an&#225;lise univariada&#44; a presen&#231;a de ef&#233;lides e a hist&#243;ria de queimadura solar pr&#233;via associaram&#8208;se igualmente a melanomas de espessura &#60;<span class="elsevierStyleHsp" style=""></span>1 mm&#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">Falta de dados relativos a algumas vari&#225;veis e aus&#234;ncia de correla&#231;&#227;o &#243;tima entre a an&#225;lise dermatosc&#243;pica e o exame anatomopatol&#243;gico&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">O padr&#227;o vascular at&#237;pico relaciona&#8208;se com uma espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1 mm&#44; auxiliando na escolha do melhor local para a realiza&#231;&#227;o de bi&#243;psia incisional&#44; no caso de bi&#243;psia excisional impratic&#225;vel&#46;</p></span>"
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                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Idade</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>40 anos&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">5&#44;9 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805; 40 anos&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">94&#44;1 &#40;112&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Homem&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&#44;7 &#40;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mulher&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&#44;3 &#40;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Localiza&#231;&#227;o</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>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">35&#44;3 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cabe&#231;a e pesco&#231;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;7 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Membro inferior &#40;exceto p&#233;&#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">16&#44;0 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P&#233;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;8 &#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"><span class="elsevierStyleHsp" style=""></span>Membro superior &#40;exceto m&#227;o&#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">5&#44;9 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#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">3&#44;4 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Espessura</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804; 1 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">49&#44;6 &#40;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 1 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">50&#44;4 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Caracteriza&#231;&#227;o demogr&#225;fica e cl&#237;nica da amostra</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabela 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Vari&#225;veis&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  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Espessura&#44; &#37; &#40;n&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Valor p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#8804; 1<span class="elsevierStyleHsp" style=""></span>mm &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>59&#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"><span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>60&#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="" 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></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"><span class="elsevierStyleItalic">Padr&#227;o</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
                  \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="" 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"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
                  \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>Homog&#234;neo&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;0 &#40;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">6&#44;8 &#40;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="" 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>Multicomponente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;1 &#40;16&#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">54&#44;2 &#40;32&#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="" 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>Reticular&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">52&#44;5 &#40;31&#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">10&#44;2 &#40;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="" 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>Paralelo das cristas&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">3&#44;4 &#40;2&#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">5&#44;1 &#40;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="" 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>Outro&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">16&#44;9 &#40;10&#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">23&#44;7 &#40;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="" valign="\n
                  \t\t\t\t\ttop\n
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                  \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"><span class="elsevierStyleItalic">Cor dos cabelos aos 18 anos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Castanho&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">9&#44;4 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">74&#44;5 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">83&#44;9 &#40;47&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;626 &#40;0&#44;244&#8208;1&#44;610&#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">0&#44;331&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rede&#47;pseudo&#8208;rede pigmentar at&#237;pica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;168 &#40;0&#44;068&#8208;0&#44;413&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;168 &#40;0&#44;058&#8208;0&#44;491&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;001</span>&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">Padr&#227;o vascular at&#237;pico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#44;104 &#40;3&#44;488&#8208;18&#44;828&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
