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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">O melanoma &#233; o tipo mais grave de c&#226;ncer da pele e sua incid&#234;ncia mundial vem aumentando&#44; apesar da taxa de mortalidade permanecer est&#225;vel e com tend&#234;ncia de diminui&#231;&#227;o em alguns pa&#237;ses nas &#250;ltimas d&#233;cadas&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> O diagn&#243;stico precoce e os avan&#231;os no tratamento da doen&#231;a avan&#231;ada s&#227;o os prov&#225;veis respons&#225;veis por essa estabiliza&#231;&#227;o nas taxas de mortalidade&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a> Do ponto de vista financeiro&#44; o melanoma cut&#226;neo representa &#244;nus cr&#237;tico para o Brasil&#44; e o custo da doen&#231;a varia de acordo com o sistema de sa&#250;de e com est&#225;gio no momento do diagn&#243;stico&#46; Os gastos com pacientes com doen&#231;a avan&#231;ada podem ser at&#233; 34 vezes &#40;Sistema &#218;nico de Sa&#250;de&#41; ou 270 vezes &#40;setor privado&#41; maiores do que o necess&#225;rio para o tratamento da doen&#231;a em est&#225;gio inicial&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Em decorr&#234;ncia das restri&#231;&#245;es sanit&#225;rias impostas pela pandemia de SARS&#8208;CoV&#8208;2&#44; o acesso aos servi&#231;os de sa&#250;de na cidade do Rio de Janeiro foi dificultado&#44; principalmente no ano de 2020&#46; Com isso&#44; houve praticamente a interrup&#231;&#227;o do seguimento dos pacientes de alto risco e dos exames de triagem para melanoma no Hospital Universit&#225;rio Pedro Ernesto &#40;HUPE&#41;&#46; A mensura&#231;&#227;o do impacto da diminui&#231;&#227;o da triagem do c&#226;ncer da pele nesse per&#237;odo na piora do progn&#243;stico dos pacientes com melanoma cut&#226;neo &#233; um desafio&#44; mas indicador necess&#225;rio aos servi&#231;os de sa&#250;de&#46; Nosso objetivo foi avaliar o impacto da pandemia de SARS&#8208;CoV&#8208;2 no diagn&#243;stico do melanoma cut&#226;neo prim&#225;rio no Servi&#231;o de Dermatologia de um hospital universit&#225;rio na cidade do Rio de Janeiro&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">M&#233;todos</span><p id="par0015" class="elsevierStylePara elsevierViewall">Realizamos estudo observacional transversal do tipo descritivo e anal&#237;tico sobre os casos de melanoma diagnosticados no Servi&#231;o de Dermatologia do HUPE&#46; Foram inclu&#237;dos os casos diagnosticados como melanoma cut&#226;neo prim&#225;rio com confirma&#231;&#227;o por meio de exame histopatol&#243;gico&#44; no per&#237;odo entre os anos de 2012 e 2021&#46; O impacto da pandemia de SARS&#8208;CoV&#8208;2 no diagn&#243;stico do melanoma cut&#226;neo prim&#225;rio foi avaliado a partir da compara&#231;&#227;o do n&#250;mero de casos diagnosticados e da m&#233;dia anual da espessura tumoral medida em mil&#237;metros nesse per&#237;odo&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A associac&#807;a&#771;o entre duas vari&#225;veis qualitativas foi verificada pelo teste de diferen&#231;a de propor&#231;&#245;es por meio do ajuste de Fisher para pequenos n&#250;meros&#46; A regress&#227;o de Poisson foi utilizada para estimativa das raz&#245;es de incid&#234;ncia e dos Intervalos de Confian&#231;a de 95&#37;&#46; A an&#225;lise estat&#237;stica foi realizada pelo software Stata&#47;SE 12&#46;0 for Mac&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Resultados</span><p id="par0025" class="elsevierStylePara elsevierViewall">Nos &#250;ltimos 10 anos&#44; desde que foi iniciado o atendimento no ambulat&#243;rio de les&#245;es pigmentadas do Servi&#231;o de Dermatologia do HUPE&#44; foram diagnosticados 91 novos casos de melanoma cut&#226;neo em 89 pacientes&#59; um paciente apresentou dois melanomas ass&#237;ncronos&#44; e outro paciente&#44; dois melanomas s&#237;ncronos&#46; Dos 91 tumores avaliados&#44; 24&#37; &#40;22&#41; eram les&#245;es <span class="elsevierStyleItalic">in situ</span> e 75&#37; &#40;69&#41; tumores invasivos com espessura m&#233;dia de 1&#44;04<span class="elsevierStyleHsp" style=""></span>mm &#40;0&#44;10&#8208;5&#44;72 mm&#41;&#44; com predom&#237;nio de 47&#37; &#40;42&#41; das les&#245;es com n&#237;vel II de invas&#227;o Clark&#46; Na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#44; observa&#8208;se a distribui&#231;&#227;o da mediana das espessuras de Breslow observadas entre os anos de 2012 e 2021&#46; A m&#233;dia do n&#250;mero de casos diagnosticados entre os anos de 2013 e 2019 foi de 9&#44;8 casos&#47;ano&#46; Em 2020&#44; observamos diminui&#231;&#227;o de 49&#44;0&#37; &#40;5&#41; no n&#250;mero de casos