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estudo recente estimou aumento de 45&#37; dos casos de melanoma invasivo ap&#243;s atraso de tr&#234;s meses&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Embora alguns autores tenham observado redu&#231;&#227;o no n&#250;mero de melanomas diagnosticados durante o <span class="elsevierStyleItalic">lockdown</span>&#44;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">2&#44;9</span></a> outros estudos mostraram resultados opostos&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">10&#44;11</span></a> Entretanto&#44; como a maioria dos artigos limitou o per&#237;odo estudado ao <span class="elsevierStyleItalic">lockdown</span>&#44; s&#243; &#233; poss&#237;vel estimar o impacto do atraso no diagn&#243;stico do melanoma&#46; Os melanomas diagnosticados ap&#243;s o <span class="elsevierStyleItalic">lockdown</span> foram comparados n&#227;o apenas em curto prazo&#44; mas tamb&#233;m ap&#243;s o restabelecimento da atividade cl&#237;nica normal&#44; para avaliar se o atraso no diagn&#243;stico devido ao <span class="elsevierStyleItalic">lockdown</span> causado pela COVID&#8208;19 realmente significou piora do progn&#243;stico dos melanomas&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0015" class="elsevierStylePara elsevierViewall">Foi realizado estudo com desenho observacional retrospectivo&#44; unic&#234;ntrico&#44; de melanomas diagnosticados histopatologicamente entre 14 de mar&#231;o de 2019 e 13 de mar&#231;o de 2021&#46; Esse estudo foi aprovado pelo Comit&#234; de &#201;tica Institucional&#46; Os dados foram recuperados dos prontu&#225;rios do Departamento de Patologia do hospital da institui&#231;&#227;o&#46; Foram coletados dados demogr&#225;ficos&#44; encaminhamento por teledermatologia&#44; localiza&#231;&#227;o do melanoma&#44; espessura de Breslow &#40;mm&#41;&#44; presen&#231;a de mitoses&#44; ulcera&#231;&#227;o e estadiamento do AJCC &#40;<span class="elsevierStyleItalic">American Joint Committee on Cancer 8</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">th</span></span><span class="elsevierStyleItalic">edition</span>&#41;&#46; A incid&#234;ncia foi calculada por 100&#46;000 habitantes&#46; Melanomas metast&#225;ticos e melanomas diagnosticado clinicamente sem confirma&#231;&#227;o histopatol&#243;gica foram exclu&#237;dos&#46; O primeiro per&#237;odo de seis meses ap&#243;s o in&#237;cio do lockdown&#44; entre 14 de mar&#231;o de 2020 e 13 de setembro de 2020 &#40;1&#176; P20&#41; e um segundo per&#237;odo de seis meses entre 14 de setembro de 2020 e 13 de mar&#231;o de 2021 &#40;2&#176; P20&#41; foram comparados com os mesmos per&#237;odos do ano anterior &#40;1&#176; P19 e 2&#176; P19&#44; respectivamente&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A an&#225;lise estat&#237;stica foi realizada utilizando R &#40;R Core Team&#44; Viena&#44; &#193;ustria&#41;&#59; teste <span class="elsevierStyleItalic">t</span> e teste U de Mann&#8208;Whitney foram usados para vari&#225;veis quantitativas&#46; O teste exato de Fisher foi usado para a an&#225;lise das vari&#225;veis qualitativas&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0025" class="elsevierStylePara elsevierViewall">Um total de 119 melanomas foi inclu&#237;do no estudo&#46; As caracter&#237;sticas dos melanomas est&#227;o resumidas na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; Um total de 29 e 24 melanomas foram diagnosticados no 1&#176; P19 e 1&#176; P20 respectivamente&#44; e n&#227;o foram encontradas diferen&#231;as em rela&#231;&#227;o &#224; incid&#234;ncia &#40;16&#44;1 vs&#46; 13&#44;3 por 100&#46;000 habitantes&#44; p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41;&#46; Um total de 36 e 30 melanomas foram diagnosticados no 2&#176; P19 e 2&#176; P20 respectivamente&#44; tamb&#233;m sem diferen&#231;as na incid&#234;ncia &#40;20 vs&#46; 16&#44;7 por 100&#46;000 habitantes&#44; p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Os pacientes em ambos os per&#237;odos foram semelhantes em rela&#231;&#227;o a idade e sexo &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41;&#46; N&#227;o houve diferen&#231;as na localiza&#231;&#227;o dos tumores&#44; taxa de encaminhamento &#224; teledermatologia e presen&#231;a de ulcera&#231;&#227;o ou mitoses &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Os melanomas invasivos representaram 45&#37; e 67&#37; dos melanomas diagnosticados no 1&#176; P19 e 1&#176; P20&#44; respectivamente&#46; Ap&#243;s a recupera&#231;&#227;o da atividade normal&#44; a propor&#231;&#227;o de melanomas invasivos foi de 58&#37; para o 2&#176; P19 e 47&#37; para o 2&#176; P20&#46; No entanto&#44; n&#227;o foram encontradas diferen&#231;as estatisticamente significativas nas taxas de melanoma <span class="elsevierStyleItalic">in situ</span>&#47;invasivo em nenhum dos per&#237;odos&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">A espessura de Breslow dos melanomas diagnosticados aumentou no 2&#176;P20 em compara&#231;&#227;o com o ano anterior &#40;2&#44;4 <span