                  \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">6&#44;621 &#40;2&#44;462&#8208;17&#44;807&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Linhas brancas brilhantes&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">13&#44;020 &#40;1&#44;623&#8208;104&#44;445&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;016</span>&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">7&#44;005 &#40;0&#44;682&#8208;71&#44;939&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;101&nbsp;\t\t\t\t\t\t\n
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                  """
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        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Fatores preditores da espessura<span class="elsevierStyleHsp" style=""></span>&#62;1<span class="elsevierStyleHsp" style=""></span>mm em doentes com melanoma maligno</p>"
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      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
        0 => array:2 [
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          "bibliografiaReferencia" => array:14 [
            0 => array:3 [
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;C&#46;F&#46;P&#46; Cherobin"
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                            4 => "F&#46;V&#46; Bittencourt"
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                    0 => array:2 [
                      "doi" => "10.1590/abd1806-4841.20184779"
                      "Revista" => array:6 [
                        "tituloSerie" => "An Bras Dermatol&#46;"
                        "fecha" => "2018"
                        "volumen" => "93"
                        "paginaInicial" => "19"
                        "paginaFinal" => "26"
                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European consensus&#8208;based interdisciplinary guideline for melanoma"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Garbe"
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                            3 => "A&#46; Hauschild"
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                  "host" => array:1 [
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                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Dermatology&#46;"
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                      ]
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                  "contribucion" => array:1 [
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                            0 => "D&#46;L&#46; Morton"
                            1 => "J&#46;F&#46; Thompson"
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                    0 => array:2 [
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                            0 => "J&#46; Etzkorn"
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                            2 => "J&#46; Grunyk"
                            3 => "T&#46; Shin"
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                      "doi" => "10.1016/j.jaad.2017.03.018"
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                        "tituloSerie" => "J Am Acad Dermatol&#46;"
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46; Kittler"
                            1 => "H&#46; Pehamberger"
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                      "doi" => "10.1016/s1470-2045(02)00679-4"
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                            1 => "G&#46; Fabbrocini"
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                      ]
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                          "etal" => false
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                            0 => "M&#46; Stante"
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                    0 => array:2 [
                      "doi" => "10.1097/00008390-200104000-00009"
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                        "tituloSerie" => "Melanoma Res&#46;"
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                      "doi" => "10.1016/j.ad.2020.11.015"
                      "Revista" => array:6 [
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                        "paginaInicial" => "434"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                        0 => array:2 [
                          "etal" => true
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Dermoscopic characteristics of melanoma according to the criteria&#44; ulceration&#8220;and&#44; mitotic rate&#8221; of the AJCC 2009 staging system for melanoma"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Deinlein"
                            1 => "E&#46; Arzberger"
                            2 => "I&#46; Zalaudek"
                            3 => "C&#46; Massone"
                            4 => "J&#46; Garcias-Ladaria"
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                      "titulo" => "Clinicopathological analysis of 1571 cutaneous malignant melanoma in Valencia&#44; Spain&#58; factors related to tumour thickness"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; Nagore"
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                            2 => "R&#46; Botella-Estrada"
                            3 => "S&#46; Moreno-Picot"
                            4 => "C&#46; Guill&#233;n"
                            5 => "J&#46; Fortea"
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                    0 => array:2 [
                      "doi" => "10.2340/00015555-0004"
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                        "volumen" => "86"
                        "paginaInicial" => "50"
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Artigo original
Fatores preditivos da espessura do melanoma
Ana Rita Carreiro Silvaa,
Autor para correspondência
arita.carreirosilva@gmail.com

Autor para correspondência.
, Ricardo José David Costa Vieiraa,b
a Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