diagnosticados&#46; No ano de 2021&#44; tivemos 11 casos diagnosticados&#46; Apenas no primeiro trimestre de 2021&#44; foi diagnosticada a mesma quantidade de casos de melanoma de todo o ano de 2020&#46; Os achados da <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a> indicam que as taxas de incid&#234;ncia de melanoma decresceram entre o bi&#234;nio 2018&#47;2019 e 2020&#47;21&#44; variando de 3&#44;15 casos por 1&#46;000 agendamentos a 1&#44;34 casos por 1&#46;000 em 2020&#47;21&#46; As raz&#245;es de incid&#234;ncia indicaram que as taxas de 2020 e de 2021 foram&#44; respectivamente&#44; 72&#37; e 80&#37; menores se comparadas &#224; taxa de 2018&#47;2019&#46; A taxa mais baixa foi acompanhada da maior gravidade dos casos&#44; o que pode ser corroborado por n&#237;veis de invas&#227;o de Clark com clara tend&#234;ncia de avan&#231;o em 2020&#47;21 comparados com 2018&#47;2019&#46; Assim&#44; nota&#8208;se que em metade dos casos em 2020&#47;21 os n&#237;veis de invas&#227;o foram IV ou V&#59; esse percentual foi de 5&#37; em 2018&#47;2019&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discussa&#771;o</span><p id="par0030" class="elsevierStylePara elsevierViewall">Conforme recentemente demonstrado por meio de modelo de taxa de crescimento&#44; a probabilidade de aumento da espessura e progress&#227;o para est&#225;gio mais avan&#231;ado de doen&#231;a &#233; de 21&#37;&#44; 29&#37; e 45&#37; com um&#44; dois e tr&#234;s meses de atraso no diagn&#243;stico do melanoma&#44; respectivamente&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Diante das restri&#231;&#245;es impostas pela crise sanit&#225;ria&#44; podemos inferir que a pandemia do SARS&#8208;CoV&#8208;2 seja a justificativa mais prov&#225;vel para que tenhamos tido menor taxa mensal de casos diagnosticados no per&#237;odo ap&#243;s o in&#237;cio da pandemia e maiores espessuras de Breslow do que dos &#250;ltimos 10 anos&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">A incid&#234;ncia mundial do melanoma vem aumentando nas &#250;ltimas d&#233;cadas&#59; j&#225; as taxas de mortalidade parecem estar tendendo a se estabilizar&#46; Uma das principais raz&#245;es para essa estabiliza&#231;&#227;o &#233; o diagn&#243;stico precoce&#46; Apesar de recente trabalho cient&#237;fico realizado nos Estados Unidos ter proposto a interrup&#231;&#227;o de campanhas para detec&#231;&#227;o precoce do c&#226;ncer da pele como maneira de diminuir a quantidade de melanomas diagnosticados&#44; essa n&#227;o nos parece ser uma estrat&#233;gia prudente a ser adotada&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a> Quando comparamos a quantidade de melanomas diagnosticados no HUPE na d&#233;cada anterior &#40;2002&#8208;2011&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>71&#41;&#44; nota&#8208;se um incremento da ordem de 10&#37;&#46; Entretanto&#44; conforme nossos dados demonstram&#44; houve redu&#231;&#227;o de mais da metade do n&#250;mero de casos diagnosticados em 2020&#44; e os que foram detectados encontravam&#8208;se em fase mais avan&#231;ada&#46; &#192; semelhan&#231;a do que ocorreu com outros tipos de c&#226;ncer e do que foi observado com o diagn&#243;stico do melanoma na It&#225;lia&#44; durante o in&#237;cio da pandemia de SARS&#8208;CoV&#8208;2&#44; observamos uma significativa redu&#231;&#227;o do n&#250;mero de casos de melanoma cut&#226;neo diagnosticados&#44; o que potencialmente est&#225; associado com aumento na morbidade&#44; mortalidade e custos financeiros&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">6&#8211;13</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">O impacto do atraso no diagn&#243;stico ocasionado pela pandemia de SARS&#8208;CoV&#8208;2 na sobrevida dos pacientes com melanoma e nos custos envolvidos para o tratamento da doen&#231;a em est&#225;gios mais avan&#231;ados dever&#225; ser objeto de futuros estudos&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclus&#227;o</span><p id="par0050" class="elsevierStylePara elsevierViewall">No primeiro ano da pandemia de SARS&#8208;CoV&#8208;2 &#40;2020&#41;&#44; observamos significativa redu&#231;&#227;o do n&#250;mero de casos de melanoma cut&#226;neo prim&#225;rio diagnosticados&#44; e a espessura m&#233;dia dos tumores foi maior quando comparada com a dos casos diagnosticados nos &#250;ltimos oito anos anteriores&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Suporte financeiro</span><p id="par0055" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Contribui&#231;&#227;o dos autores</span><p id="par0060" class="elsevierStylePara elsevierViewall">Carlos Baptista Barcaui&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Carla