class="elsevierStyleItalic">vs</span>&#46; 1&#44;9<span class="elsevierStyleHsp" style=""></span>mm&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; o que implicou em diferen&#231;as no est&#225;gio AJCC &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Entretanto&#44; n&#227;o foram encontradas diferen&#231;as no primeiro per&#237;odo &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41; &#8211; <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0045" class="elsevierStylePara elsevierViewall">Diferentes abordagens&#44; como a promo&#231;&#227;o da teledermatologia&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> foram consideradas para minimizar os efeitos da COVID&#8208;19 no diagn&#243;stico de melanomas&#46; Valenti et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> relataram adiamento de 2&#44;3 meses das revis&#245;es de c&#226;ncer de pele avan&#231;ado&#44; que &#233; semelhante ao atraso m&#233;dio estimado de tr&#234;s meses&#44; pois foram necess&#225;rios seis meses desde o in&#237;cio do <span class="elsevierStyleItalic">lockdown</span> at&#233; que a atividade cl&#237;nica normal fosse novamente alcan&#231;ada&#46; De acordo com alguns estudos&#44; esse atraso seria suficiente para determinar o aumento do est&#225;gio de melanomas invasivos&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> mas esse aumento na espessura de Breslow s&#243; seria visto quando o atraso ocorresse e n&#227;o durante o <span class="elsevierStyleItalic">lockdown</span>&#46; Por isso&#44; foi inclu&#237;do um segundo per&#237;odo ap&#243;s a atividade cl&#237;nica ter recuperado os n&#237;veis de pr&#233;&#8208;<span class="elsevierStyleItalic">lockdown</span> para analisar se o atraso no diagn&#243;stico realmente teve repercuss&#227;o naqueles melanomas que potencialmente &#8220;ficaram em casa&#8221;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Alguns autores encontraram uma redu&#231;&#227;o significativa no diagn&#243;stico de melanoma durante o <span class="elsevierStyleItalic">lockdown</span>&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">2&#44;9</span></a> Entretanto&#44; semelhante a outros relatos&#44;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">10&#44;11</span></a> embora uma diminui&#231;&#227;o no n&#250;mero de melanomas tenha sido encontrada em ambos os per&#237;odos &#40;cinco no primeiro per&#237;odo e seis no segundo per&#237;odo&#41;&#44; n&#227;o foi identificada uma redu&#231;&#227;o significativa na incid&#234;ncia de melanomas por 100&#46;000 habitantes em nenhum per&#237;odo&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Alguns relatos mostraram um aumento na espessura de Breslow ou um aumento do est&#225;gio dos melanomas diagnosticados durante o <span class="elsevierStyleItalic">lockdown</span> em compara&#231;&#227;o com o ano anterior&#44;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">14&#44;15</span></a> mas como alguns tamb&#233;m mostraram uma diminui&#231;&#227;o importante no n&#250;mero de diagn&#243;sticos&#44; principalmente de melanomas <span class="elsevierStyleItalic">in situ</span>&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> acredita&#8208;se que seria o resultado do subdiagn&#243;stico de melanomas finos&#44; e n&#227;o de um crescimento &#8220;imediato&#8221; de melanomas devido ao <span class="elsevierStyleItalic">lockdown</span>&#46; Como esperado&#44; n&#227;o foram encontradas diferen&#231;as na espessura de Breslow no primeiro per&#237;odo&#44; mas foi encontrado aumento significante na espessura de Breslow ap&#243;s a recupera&#231;&#227;o da atividade normal em compara&#231;&#227;o com o ano anterior &#40;1&#44;9<span class="elsevierStyleHsp" style=""></span>mm no 2&#176; P19 <span class="elsevierStyleItalic">vs</span>&#46; 2&#44;4<span class="elsevierStyleHsp" style=""></span>mm no 2&#176; P20&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#59; <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#44; o que implicou em aumento do est&#225;gio de acordo com os crit&#233;rios do AJCC 8&#170; ed&#46; &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Isso indica que&#44; embora n&#227;o tenha sido encontrada redu&#231;&#227;o na incid&#234;ncia&#44; alguns melanomas sofreram atraso no diagn&#243;stico&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Entretanto&#44; essa piora de progn&#243;stico encontrada nos melanomas invasivos devido ao atraso parece n&#227;o afetar da mesma forma os melanomas <span class="elsevierStyleItalic">in situ</span>&#46; Coincidindo com outros relatos&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> os resultados do presente estudo n&#227;o mostram diferen&#231;as nas taxas de melanoma <span class="elsevierStyleItalic">in situ</span> e invasivo antes e ap&#243;s o in&#237;cio do <span class="elsevierStyleItalic">lockdown</span> e ap&#243;s a recupera&#231;&#227;o da atividade cl&#237;nica normal &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41;&#46; Portanto&#44; pode&#8208;se supor que um atraso m&#233;dio de