b Unidade de Cirurgia Dermatológica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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na aus&#234;ncia de ulcera&#231;&#227;o e de um n&#250;mero de mitoses<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>&#44; a taxa de positividade do linfonodo sentinela &#233; inferior a 6&#37;&#44; sendo de pelo menos 14&#37; para espessuras<span class="elsevierStyleHsp" style=""></span>&#62; 1&#44;0<span class="elsevierStyleHsp" style=""></span>mm&#44; pelo que&#44; neste &#250;ltimo caso&#44; est&#225; recomendado realizar a bi&#243;psia de linfonodo sentinela&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a> Al&#233;m da decis&#227;o acerca da pesquisa do linfonodo sentinela&#44; a espessura influencia tamb&#233;m a extens&#227;o das margens de resse&#231;&#227;o cir&#250;rgica&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">3&#44;5</span></a> A bi&#243;psia de uma les&#227;o suspeita de melanoma deve ser&#44; tanto quanto poss&#237;vel&#44; excisional&#44; de modo a que a decis&#227;o terap&#234;utica esteja fundamentada em par&#226;metros de estadiamento precisos&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a> As bi&#243;psias incisionais podem subvalorizar a espessura em 5 a 22&#37; dos casos&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">6</span></a> baseando&#8208;se numa colheita por amostragem que nem sempre representa a zona de maior espessura tumoral&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A dermatoscopia &#233; t&#233;cnica que permite aumentar a acuidade diagn&#243;stica no melanoma&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a> Alguns estudos evidenciaram sua capacidade de inferir caracter&#237;sticas histol&#243;gicas&#44; nomeadamente a espessura&#44; o &#237;ndice mit&#243;tico e a presen&#231;a de ulcera&#231;&#227;o&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">8&#8211;12</span></a> Por&#233;m&#44; a literatura mais recente &#233; pouco abundante nesse contexto&#44; e a aplica&#231;&#227;o concreta dos resultados &#233; pouco explorada&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Desse modo&#44; este trabalho tem como objetivo prim&#225;rio estudar a rela&#231;&#227;o entre a espessura do melanoma e as vari&#225;veis dermatosc&#243;picas e&#44; em segundo lugar&#44; entre a espessura e as vari&#225;veis demogr&#225;ficas&#44; epidemiol&#243;gicas e cl&#237;nicas&#44; procurando identificar fatores preditivos da espessura do melanoma&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material e m&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Realizou&#8208;se estudo anal&#237;tico&#44; observacional e transversal numa amostra de doentes diagnosticados com melanoma cut&#226;neo&#44; no Servi&#231;o de Dermatologia e Venereologia do Centro Hospitalar e Universit&#225;rio de Coimbra&#44; entre janeiro de 2014 e dezembro de 2017&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Para a sele&#231;&#227;o&#44; teve&#8208;se em conta os seguintes crit&#233;rios de inclus&#227;o&#58; diagn&#243;stico definitivo de melanoma cut&#226;neo localizado na cabe&#231;a e pesco&#231;o&#44; tronco&#44; membro superior&#44; m&#227;o&#44; membro inferior ou p&#233;&#44; e presen&#231;a de dados cl&#237;nicos relativos ao exame dermatosc&#243;pico e anatomopatol&#243;gico&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Consultou&#8208;se o processo cl&#237;nico dos doentes selecionados para coleta de vari&#225;veis demogr&#225;ficas &#40;idade e sexo&#41;&#44; epidemiol&#243;gicas &#40;fototipo&#44; cor dos olhos&#44; cor dos cabelos aos 18 anos&#44; presen&#231;a de ef&#233;lides&#44; presen&#231;a de lentigos solares&#44; hist&#243;ria de queimadura solar com eritema e bolhas&#44; n&#250;mero de nevos melanoc&#237;ticos de dimens&#227;o<span class="elsevierStyleHsp" style=""></span>&#62; 2<span class="elsevierStyleHsp" style=""></span>mm segundo a defini&#231;&#227;o da International Agency Research on Cancer&#44; presen&#231;a de nevos at&#237;picos segundo os crit&#233;rios do ABCDE e presen&#231;a de queratoses act&#237;nicas&#41;&#44; cl&#237;nicas &#40;localiza&#231;&#227;o do melanoma&#44; assimetria&#44; bordo&#44; colora&#231;&#227;o&#44; mudan&#231;a de dimens&#227;o nos &#250;ltimos 12 meses e mudan&#231;a de colora&#231;&#227;o nos &#250;ltimos 12 meses&#41;&#44; dermatosc&#243;picas &#40;padr&#227;o dermatosc&#243;pico&#44; presen&#231;a de rede ou pseudo&#8208;rede pigmentada at&#237;pica&#44; presen&#231;a de rede negativa&#44; presen&#231;a de pontos ou gl&#243;bulos irregulares&#44; presen&#231;a de hipopigmenta&#231;&#227;o&#44; presen&#231;a de estrias ou pseud&#243;podes&#44; presen&#231;a de v&#233;u azul&#8208;acinzentado&#44; presen&#231;a de vasos at&#237;picos e presen&#231;a de linhas brancas brilhantes&#41; e anatomopatol&#243;gicas &#40;espessura ou &#237;ndice de Breslow&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A an&#225;lise estat&#237;stica foi realizada com recurso ao Statistical Package for the Social Sciences &#40;SPSS&#174;&#41;&#44; vers&#227;o 25&#44; com um n&#237;vel de signific&#226;ncia definido de 0&#44;05&#46; As vari&#225;veis foram representadas por meio de sua frequ&#234;ncia relativa e absoluta&#46; O teste do Qui&#8208;Quadrado e o teste de Fisher foram usados para estabelecer associa&#231;&#245;es entre as vari&#225;veis recolhidas&#46; A regress&#227;o log&#237;stica bin&#225;ria univariada e multivariada possibilitou determinar fatores preditivos de uma espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">O estudo foi realizado de acordo com as recomenda&#231;&#245;es da Declara&#231;&#227;o de Helsinque da Organiza&#231;&#227;o Mundial da Sa&#250;de e aprovado pela Comiss&#227;o de &#201;tica do Centro Hospitalar e Universit&#225;rio de Coimbra&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Esta pesquisa n&#227;o recebeu nenhum financiamento espec&#237;fico de ag&#234;ncias p&#250;blicas&#44; privadas ou sem fins lucrativos&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0050" class="elsevierStylePara elsevierViewall">Foram diagnosticados 314 doentes com melanoma maligno cut&#226;neo no per&#237;odo temporal referido&#46; Foram exclu&#237;dos 195 casos por aus&#234;ncia de registo das vari&#225;veis dermatosc&#243;picas em estudo&#44; tendo sido inclu&#237;dos os restantes 119 casos&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">As caracter&#237;sticas demogr&#225;ficas e cl&#237;nicas dos indiv&#237;duos inclu&#237;dos est&#227;o representadas na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; A maioria dos doentes &#40;94&#44;1&#37;&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>112&#41; tinha pelo menos 40 anos &#224; &#233;poca do diagn&#243;stico e