Jorge Machado&#58; An&#225;lise estat&#237;stica&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Juan Pi&#241;eiro&#8208;Maceira&#58; Participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflito de interesses</span><p id="par0075" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Como citar este artigo&#58; Barcaui CB&#44; Machado CJ&#44; Pi&#241;eiro&#8208;Maceira J&#46; Impact of the SARS&#8208;CoV&#8208;2 pandemic on the diagnosis of primary cutaneous melanoma at a University Hospital in Rio de Janeiro&#46; An Bras Dermatol&#46; 2022&#59;97&#58;801&#8211;3&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Trabalho realizado no Hospital Universit&#225;rio Pedro Ernesto&#44; Universidade do Estado do Rio de Janeiro&#44; Rio de Janeiro&#44; RJ&#44; Brasil&#46;</p>"
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                  <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">Ano&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">N&#176; casos&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">Idade dos pacientes<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Espessura de Breslow &#40;mm&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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="" 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">Mediana &#40;p25&#59; p75&#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">Mediana &#40;p25&#59; p75&#41;&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">2012 &#40;mar&#8208;dez&#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&nbsp;\t\t\t\t\t\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">64 &#40;58&#59; 75&#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;44 &#40;0&#44;00&#59; 0&#44;57&#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">2013&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;58&#59; 71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;41 &#40;0&#44;00&#59; 0&#44;93&#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">2014&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;57&#59; 77&#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;00 &#40;0&#44;00&#59; 0&#44;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2015&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#40;47&#59; 65&#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;50 &#40;0&#44;31&#59; 0&#44;70&#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">2016&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;56&#59; 67&#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;23 &#40;0&#44;00&#59; 0&#44;77&#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">2017&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75 &#40;58&#59; 85&#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;45 &#40;0&#44;30&#59; 1&#44;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2018&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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">73 &#40;52&#59; 80&#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;30 &#40;0&#44;00&#59; 0&#44;50&#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">2019&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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">65 &#40;53&#59; 73&#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;60 &#40;0&#44;20&#59; 0&#44;60&#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">2020&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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">83 &#40;71&#59; 85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;40 &#40;0&#44;00&#59; 3&#44;30&#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">2021&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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">72 &#40;57&#59; 81&#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;50 &#40;0&#44;30&#59; 2&#44;60&#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">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&nbsp;\t\t\t\t\t\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">65 &#40;57&#59; 76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;40 &#40;0&#44;05&#59; 0&#44;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3688215.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Mediana e percentis utilizados pois o teste de Shapiro&#8208;Wilk indicou aus&#234;ncia de normalidade para idade &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;049&#41; e para espessura de Breslow &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">N&#250;mero de casos de melanoma cut&#226;neo diagnosticados no servi&#231;o de Dermatologia do HUPE entre mar&#231;o de 2012 e 31 de dezembro de 2021&#44; idade m&#233;dia e mediana da espessura de Breslow dos casos invasivos</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:3 [