tr&#234;s meses no diagn&#243;stico decorrente da COVID&#8208;19 n&#227;o significou progress&#227;o de melanomas <span class="elsevierStyleItalic">in situ</span> no hospital onde o presente estudo foi realizado&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Mais estudos ap&#243;s a retomada da atividade cl&#237;nica normal s&#227;o necess&#225;rios para avaliar se o atraso do diagn&#243;stico realmente implicou em um aumento da progress&#227;o para melanomas invasivos&#46; Embora os autores tenham esperan&#231;a de que essa situa&#231;&#227;o de atraso no diagn&#243;stico do melanoma n&#227;o se repetir&#225;&#44; eles acreditam que &#233; uma oportunidade excepcional para a investiga&#231;&#227;o da biologia do melanoma <span class="elsevierStyleItalic">in situ</span> e invasivo&#46; Uma investiga&#231;&#227;o mais aprofundada nesta &#225;rea poderia fornecer informa&#231;&#245;es valiosas para os protocolos de detec&#231;&#227;o de melanoma e para melhor compreender seu comportamento natural&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#245;es</span><p id="par0070" class="elsevierStylePara elsevierViewall">N&#227;o foi encontrada redu&#231;&#227;o na incid&#234;ncia de melanomas em nenhum dos per&#237;odos considerados&#46; No entanto&#44; o aumento da espessura de Breslow e o consequente aumento do est&#225;gio observado&#44; uma vez restabelecida a atividade cl&#237;nica normal&#44; sugere que o <span class="elsevierStyleItalic">lockdown</span> causado pela COVID&#8208;19 resultou em atraso no diagn&#243;stico do melanoma e piora do progn&#243;stico dos melanomas invasivos&#46; As taxas semelhantes de melanoma <span class="elsevierStyleItalic">in situ</span>&#47;invasivo sugerem que um atraso m&#233;dio de tr&#234;s meses no diagn&#243;stico n&#227;o implica necessariamente em um aumento na progress&#227;o dos melanomas <span class="elsevierStyleItalic">in situ</span>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Os autores acreditam que &#233; importante reavaliar a real repercuss&#227;o do <span class="elsevierStyleItalic">lockdown</span> no melanoma analisando os melanomas diagnosticados uma vez restabelecida a atividade cl&#237;nica pr&#233;&#8208;pandemia&#46; Os resultados apresentados podem n&#227;o ser completamente generaliz&#225;veis para outras regi&#245;es com diferentes incid&#234;ncias de COVID&#8208;19&#46; Portanto&#44; os autores encorajam outros pesquisadores a analisar os diagn&#243;sticos de melanoma em m&#233;dio prazo&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0080" 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="par0085" class="elsevierStylePara elsevierViewall">Pedro Gil&#8208;Pallares&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o de dados&#44; ou an&#225;lise e interpreta&#231;&#227;o de dados&#59; an&#225;lise estat&#237;stica&#59; reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#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; 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; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Olalla Figueroa&#8208;Silva&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o de dados&#44; ou an&#225;lise e interpreta&#231;&#227;o de dados&#59; an&#225;lise estat&#237;stica&#59; reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#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; 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; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Maria Eugenia Gil&#8208;Pallares&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o de dados&#44; ou an&#225;lise e interpreta&#231;&#227;o de dados&#59; an&#225;lise estat&#237;stica&#59; reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#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; 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; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Jos&#233; &#193;ngel V&#225;zquez&#8208;Bueno&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;p de dados&#44; ou an&#225;lise e interpreta&#231;&#227;o de dados&#59; an&#225;lise estat&#237;stica&#59; reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#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; 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; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Francisca Pi&#241;eyro&#8208;Molina&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o de dados&#44; ou an&#225;lise e interpreta&#231;&#227;o de dados&#59; an&#225;lise estat&#237;stica&#59; reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#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; 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; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Benigno Monteagudo&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o de dados&#44; ou an&#225;lise e interpreta&#231;&#227;o de dados&#59; an&#225;lise estat&#237;stica&#59; reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#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; 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; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Cristina