era do sexo masculino &#40;51&#44;3&#37;&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>61&#41;&#46; Os melanomas malignos estavam localizados principalmente no tronco &#40;35&#44;3&#37;&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&#41;&#46; Registaram&#8208;se frequ&#234;ncias semelhantes relativamente &#224; espessura do melanoma&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">O padr&#227;o dermatosc&#243;pico multicomponente &#40;54&#44;2&#37;&#41; esteve associado a uma espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm&#44; enquanto o padr&#227;o reticular &#40;52&#44;5&#37;&#41; foi o mais frequente em melanomas com espessura &#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; A presen&#231;a de rede&#47;pseudo&#8208;rede pigmentar at&#237;pica &#40;86&#44;4&#37;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e de rede pigmentar negativa &#40;8&#44;6&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41; esteve associada a uma espessura &#8804; 1<span class="elsevierStyleHsp" style=""></span>mm&#44; enquanto a presen&#231;a de um padr&#227;o vascular at&#237;pico &#40;65&#44;0&#37;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e de linhas brancas brilhantes &#40;18&#44;3&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41; foi mais frequente nos melanomas com espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a> compara a distribui&#231;&#227;o de vari&#225;veis demogr&#225;ficas e epidemiol&#243;gicas entre pacientes com melanoma maligno de diferentes espessuras&#46; A frequ&#234;ncia de indiv&#237;duos com mais de 40 anos &#40;98&#44;3&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;049&#41; foi significativamente superior quando a espessura era<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm&#44; e essa caracter&#237;stica esteve associada a uma menor frequ&#234;ncia de ef&#233;lides &#40;1&#44;7&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;032&#41; e de queimaduras solares pr&#233;vias &#40;42&#44;1&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;032&#41;&#46; Sexo&#44; fototipo&#44; cor dos olhos&#44; cor do cabelo&#44; presen&#231;a de lentigos solares&#44; n&#250;mero de nevos melanoc&#237;ticos e presen&#231;a de nevos at&#237;picos e queratoses act&#237;nicas n&#227;o diferiu significativamente de acordo com a espessura do melanoma&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">A aus&#234;ncia de pigmenta&#231;&#227;o &#40;melanoma amelan&#243;tico&#41; associou&#8208;se a espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm &#40;17&#44;5&#37;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; N&#227;o se observaram diferen&#231;as significativas relativamente &#224; localiza&#231;&#227;o do melanoma&#44; assimetria&#44; bordo&#44; mudan&#231;a de cor e crescimento recente em fun&#231;&#227;o da espessura &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0025">tabela 5</a> representa os resultados da regress&#227;o log&#237;stica univariada e multivariada sobre fatores preditivos de uma espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm em doentes com melanoma maligno&#46; Na an&#225;lise univariada&#44; a presen&#231;a de ef&#233;lides&#44; queimadura solar pr&#233;via e de rede&#47;pseudo&#8208;rede pigmentar at&#237;pica foram preditivos de espessura &#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm&#44; mas a presen&#231;a de padr&#227;o vascular at&#237;pico ou de linhas brancas brilhantes relacionou&#8208;se com espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm&#46; O modelo de regress&#227;o multivariado permitiu explicar 49&#44;7&#37; da vari&#226;ncia associada &#224; espessura &#40;R<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;497&#41; e identificou o padr&#227;o vascular at&#237;pico &#40;risco relativo de 6&#44;621&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; como fator preditivo independente de espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm&#46; Ao contr&#225;rio&#44; a rede&#47;pseudo&#8208;rede pigmentada at&#237;pica &#40;risco relativo de 0&#44;168&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; foi identificada como um fator preditivo de espessura &#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0080" class="elsevierStylePara elsevierViewall">Das vari&#225;veis cl&#237;nicas e epidemiol&#243;gicas estudadas&#44; apenas a presen&#231;a de ef&#233;lides e a hist&#243;ria de queimadura solar pr&#233;via foram identificadas como fatores preditivos de melanomas finos&#44; fatos n&#227;o relatados consistentemente em estudos pr&#233;vios&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> Este resultado poder&#225; ser explicado pelo reconhecimento das ef&#233;lides e de queimaduras solares como fatores de risco para desenvolvimento de neoplasias cut&#226;neas e consequente ado&#231;&#227;o de medidas de preven&#231;&#227;o secund&#225;ria&#44; como o recurso ao autoexame regular da pele&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Estudos pr&#233;vios comprovaram a exist&#234;ncia de uma associa&#231;&#227;o entre a rede&#47;pseudo&#8208;rede pigmentar at&#237;pica e melanomas finos&#44; bem como uma associa&#231;&#227;o entre o padr&#227;o vascular at&#237;pico e linhas brancas brilhantes com melanomas de maior espessura&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">8&#44;9</span></a> Contudo&#44; ao contr&#225;rio de outras s&#233;ries&#44; a presen&#231;a de v&#233;u azul&#8208;acinzentado e de estrias n&#227;o mostrou rela&#231;&#227;o com melanomas de espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1<span class="elsevierStyleHsp" style=""></span>mm&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">8&#8211;10</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Ap&#243;s a regress&#227;o multivariada&#44; apenas o padr&#227;o vascular at&#237;pico e a rede&#47;pseudo&#8208;rede pigmentada at&#237;pica se distinguiram respetivamente como fatores preditivos independentes de melanomas mais espessos que 1<span class="elsevierStyleHsp" style=""></span>mm e de melanomas com 1<span class="elsevierStyleHsp" style=""></span>mm ou menos de espessura&#46; Essas associa&#231;&#245;es sugerem que melanomas mais invasivos t&#234;m maior neovasculariza&#231;&#227;o&#44; representada ao dermatosc&#243;pio por vasos at&#237;picos&#44; e que melanomas com espessura &#8804; 1<span class="elsevierStyleHsp" style=""></span>mm mant&#234;m