          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Notas&#58; <span class="elsevierStyleItalic">DP</span>&#44; desvio padr&#227;o&#59; <span class="elsevierStyleItalic">p25</span>&#44; 25&#176; percentil&#59; <span class="elsevierStyleItalic">p75</span>&#44; 75&#176; percentil&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "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" 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">Vari&#225;veis analisadas e estat&#237;sticas&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">2018&#47;2019&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">2020&#47;2021&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">N&#250;mero de casos de melanoma</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\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&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">N&#250;mero de agendamentos</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&#46;349&nbsp;\t\t\t\t\t\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&#46;912&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">Taxas de incid&#234;ncia &#40;por mil agendamentos&#41;</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">3&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Raz&#245;es de incid&#234;ncia &#40;95&#37; IC&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;44 &#40;0&#44;27&#59;0&#44;73&#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">&#8208;&nbsp;\t\t\t\t\t\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">p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Espessura de Breslow em mm&#58; Mediana &#40;p25&#59; p75&#41;</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;40 &#40;0&#44;15&#59; 0&#44;60&#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;80 &#40;0&#44;30&#59; 2&#44;90&#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  " 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">p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;502<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N&#237;vel de invas&#227;o de Clark&#44; n &#40;&#37;&#41;</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>I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;20&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;18&#44;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>II ou III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;75&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;31&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IV ou V</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;5&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;50&#44;0&#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  " 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">p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;041<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Idade em anos&#58; m&#233;dia &#40;DP&#41;</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">65&#44;0 &#40;18&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#44;0 &#40;13&#44;5&#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  " 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">p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;205<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3688216.png"
              ]
            ]
          ]
          "notaPie" => array:4 [
            0 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Estimativas de raz&#227;o de incid&#234;ncia&#44; intervalos de 95&#37; de confian&#231;a e valor de p obtidos por regress&#227;o de Poisson&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Valor de p com base em teste n&#227;o param&#233;trico de Mann&#8208;Whitney para compara&#231;&#227;o de medianas independentes &#40;teste de Shapiro&#8208;Wilk indicou aus&#234;ncia de normalidade&#58; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Valor de p com base em teste n&#227;o param&#233;trico de tend&#234;ncia de Cuzick&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Valor de p com base em teste <span class="elsevierStyleItalic">t</span> de <span class="elsevierStyleItalic">Student</span> para compara&#231;&#227;o de m&#233;dias independentes &#40;teste de Shapiro&#8208;Wilk n&#227;o indicou aus&#234;ncia de normalidade&#58; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;088&#41;&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Tabela s&#237;ntese das diferen&#231;as encontradas entre os anos de 2018&#47;2019&#59; 2020&#59; 2021 &#40;janeiro a mar&#231;o&#41; referentes aos casos de melanoma diagnosticados no servi&#231;o de Dermatologia do HUPE</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:13 [