De las Heras&#8208;Sotos&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o de dados&#44; ou an&#225;lise e interpreta&#231;&#227;o de dados&#59; an&#225;lise estat&#237;stica&#59; reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#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; 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; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#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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            1 => "Melanoma"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">O <span class="elsevierStyleItalic">lockdown</span> estabelecido pela COVID&#8208;19 possivelmente significou atraso no diagn&#243;stico e tratamento do melanoma e&#44; portanto&#44; piora do progn&#243;stico&#46; Essa situa&#231;&#227;o especial de adiamento do diagn&#243;stico &#233; oportunidade excepcional para investigar a biologia do melanoma&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar o impacto imediato e em m&#233;dio prazo do atraso no diagn&#243;stico do melanoma relacionado ao <span class="elsevierStyleItalic">lockdown</span> da COVID&#8208;19&#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 retrospectivo de melanomas diagnosticados entre 14 de mar&#231;o de 2019 e 13 de mar&#231;o de 2021&#46; Foram comparadas as caracter&#237;sticas dos melanomas diagnosticados durante um primeiro per&#237;odo de seis meses ap&#243;s a instaura&#231;&#227;o do <span class="elsevierStyleItalic">lockdown</span> e um segundo per&#237;odo ap&#243;s a recupera&#231;&#227;o da atividade normal com os mesmos per&#237;odos do ano anterior&#44; respectivamente&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Foram diagnosticados 119 melanomas&#46; N&#227;o houve diferen&#231;as em rela&#231;&#227;o &#224; idade&#44; sexo&#44; incid&#234;ncia&#44; localiza&#231;&#227;o&#44; presen&#231;a de ulcera&#231;&#227;o ou mitoses e taxa de melanoma <span class="elsevierStyleItalic">in situ</span>&#47;invasivo &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41;&#46; Ap&#243;s a recupera&#231;&#227;o da atividade normal&#44; a espessura de Breslow aumentou em compara&#231;&#227;o com o ano anterior &#40;2&#44;4 <span class="elsevierStyleItalic">vs</span>&#46; 1&#44;9<span class="elsevierStyleHsp" style=""></span>mm&#44; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; resultando em aumento significante seguindo os crit&#233;rios do AJCC 8&#170; ed&#46; &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#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">A principal limita&#231;&#227;o &#233; que este &#233; um estudo de centro &#250;nico&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">O lockdown causado pela COVID&#8208;19 implicou em atraso no diagn&#243;stico&#44; levando ao aumento em m&#233;dio prazo na espessura de Breslow e no aumento do est&#225;gio de melanomas invasivos&#46; Entretanto&#44; o adiamento da detec&#231;&#227;o n&#227;o resultou em maior progress&#227;o dos melanomas in situ para invasivos na presente institui&#231;&#227;o&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Como citar este artigo&#58; Gil&#8208;Pallares P&#44; Figueroa&#8208;Silva O&#44; Gil&#8208;Pallares ME&#44; V&#225;zquez&#8208;Bueno J&#193;&#44; Pi&#241;eyro&#8208;Molina F&#44; Monteagudo B&#44; et al&#46; Did COVID&#8208;19 lockdown diagnosis delay actually worsen melanoma prognosis&#63; An Bras Dermatol&#46; 2023&#59;98&#58;176&#8211;80&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Trabalho realizado no Departamento de Dermatologia&#44; Complejo Hospitalario Universitario de Ferrol in Ferrol&#44; Coruna&#44; Espanha&#46;</p>"
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          "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A espessura de Breslow dos melanomas invasivos n&#227;o diferiu significantemente durante o primeiro per&#237;odo &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41; &#40;A&#41;&#46; Entretanto&#44; aumento estatisticamente significante da espessura de Breslow foi observado no 2&#176; P20&#44; ap&#243;s a recupera&#231;&#227;o da atividade normal&#44; em compara&#231;&#227;o com o ano anterior &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; &#40;B&#41;&#46; Esses resultados sugerem que alguns melanomas invasivos sofreram atraso no diagn&#243;stico&#44; o que implicou em piora do progn&#243;stico&#46;</p>"
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">Sexo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \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;612&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><span class="elsevierStyleHsp" style=""></span>Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;48&#37;&#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">11 &#40;46&#37;&#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><td class="td" title="\n