a jun&#231;&#227;o dermoepid&#233;rmica intacta&#44; j&#225; que a rede pigmentada at&#237;pica corresponde &#224; prolifera&#231;&#227;o melanoc&#237;tica at&#237;pica juncional&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Salientam&#8208;se limita&#231;&#245;es como a falta de dados relativos a algumas das vari&#225;veis estudadas e a aus&#234;ncia de correla&#231;&#227;o &#243;tima entre a an&#225;lise dermatosc&#243;pica&#44; feita num plano horizontal&#44; e o exame anatomopatol&#243;gico&#44; realizado por meio de bi&#243;psia vertical&#46; Para al&#233;m disso&#44; no futuro&#44; ser&#225; relevante realizar estudos de coorte propectivos para confirma&#231;&#227;o dos resultados obtidos&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#245;es</span><p id="par0100" class="elsevierStylePara elsevierViewall">A bi&#243;psia incisional acarreta o risco de subestimar a espessura&#44; levando a um subestadiamento e a eventuais imprecis&#245;es na defini&#231;&#227;o das margens apropriadas de excis&#227;o e na indica&#231;&#227;o da bi&#243;psia de linfonodo sentinela&#46; A dermatoscopia &#233; uma t&#233;cnica potencialmente &#250;til para a redu&#231;&#227;o dos erros de subestadiamento&#44; pois possibilita a escolha do local mais adequado para a realiza&#231;&#227;o da bi&#243;psia incisional &#8211; deve&#8208;se evitar zonas onde exista apenas rede pigmentada at&#237;pica &#40;relacionadas com espessuras tumorais mais baixas&#41; e incidir de prefer&#234;ncia em zonas onde se observem vasos at&#237;picos &#40;associadas a espessuras mais elevadas&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0105" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0110" class="elsevierStylePara elsevierViewall">Ana Rita Silva&#58; An&#225;lise estat&#237;stica&#59; conce&#231;&#227;o e planeamento 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="par0115" class="elsevierStylePara elsevierViewall">Ricardo Vieira&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; conce&#231;&#227;o e planeamento 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; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica do manuscrito&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflito de interesses</span><p id="par0120" 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 espessura do melanoma &#233; importante fator progn&#243;stico e &#233; fundamental para o estadiamento&#44; que depende do estudo histopatol&#243;gico&#46; Existe risco de subestima&#231;&#227;o da espessura numa bi&#243;psia incisional&#44; caso esta n&#227;o seja realizada na zona onde a espessura &#233; m&#225;xima&#46; Isso acarreta um claro impacto na decis&#227;o terap&#234;utica&#44; em especial quanto &#224;s margens de excis&#227;o e a realiza&#231;&#227;o ou n&#227;o de bi&#243;psia de linfonodo sentinela&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar a rela&#231;&#227;o entre a espessura e diversas vari&#225;veis dermatosc&#243;picas&#44; demogr&#225;ficas&#44; epidemiol&#243;gicas e cl&#237;nicas&#44; procurando identificar fatores preditivos de espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1 mm&#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 observacional e transversal realizado em pacientes diagnosticados com melanoma num &#250;nico centro num per&#237;odo de quatro anos&#46; Foram coletadas vari&#225;veis anatomopatol&#243;gicas &#40;espessura&#41;&#44; dermatosc&#243;picas&#44; demogr&#225;ficas&#44; epidemiol&#243;gicas e cl&#237;nicas&#46; Avaliou&#8208;se a associa&#231;&#227;o das vari&#225;veis com a espessura do melanoma&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Foram inclu&#237;dos 119 doentes&#46; A presen&#231;a de vasos at&#237;picos &#224; dermatoscopia foi um fator preditivo independente de espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1 mm&#46; Ao contr&#225;rio&#44; a presen&#231;a de um padr&#227;o reticular at&#237;pico &#233; preditiva de melanomas de espessura &#60;<span class="elsevierStyleHsp" style=""></span>1 mm&#46; Na an&#225;lise univariada&#44; a presen&#231;a de ef&#233;lides e a hist&#243;ria de queimadura solar pr&#233;via associaram&#8208;se igualmente a melanomas de espessura &#60;<span class="elsevierStyleHsp" style=""></span>1 mm&#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">Falta de dados relativos a algumas vari&#225;veis e aus&#234;ncia de correla&#231;&#227;o &#243;tima entre a an&#225;lise dermatosc&#243;pica e o exame anatomopatol&#243;gico&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">O padr&#227;o vascular at&#237;pico relaciona&#8208;se com uma espessura<span class="elsevierStyleHsp" style=""></span>&#62; 1 mm&#44; auxiliando na escolha do melhor local para a realiza&#231;&#227;o de bi&#243;psia incisional&#44; no caso de bi&#243;psia excisional impratic&#225;vel&#46;</p></span>"
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          4 => array:2 [
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    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Silva ARC&#44; Vieira RJDC&#46; Predictive factors of melanoma thickness&#46; An Bras Dermatol&#46; 2022&#59;97&#58;601&#8211;5&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Trabalho realizado no Servi&#231;o de Dermatologia e Venereologia do Centro Hospitalar e Universit&#225;rio de Coimbra&#44; Coimbra&#44; Portugal&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vari&#225;vel&#44; &#37; &#40;n&#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">5&#44;9 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">94&#44;1 &#40;112&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">48&#44;7 &#40;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mulher&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-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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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"><span class="elsevierStyleHsp" style=""></span>Tronco&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-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>Cabe&#231;a e pesco&#231;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \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>Membro inferior &#40;exceto p&#233;&#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">16&#44;0 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P&#233;&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">11&#44;8 &#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"><span class="elsevierStyleHsp" style=""></span>Membro superior &#40;exceto m&#227;o&#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">5&#44;9 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#227;o&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Masculino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44&#44;1 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">53&#44;3 &#40;32&#41;&nbsp;\t\t\t\t\t\t\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"><span class="elsevierStyleHsp" style=""></span>Feminino&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">55&#44;9 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">46&#44;7 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Idade</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;049&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>40 anos&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