            0 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estimates of worldwide burden of cancer in 2008&#58; GLOBOCAN 2008"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Ferlay"
                            1 => "H&#46;R&#46; Shin"
                            2 => "F&#46; Bray"
                            3 => "D&#46; Forman"
                            4 => "C&#46; Mathers"
                            5 => "D&#46;M&#46; Parkin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ijc.25516"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cancer&#46;"
                        "fecha" => "2010"
                        "volumen" => "127"
                        "paginaInicial" => "2893"
                        "paginaFinal" => "2917"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21351269"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of Skin Cancer&#58; Update 2019"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "U&#46; Leiter"
                            1 => "U&#46; Keim"
                            2 => "C&#46; Garbe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/978-3-030-46227-7_6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Adv Exp Med Biol&#46;"
                        "fecha" => "2020"
                        "volumen" => "1268"
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Carta ‐ Investigação
Impacto da pandemia do SARS‐CoV‐2 no diagnóstico do melanoma cutâneo primário em hospital universitário no Rio de Janeiro
Carlos Baptista Barcauia,
Autor para correspondência
carlos.barcaui@uerj.br

Autor para correspondência.
, Carla Jorge Machadob, Juan Piñeiro‐Maceirac
a Departamento de Dermatologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
b Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais, Rio de Janeiro, RJ, Brasil
c Departamento de Patologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">O melanoma &#233; o tipo mais grave de c&#226;ncer da pele e sua incid&#234;ncia mundial vem aumentando&#44; apesar da taxa de mortalidade permanecer est&#225;vel e com tend&#234;ncia de diminui&#231;&#227;o em alguns pa&#237;ses nas &#250;ltimas d&#233;cadas&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> O diagn&#243;stico precoce e os avan&#231;os no tratamento da doen&#231;a avan&#231;ada s&#227;o os prov&#225;veis respons&#225;veis por essa estabiliza&#231;&#227;o nas taxas de mortalidade&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a> Do ponto de vista financeiro&#44; o melanoma cut&#226;neo representa &#244;nus cr&#237;tico para o Brasil&#44; e o custo da doen&#231;a varia de acordo com o sistema de sa&#250;de e com est&#225;gio no momento do diagn&#243;stico&#46; Os gastos com pacientes com doen&#231;a avan&#231;ada podem ser at&#233; 34 vezes &#40;Sistema &#218;nico de Sa&#250;de&#41; ou 270 vezes &#40;setor privado&#41; maiores do que o necess&#225;rio para o tratamento da doen&#231;a em est&#225;gio inicial&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Em decorr&#234;ncia das restri&#231;&#245;es sanit&#225;rias impostas pela pandemia de SARS&#8208;CoV&#8208;2&#44; o acesso aos servi&#231;os de sa&#250;de na cidade do Rio de Janeiro foi dificultado&#44; principalmente no ano de 2020&#46; Com isso&#44; houve praticamente a interrup&#231;&#227;o do seguimento dos pacientes de alto risco e dos exames de triagem para melanoma no Hospital Universit&#225;rio Pedro Ernesto &#40;HUPE&#41;&#46; A mensura&#231;&#227;o do impacto da diminui&#231;&#227;o da triagem do c&#226;ncer da pele nesse per&#237;odo na piora do progn&#243;stico dos pacientes com melanoma cut&#226;neo &#233; um desafio&#44; mas indicador necess&#225;rio aos servi&#231;os de sa&#250;de&#46; Nosso objetivo foi avaliar o impacto da pandemia de SARS&#8208;CoV&#8208;2 no diagn&#243;stico do melanoma cut&#226;neo prim&#225;rio no Servi&#231;o de Dermatologia de um hospital universit&#225;rio na cidade do Rio de Janeiro&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">M&#233;todos</span><p id="par0015" class="elsevierStylePara elsevierViewall">Realizamos estudo observacional transversal do tipo descritivo e anal&#237;tico sobre os casos de melanoma diagnosticados no Servi&#231;o de Dermatologia do HUPE&#46; Foram inclu&#237;dos os casos diagnosticados como melanoma cut&#226;neo prim&#225;rio com confirma&#231;&#227;o por meio de exame histopatol&#243;gico&#44; no per&#237;odo entre os anos de 2012 e 2021&#46; O impacto da pandemia de SARS&#8208;CoV&#8208;2 no diagn&#243;stico do melanoma cut&#226;neo prim&#225;rio foi avaliado a