                  \t\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 &#40;31&#37;&#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">11 &#40;37&#37;&#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><span class="elsevierStyleHsp" style=""></span>Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;52&#37;&#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 &#40;54&#37;&#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><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;69&#37;&#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">19 &#40;63&#37;&#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="elsevierStyleBold">Localiza&#231;&#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">0&#44;777&nbsp;\t\t\t\t\t\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;396&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><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">10 &#40;34&#37;&#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">7 &#40;29&#37;&#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><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;33&#37;&#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 &#40;30&#37;&#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><span class="elsevierStyleHsp" style=""></span>Tronco anterior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;7&#37;&#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">4 &#40;17&#37;&#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><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;6&#37;&#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 &#40;3&#37;&#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><span class="elsevierStyleHsp" style=""></span>Tronco posterior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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 &#40;31&#37;&#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">7 &#40;29&#37;&#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><td class="td" title="\n
                  \t\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 &#40;31&#37;&#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;27&#37;&#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><span class="elsevierStyleHsp" style=""></span>Extremidade superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;21&#37;&#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;13&#37;&#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><td class="td" title="\n
                  \t\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;11&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;7&#37;&#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><span class="elsevierStyleHsp" style=""></span>Extremidade inferior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;8&#37;&#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><td class="td" title="\n
                  \t\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 &#40;19&#37;&#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 &#40;20&#37;&#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><span class="elsevierStyleHsp" style=""></span>Acral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;4&#37;&#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><td class="td" title="\n
                  \t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;13&#37;&#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="elsevierStyleBold">Encaminhamento</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"><span class="elsevierStyleBold">Espessura de Breslow &#40;mm&#44; m&#233;dia&#41;</span></td><td class="td" title="\n
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                  """
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                    0 => array:2 [
                      "titulo" => "Impact of the COVID&#8208;19 pandemic and related control measures on cancer diagnosis in Catalonia&#58; a time&#8208;series analysis of primary care electronic health records covering about five million people"
                      "autores" => array:1 [
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                          "autores" => array:6 [
                            0 => "E&#46; Coma"
                            1 => "C&#46; Guiriguet"
                            2 => "N&#46; Mora"
                            3 => "M&#46; Marzo-Castillejo"
                            4 => "M&#46; Ben&#237;tez"
                            5 => "L&#46; M&#233;ndez-Boo"
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                      "doi" => "10.1136/bmjopen-2020-047567"
                      "Revista" => array:6 [
                        "tituloSerie" => "BMJ Open&#46;"
                        "fecha" => "2021"
                        "volumen" => "11"
                        "numero" => "8"
                        "paginaInicial" => "e047567"
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Artigo original
O atraso no diagnóstico causado pelo lockdown da COVID‐19 piorou o prognóstico do melanoma?
Pedro Gil‐Pallaresa,
Autor para correspondência
pedrogilpallares@gmail.com

Autor para correspondência.