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                  \t\t\t\t">10&#44;2 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;7 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805; 40 anos&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
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                  \t\t\t\t">89&#44;8 &#40;53&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">98&#44;3 &#40;59&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Fototipo</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;320&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>I&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
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                  \t\t\t\t">1&#44;7 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>II&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">16&#44;9 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30&#44;5 &#40;18&#41;&nbsp;\t\t\t\t\t\t\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"><span class="elsevierStyleHsp" style=""></span>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
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                  \t\t\t\t">64&#44;4 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">57&#44;6 &#40;34&#41;&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="elsevierStyleHsp" style=""></span>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
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                  \t\t\t\t">16&#44;9 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#44;2 &#40;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 ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Cor dos olhos</span>&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  " align="left" valign="\n
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                  \t\t\t\t">0&#44;724&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Verde&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">18&#44;6 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Castanho&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">61&#44;0 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">54&#44;2 &#40;32&#41;&nbsp;\t\t\t\t\t\t\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"><span class="elsevierStyleHsp" style=""></span>Azul&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">18&#44;6 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20&#44;3 &#40;12&#41;&nbsp;\t\t\t\t\t\t\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"><span class="elsevierStyleHsp" style=""></span>Preto&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">1&#44;7 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;1 &#40;3&#41;&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\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">Cor dos cabelos aos 18 anos</span>&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  " align="left" valign="\n
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                  \t\t\t\t">0&#44;592&nbsp;\t\t\t\t\t\t\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"><span class="elsevierStyleHsp" style=""></span>Loiro&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">10&#44;2 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18&#44;6 &#40;11&#41;&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></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grisalho&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
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                  \t\t\t\t">31&#44;7 &#40;19&#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="" 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>Membro superior &#40;exceto m&#227;o&#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">6&#44;8 &#40;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">5&#44;0 &#40;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="" 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\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#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">3&#44;4 &#40;2&#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">3&#44;3 &#40;2&#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="" 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>Membro inferior &#40;exceto p&#233;&#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">18&#44;6 &#40;11&#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">13&#44;3 &#40;8&#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="" 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\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P&#233;&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">3&#44;4 &#40;2&#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">20&#44;0 &#40;12&#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="" 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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Assimetria</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
                  \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="" 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;725&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>Sim&#233;trico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;5 &#40;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">9&#44;4 &#40;5&#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="" 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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Assim&#233;trico&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">90&#44;6 &#40;48&#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="" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Bordo</span>&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  " align="left" valign="\n