partir da compara&#231;&#227;o do n&#250;mero de casos diagnosticados e da m&#233;dia anual da espessura tumoral medida em mil&#237;metros nesse per&#237;odo&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A associac&#807;a&#771;o entre duas vari&#225;veis qualitativas foi verificada pelo teste de diferen&#231;a de propor&#231;&#245;es por meio do ajuste de Fisher para pequenos n&#250;meros&#46; A regress&#227;o de Poisson foi utilizada para estimativa das raz&#245;es de incid&#234;ncia e dos Intervalos de Confian&#231;a de 95&#37;&#46; A an&#225;lise estat&#237;stica foi realizada pelo software Stata&#47;SE 12&#46;0 for Mac&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Resultados</span><p id="par0025" class="elsevierStylePara elsevierViewall">Nos &#250;ltimos 10 anos&#44; desde que foi iniciado o atendimento no ambulat&#243;rio de les&#245;es pigmentadas do Servi&#231;o de Dermatologia do HUPE&#44; foram diagnosticados 91 novos casos de melanoma cut&#226;neo em 89 pacientes&#59; um paciente apresentou dois melanomas ass&#237;ncronos&#44; e outro paciente&#44; dois melanomas s&#237;ncronos&#46; Dos 91 tumores avaliados&#44; 24&#37; &#40;22&#41; eram les&#245;es <span class="elsevierStyleItalic">in situ</span> e 75&#37; &#40;69&#41; tumores invasivos com espessura m&#233;dia de 1&#44;04<span class="elsevierStyleHsp" style=""></span>mm &#40;0&#44;10&#8208;5&#44;72 mm&#41;&#44; com predom&#237;nio de 47&#37; &#40;42&#41; das les&#245;es com n&#237;vel II de invas&#227;o Clark&#46; Na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#44; observa&#8208;se a distribui&#231;&#227;o da mediana das espessuras de Breslow observadas entre os anos de 2012 e 2021&#46; A m&#233;dia do n&#250;mero de casos diagnosticados entre os anos de 2013 e 2019 foi de 9&#44;8 casos&#47;ano&#46; Em 2020&#44; observamos diminui&#231;&#227;o de 49&#44;0&#37; &#40;5&#41; no n&#250;mero de casos diagnosticados&#46; No ano de 2021&#44; tivemos 11 casos diagnosticados&#46; Apenas no primeiro trimestre de 2021&#44; foi diagnosticada a mesma quantidade de casos de melanoma de todo o ano de 2020&#46; Os achados da <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a> indicam que as taxas de incid&#234;ncia de melanoma decresceram entre o bi&#234;nio 2018&#47;2019 e 2020&#47;21&#44; variando de 3&#44;15 casos por 1&#46;000 agendamentos a 1&#44;34 casos por 1&#46;000 em 2020&#47;21&#46; As raz&#245;es de incid&#234;ncia indicaram que as taxas de 2020 e de 2021 foram&#44; respectivamente&#44; 72&#37; e 80&#37; menores se comparadas &#224; taxa de 2018&#47;2019&#46; A taxa mais baixa foi acompanhada da maior gravidade dos casos&#44; o que pode ser corroborado por n&#237;veis de invas&#227;o de Clark com clara tend&#234;ncia de avan&#231;o em 2020&#47;21 comparados com 2018&#47;2019&#46; Assim&#44; nota&#8208;se que em metade dos casos em 2020&#47;21 os n&#237;veis de invas&#227;o foram IV ou V&#59; esse percentual foi de 5&#37; em 2018&#47;2019&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discussa&#771;o</span><p id="par0030" class="elsevierStylePara elsevierViewall">Conforme recentemente demonstrado por meio de modelo de taxa de crescimento&#44; a probabilidade de aumento da espessura e progress&#227;o para est&#225;gio mais avan&#231;ado de doen&#231;a &#233; de 21&#37;&#44; 29&#37; e 45&#37; com um&#44; dois e tr&#234;s meses de atraso no diagn&#243;stico do melanoma&#44; respectivamente&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Diante das restri&#231;&#245;es impostas pela crise sanit&#225;ria&#44; podemos inferir que a pandemia do SARS&#8208;CoV&#8208;2 seja a justificativa mais prov&#225;vel para que tenhamos tido menor taxa mensal de casos diagnosticados no per&#237;odo ap&#243;s o in&#237;cio da pandemia e maiores espessuras de Breslow do que dos &#250;ltimos 10 anos&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">A incid&#234;ncia mundial do melanoma vem aumentando nas &#250;ltimas d&#233;cadas&#59; j&#225; as taxas de mortalidade parecem estar tendendo a se estabilizar&#46; Uma das principais raz&#245;es para essa estabiliza&#231;&#227;o &#233; o diagn&#243;stico precoce&#46; Apesar de recente trabalho cient&#237;fico realizado nos Estados Unidos ter proposto a interrup&#231;&#227;o de campanhas para detec&#231;&#227;o precoce do c&#226;ncer da pele como maneira de diminuir a quantidade de melanomas diagnosticados&#44; essa n&#227;o nos parece ser uma estrat&#233;gia prudente a ser adotada&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a> Quando comparamos a quantidade de melanomas diagnosticados no HUPE na d&#233;cada anterior &#40;2002&#8208;2011&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>71&#41;&#44; nota&#8208;se