, Olalla Figueroa‐Silvaa, Maria Eugenia Gil‐Pallaresc, José Ángel Vázquez‐Buenob, Francisca Piñeyro‐Molinaa, Benigno Monteagudoa, Cristina De las Heras‐Sotosa
a Departamento de Dermatologia, Complejo Hospitalario Universitario de Ferrol, Ferrol, Espanha
b Departamento de Patologia, Complejo Hospitalario Universitario de Ferrol, Ferrol, Espanha
c Universidad de Santiago de Compostela, Santiago de Compostela, Espanha
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espessura de Breslow &#40;mm&#41;&#44; presen&#231;a de mitoses&#44; ulcera&#231;&#227;o e estadiamento do AJCC &#40;<span class="elsevierStyleItalic">American Joint Committee on Cancer 8</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">th</span></span><span class="elsevierStyleItalic">edition</span>&#41;&#46; A incid&#234;ncia foi calculada por 100&#46;000 habitantes&#46; Melanomas metast&#225;ticos e melanomas diagnosticado clinicamente sem confirma&#231;&#227;o histopatol&#243;gica foram exclu&#237;dos&#46; O primeiro per&#237;odo de seis meses ap&#243;s o in&#237;cio do lockdown&#44; entre 14 de mar&#231;o de 2020 e 13 de setembro de 2020 &#40;1&#176; P20&#41; e um segundo per&#237;odo de seis meses entre 14 de setembro de 2020 e 13 de mar&#231;o de 2021 &#40;2&#176; P20&#41; foram comparados com os mesmos per&#237;odos do ano anterior &#40;1&#176; P19 e 2&#176; P19&#44; respectivamente&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A an&#225;lise estat&#237;stica foi realizada utilizando R &#40;R Core Team&#44; Viena&#44; &#193;ustria&#41;&#59; teste <span class="elsevierStyleItalic">t</span> e teste U de Mann&#8208;Whitney foram usados para vari&#225;veis quantitativas&#46; O teste exato de Fisher foi usado para a an&#225;lise das vari&#225;veis qualitativas&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0025" class="elsevierStylePara elsevierViewall">Um total de 119 melanomas foi inclu&#237;do no estudo&#46; As caracter&#237;sticas dos melanomas est&#227;o resumidas na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; Um total de 29 e 24 melanomas foram diagnosticados no 1&#176; P19 e 1&#176; P20 respectivamente&#44; e n&#227;o foram encontradas diferen&#231;as em rela&#231;&#227;o &#224; incid&#234;ncia &#40;16&#44;1 vs&#46; 13&#44;3 por 100&#46;000 habitantes&#44; p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41;&#46; Um total de 36 e 30 melanomas foram diagnosticados no 2&#176; P19 e 2&#176; P20 respectivamente&#44; tamb&#233;m sem diferen&#231;as na incid&#234;ncia &#40;20 vs&#46; 16&#44;7 por 100&#46;000 habitantes&#44; p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Os pacientes em ambos os per&#237;odos foram semelhantes em rela&#231;&#227;o a idade e sexo &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41;&#46; N&#227;o houve diferen&#231;as na localiza&#231;&#227;o dos tumores&#44; taxa de encaminhamento &#224; teledermatologia e presen&#231;a de ulcera&#231;&#227;o ou mitoses &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Os melanomas invasivos representaram 45&#37; e 67&#37; dos melanomas diagnosticados no 1&#176; P19 e 1&#176; P20&#44; respectivamente&#46; Ap&#243;s a recupera&#231;&#227;o da atividade normal&#44; a propor&#231;&#227;o de melanomas invasivos foi de 58&#37; para o 2&#176; P19 e 47&#37; para o 2&#176; P20&#46; No entanto&#44; n&#227;o foram encontradas diferen&#231;as estatisticamente significativas nas taxas de melanoma <span class="elsevierStyleItalic">in situ</span>&#47;invasivo em nenhum dos per&#237;odos&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">A espessura de Breslow dos melanomas diagnosticados aumentou no 2&#176;P20 em compara&#231;&#227;o com o ano anterior &#40;2&#44;4 <span class="elsevierStyleItalic">vs</span>&#46; 1&#44;9<span class="elsevierStyleHsp" style=""></span>mm&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; o que implicou em diferen&#231;as no est&#225;gio AJCC &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Entretanto&#44; n&#227;o foram encontradas diferen&#231;as no primeiro per&#237;odo &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41; &#8211; <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0045" class="elsevierStylePara elsevierViewall">Diferentes abordagens&#44; como a promo&#231;&#227;o da teledermatologia&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> foram consideradas para minimizar os efeitos da COVID&#8208;19 no diagn&#243;stico de melanomas&#46; Valenti et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> relataram adiamento de 2&#44;3 meses das revis&#245;es de c&#226;ncer de pele avan&#231;ado&#44; que &#233; semelhante ao atraso m&#233;dio estimado de tr&#234;s meses&#44; pois foram necess&#225;rios seis meses desde o in&#237;cio do <span class="elsevierStyleItalic">lockdown</span> at&#233; que a atividade cl&#237;nica