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                  \t\t\t\t">0&#44;810&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>Regular&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&#44;0 &#40;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">14&#44;5 &#40;8&#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="" 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>Irregular&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">87&#44;0 &#40;47&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#44;5 &#40;47&#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="" 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
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                  \t\t\t\t"><span class="elsevierStyleItalic">Colora&#231;&#227;o</span>&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
                  \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
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                  \t\t\t\t"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o pigmentado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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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&#44;5 &#40;10&#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\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pigmentado&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">100&#44;0 &#40;56&#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">82&#44;5 &#40;47&#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="" 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">Mudan&#231;a de cor recente</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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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">59&#44;6 &#40;31&#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">0&#44;896&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">Crescimento recente</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">74&#44;5 &#40;38&#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">83&#44;9 &#40;47&#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">0&#44;229&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" scope="col">Dimens&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RR &#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 p&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">RR &#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 p&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">Idade &#8805; 40 anos&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&#44;679 &#40;0&#44;779&#8208;57&#44;298&#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;083&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&#47;NC&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">Ef&#233;lides&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;110 &#40;0&#44;013&#8208;0&#44;909&#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"><span class="elsevierStyleBold">0&#44;041</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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&#47;NC&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">Queimadura solar pr&#233;via&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;444 &#40;0&#44;211&#8208;0&#44;938&#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"><span class="elsevierStyleBold">0&#44;033</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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;626 &#40;0&#44;244&#8208;1&#44;610&#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;331&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">Rede&#47;pseudo&#8208;rede pigmentar at&#237;pica&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;168 &#40;0&#44;068&#8208;0&#44;413&#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"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
                  \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;168 &#40;0&#44;058&#8208;0&#44;491&#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"><span class="elsevierStyleBold">0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Padr&#227;o vascular at&#237;pico&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&#44;104 &#40;3&#44;488&#8208;18&#44;828&#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"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
                  \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&#44;621 &#40;2&#44;462&#8208;17&#44;807&#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"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
                  \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">Linhas brancas brilhantes&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&#44;020 &#40;1&#44;623&#8208;104&#44;445&#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"><span class="elsevierStyleBold">0&#44;016</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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;005 &#40;0&#44;682&#8208;71&#44;939&#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;101&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Fatores preditores da espessura<span class="elsevierStyleHsp" style=""></span>&#62;1<span class="elsevierStyleHsp" style=""></span>mm em doentes com melanoma maligno</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:14 [
            0 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic factors for metastasis in cutaneous melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;C&#46;F&#46;P&#46; Cherobin"
                            1 => "A&#46;J&#46;A&#46; Wainstein"
                            2 => "E&#46;A&#46; Colosimo"
                            3 => "E&#46;M&#46;A&#46; Goulart"
                            4 => "F&#46;V&#46; Bittencourt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/abd1806-4841.20184779"
                      "Revista" => array:6 [
                        "tituloSerie" => "An Bras Dermatol&#46;"
                        "fecha" => "2018"
                        "volumen" => "93"
                        "paginaInicial" => "19"