um incremento da ordem de 10&#37;&#46; Entretanto&#44; conforme nossos dados demonstram&#44; houve redu&#231;&#227;o de mais da metade do n&#250;mero de casos diagnosticados em 2020&#44; e os que foram detectados encontravam&#8208;se em fase mais avan&#231;ada&#46; &#192; semelhan&#231;a do que ocorreu com outros tipos de c&#226;ncer e do que foi observado com o diagn&#243;stico do melanoma na It&#225;lia&#44; durante o in&#237;cio da pandemia de SARS&#8208;CoV&#8208;2&#44; observamos uma significativa redu&#231;&#227;o do n&#250;mero de casos de melanoma cut&#226;neo diagnosticados&#44; o que potencialmente est&#225; associado com aumento na morbidade&#44; mortalidade e custos financeiros&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">6&#8211;13</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">O impacto do atraso no diagn&#243;stico ocasionado pela pandemia de SARS&#8208;CoV&#8208;2 na sobrevida dos pacientes com melanoma e nos custos envolvidos para o tratamento da doen&#231;a em est&#225;gios mais avan&#231;ados dever&#225; ser objeto de futuros estudos&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclus&#227;o</span><p id="par0050" class="elsevierStylePara elsevierViewall">No primeiro ano da pandemia de SARS&#8208;CoV&#8208;2 &#40;2020&#41;&#44; observamos significativa redu&#231;&#227;o do n&#250;mero de casos de melanoma cut&#226;neo prim&#225;rio diagnosticados&#44; e a espessura m&#233;dia dos tumores foi maior quando comparada com a dos casos diagnosticados nos &#250;ltimos oito anos anteriores&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Suporte financeiro</span><p id="par0055" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Contribui&#231;&#227;o dos autores</span><p id="par0060" class="elsevierStylePara elsevierViewall">Carlos Baptista Barcaui&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Carla Jorge Machado&#58; An&#225;lise estat&#237;stica&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Juan Pi&#241;eiro&#8208;Maceira&#58; Participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflito de interesses</span><p id="par0075" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">2012 &#40;mar&#8208;dez&#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&nbsp;\t\t\t\t\t\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">64 &#40;58&#59; 75&#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;44 &#40;0&#44;00&#59; 0&#44;57&#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">2013&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;58&#59; 71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;41 &#40;0&#44;00&#59; 0&#44;93&#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">2014&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;57&#59; 77&#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;00 &#40;0&#44;00&#59; 0&#44;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2015&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#40;47&#59; 65&#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;50 &#40;0&#44;31&#59; 0&#44;70&#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">2016&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;56&#59; 67&#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;23 &#40;0&#44;00&#59; 0&#44;77&#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">2017&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75 &#40;58&#59; 85&#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;45 &#40;0&#44;30&#59; 1&#44;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2018&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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">73 &#40;52&#59; 80&#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;30 &#40;0&#44;00&#59; 0&#44;50&#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">2019&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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">65 &#40;53&#59; 73&#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;60 &#40;0&#44;20&#59; 0&#44;60&#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">2020&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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">83 &#40;71&#59; 85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;40 &#40;0&#44;00&#59; 3&#44;30&#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">2021&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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">72 &#40;57&#59; 81&#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;50 &#40;0&#44;30&#59; 2&#44;60&#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">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&nbsp;\t\t\t\t\t\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">65 &#40;57&#59; 76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;40 &#40;0&#44;05&#59; 0&#44;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3688215.png"