normal fosse novamente alcan&#231;ada&#46; De acordo com alguns estudos&#44; esse atraso seria suficiente para determinar o aumento do est&#225;gio de melanomas invasivos&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> mas esse aumento na espessura de Breslow s&#243; seria visto quando o atraso ocorresse e n&#227;o durante o <span class="elsevierStyleItalic">lockdown</span>&#46; Por isso&#44; foi inclu&#237;do um segundo per&#237;odo ap&#243;s a atividade cl&#237;nica ter recuperado os n&#237;veis de pr&#233;&#8208;<span class="elsevierStyleItalic">lockdown</span> para analisar se o atraso no diagn&#243;stico realmente teve repercuss&#227;o naqueles melanomas que potencialmente &#8220;ficaram em casa&#8221;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Alguns autores encontraram uma redu&#231;&#227;o significativa no diagn&#243;stico de melanoma durante o <span class="elsevierStyleItalic">lockdown</span>&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">2&#44;9</span></a> Entretanto&#44; semelhante a outros relatos&#44;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">10&#44;11</span></a> embora uma diminui&#231;&#227;o no n&#250;mero de melanomas tenha sido encontrada em ambos os per&#237;odos &#40;cinco no primeiro per&#237;odo e seis no segundo per&#237;odo&#41;&#44; n&#227;o foi identificada uma redu&#231;&#227;o significativa na incid&#234;ncia de melanomas por 100&#46;000 habitantes em nenhum per&#237;odo&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Alguns relatos mostraram um aumento na espessura de Breslow ou um aumento do est&#225;gio dos melanomas diagnosticados durante o <span class="elsevierStyleItalic">lockdown</span> em compara&#231;&#227;o com o ano anterior&#44;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">14&#44;15</span></a> mas como alguns tamb&#233;m mostraram uma diminui&#231;&#227;o importante no n&#250;mero de diagn&#243;sticos&#44; principalmente de melanomas <span class="elsevierStyleItalic">in situ</span>&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> acredita&#8208;se que seria o resultado do subdiagn&#243;stico de melanomas finos&#44; e n&#227;o de um crescimento &#8220;imediato&#8221; de melanomas devido ao <span class="elsevierStyleItalic">lockdown</span>&#46; Como esperado&#44; n&#227;o foram encontradas diferen&#231;as na espessura de Breslow no primeiro per&#237;odo&#44; mas foi encontrado aumento significante na espessura de Breslow ap&#243;s a recupera&#231;&#227;o da atividade normal em compara&#231;&#227;o com o ano anterior &#40;1&#44;9<span class="elsevierStyleHsp" style=""></span>mm no 2&#176; P19 <span class="elsevierStyleItalic">vs</span>&#46; 2&#44;4<span class="elsevierStyleHsp" style=""></span>mm no 2&#176; P20&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#59; <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#44; o que implicou em aumento do est&#225;gio de acordo com os crit&#233;rios do AJCC 8&#170; ed&#46; &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Isso indica que&#44; embora n&#227;o tenha sido encontrada redu&#231;&#227;o na incid&#234;ncia&#44; alguns melanomas sofreram atraso no diagn&#243;stico&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Entretanto&#44; essa piora de progn&#243;stico encontrada nos melanomas invasivos devido ao atraso parece n&#227;o afetar da mesma forma os melanomas <span class="elsevierStyleItalic">in situ</span>&#46; Coincidindo com outros relatos&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> os resultados do presente estudo n&#227;o mostram diferen&#231;as nas taxas de melanoma <span class="elsevierStyleItalic">in situ</span> e invasivo antes e ap&#243;s o in&#237;cio do <span class="elsevierStyleItalic">lockdown</span> e ap&#243;s a recupera&#231;&#227;o da atividade cl&#237;nica normal &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41;&#46; Portanto&#44; pode&#8208;se supor que um atraso m&#233;dio de tr&#234;s meses no diagn&#243;stico decorrente da COVID&#8208;19 n&#227;o significou progress&#227;o de melanomas <span class="elsevierStyleItalic">in situ</span> no hospital onde o presente estudo foi realizado&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Mais estudos ap&#243;s a retomada da atividade cl&#237;nica normal s&#227;o necess&#225;rios para avaliar se o atraso do diagn&#243;stico realmente implicou em um aumento da progress&#227;o para melanomas invasivos&#46; Embora os autores tenham esperan&#231;a de que essa situa&#231;&#227;o de atraso no diagn&#243;stico do melanoma n&#227;o se repetir&#225;&#44; eles acreditam que &#233; uma oportunidade excepcional para a investiga&#231;&#227;o da biologia do melanoma <span class="elsevierStyleItalic">in situ</span> e invasivo&#46; Uma investiga&#231;&#227;o mais aprofundada nesta &#225;rea poderia fornecer