                        "paginaFinal" => "26"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29641692"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            1 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European consensus&#8208;based interdisciplinary guideline for melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Garbe"
                            1 => "T&#46; Amaral"
                            2 => "K&#46; Peris"
                            3 => "A&#46; Hauschild"
                            4 => "P&#46; Arenberger"
                            5 => "L&#46; Bastholt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Part 1&#58; Diagnosis &#8208; Update 2019&#46; Eur J Cancer&#46;"
                        "fecha" => "2020"
                        "volumen" => "126"
                        "paginaInicial" => "141"
                        "paginaFinal" => "158"
                      ]
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                  ]
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            2 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines of care for the management of primary cutaneous melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "W&#46; Group"
                            1 => "S&#46;M&#46; Swetter"
                            2 => "H&#46; Tsao"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Dermatology&#46;"
                        "fecha" => "2018"
                        "volumen" => "80"
                        "paginaInicial" => "208"
                        "paginaFinal" => "250"
                      ]
                    ]
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              "identificador" => "bib0090"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Final trial report of sentinel&#8208;node biopsy versus nodal observation in melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;L&#46; Morton"
                            1 => "J&#46;F&#46; Thompson"
                            2 => "A&#46;J&#46; Cochran"
                            3 => "N&#46; Mozzillo"
                            4 => "O&#46;E&#46; Nieweg"
                            5 => "D&#46;F&#46; Roses"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1310460"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med&#46;"
                        "fecha" => "2014"
                        "volumen" => "370"
                        "paginaInicial" => "599"
                        "paginaFinal" => "609"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24521106"
                            "web" => "Medline"
                          ]
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            4 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Europeam consensus&#8208;based interdisciplinary guideline for melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Garbe"
                            1 => "T&#46; Amaral"
                            2 => "K&#46; Peris"
                            3 => "A&#46; Hauschild"
                            4 => "P&#46; Arenberger"
                            5 => "L&#46; Bastholt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejca.2019.11.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "Part 2&#58; Treatment &#8208; Update 2019&#46; Eur J Cancer&#46;"
                        "fecha" => "2020"
                        "volumen" => "126"
                        "paginaInicial" => "159"
                        "paginaFinal" => "177"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31866016"
                            "web" => "Medline"
                          ]
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            5 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Frequency of and risk factor for melanoma upstaging after wide local excision of primary cutaneous melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Etzkorn"
                            1 => "J&#46; Sharkey"
                            2 => "J&#46; Grunyk"
                            3 => "T&#46; Shin"
                            4 => "J&#46; Sobanko"
                            5 => "C&#46; Miller"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2017.03.018"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol&#46;"
                        "fecha" => "2017"
                        "volumen" => "77"
                        "paginaInicial" => "341"
                        "paginaFinal" => "348"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28601390"
                            "web" => "Medline"
                          ]
                        ]
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            6 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic accuracy of dermoscopy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46; Kittler"
                            1 => "H&#46; Pehamberger"
                            2 => "K&#46; Wolff"
                            3 => "M&#46; Binder"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s1470-2045(02)00679-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Oncol&#46;"
                        "fecha" => "2002"
                        "volumen" => "3"
                        "paginaInicial" => "159"
                        "paginaFinal" => "165"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11902502"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical and dermatoscopic criteria for the preoperative evaluation of cutaneous melanoma thickness"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46; Argenziano"
                            1 => "G&#46; Fabbrocini"
                            2 => "P&#46; Carli"
                            3 => "V&#46; Giorgi"
                            4 => "M&#46; Delfino"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0190-9622(99)70528-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol&#46;"
                        "fecha" => "1999"
                        "volumen" => "40"
                        "paginaInicial" => "61"
                        "paginaFinal" => "68"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9922013"
                            "web" => "Medline"
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            8 => array:3 [
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ISSN: 26662752
Idioma original: Português
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