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          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Mediana e percentis utilizados pois o teste de Shapiro&#8208;Wilk indicou aus&#234;ncia de normalidade para idade &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;049&#41; e para espessura de Breslow &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">N&#250;mero de casos de melanoma cut&#226;neo diagnosticados no servi&#231;o de Dermatologia do HUPE entre mar&#231;o de 2012 e 31 de dezembro de 2021&#44; idade m&#233;dia e mediana da espessura de Breslow dos casos invasivos</p>"
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      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabela 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabela "
            "rol" => "short"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Notas&#58; <span class="elsevierStyleItalic">DP</span>&#44; desvio padr&#227;o&#59; <span class="elsevierStyleItalic">p25</span>&#44; 25&#176; percentil&#59; <span class="elsevierStyleItalic">p75</span>&#44; 75&#176; percentil&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "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" 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">Vari&#225;veis analisadas e estat&#237;sticas&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">2018&#47;2019&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">2020&#47;2021&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">N&#250;mero de casos de melanoma</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\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&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">N&#250;mero de agendamentos</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&#46;349&nbsp;\t\t\t\t\t\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&#46;912&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">Taxas de incid&#234;ncia &#40;por mil agendamentos&#41;</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">3&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Raz&#245;es de incid&#234;ncia &#40;95&#37; IC&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;44 &#40;0&#44;27&#59;0&#44;73&#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">&#8208;&nbsp;\t\t\t\t\t\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">p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Ferlay"
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                            2 => "F&#46; Bray"
                            3 => "D&#46; Forman"
                            4 => "C&#46; Mathers"
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                          "etal" => false
                          "autores" => array:3 [
                            0 => "U&#46; Leiter"
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                        "link" => array:1 [
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                            0 => "C&#46;R&#46;P&#46; Veiga"
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                            2 => "A&#46; Souza"
                            3 => "A&#46;J&#46;A&#46; Wainstein"
                            4 => "A&#46;C&#46; Melo"
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                        "tituloSerie" => "BMC Health Serv Res&#46;"
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                          0 => array:2 [
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                      "Revista" => array:5 [
                        "tituloSerie" => "J Europ Acad Dermatol Venerol&#46;"
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                      "titulo" => "The impact of the COVID&#8208;19 pandemic on cancer deaths due to delays in diagnosis in England&#44; UK&#58; a national&#44; population&#8208;based&#44; modelling study"
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                          "etal" => true
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                      "titulo" => "COVID&#8208;19 is Affecting the Presentation and Treatment of Melanoma Patients in the Northeastern United States"
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                          "etal" => true
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ISSN: 26662752
Idioma original: Português
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