informa&#231;&#245;es valiosas para os protocolos de detec&#231;&#227;o de melanoma e para melhor compreender seu comportamento natural&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#245;es</span><p id="par0070" class="elsevierStylePara elsevierViewall">N&#227;o foi encontrada redu&#231;&#227;o na incid&#234;ncia de melanomas em nenhum dos per&#237;odos considerados&#46; No entanto&#44; o aumento da espessura de Breslow e o consequente aumento do est&#225;gio observado&#44; uma vez restabelecida a atividade cl&#237;nica normal&#44; sugere que o <span class="elsevierStyleItalic">lockdown</span> causado pela COVID&#8208;19 resultou em atraso no diagn&#243;stico do melanoma e piora do progn&#243;stico dos melanomas invasivos&#46; As taxas semelhantes de melanoma <span class="elsevierStyleItalic">in situ</span>&#47;invasivo sugerem que um atraso m&#233;dio de tr&#234;s meses no diagn&#243;stico n&#227;o implica necessariamente em um aumento na progress&#227;o dos melanomas <span class="elsevierStyleItalic">in situ</span>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Os autores acreditam que &#233; importante reavaliar a real repercuss&#227;o do <span class="elsevierStyleItalic">lockdown</span> no melanoma analisando os melanomas diagnosticados uma vez restabelecida a atividade cl&#237;nica pr&#233;&#8208;pandemia&#46; Os resultados apresentados podem n&#227;o ser completamente generaliz&#225;veis para outras regi&#245;es com diferentes incid&#234;ncias de COVID&#8208;19&#46; Portanto&#44; os autores encorajam outros pesquisadores a analisar os diagn&#243;sticos de melanoma em m&#233;dio prazo&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0080" 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="par0085" class="elsevierStylePara elsevierViewall">Pedro Gil&#8208;Pallares&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o de dados&#44; ou an&#225;lise e interpreta&#231;&#227;o de dados&#59; an&#225;lise estat&#237;stica&#59; reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#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; 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; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Olalla Figueroa&#8208;Silva&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o de dados&#44; ou an&#225;lise e interpreta&#231;&#227;o de dados&#59; an&#225;lise estat&#237;stica&#59; reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#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; 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; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Maria Eugenia Gil&#8208;Pallares&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o de dados&#44; ou an&#225;lise e interpreta&#231;&#227;o de dados&#59; an&#225;lise estat&#237;stica&#59; reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#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; 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; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Jos&#233; &#193;ngel V&#225;zquez&#8208;Bueno&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;p de dados&#44; ou an&#225;lise e interpreta&#231;&#227;o de dados&#59; an&#225;lise estat&#237;stica&#59; reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#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; 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; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Francisca Pi&#241;eyro&#8208;Molina&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o de dados&#44; ou an&#225;lise e interpreta&#231;&#227;o de dados&#59; an&#225;lise estat&#237;stica&#59; reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#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; 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; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Benigno Monteagudo&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o de dados&#44; ou an&#225;lise e interpreta&#231;&#227;o de dados&#59; an&#225;lise estat&#237;stica&#59; reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#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; 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; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Cristina De las Heras&#8208;Sotos&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o de dados&#44; ou an&#225;lise e interpreta&#231;&#227;o de dados&#59; an&#225;lise estat&#237;stica&#59; reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#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; 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; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#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">O <span class="elsevierStyleItalic">lockdown</span> estabelecido pela COVID&#8208;19 possivelmente significou atraso no diagn&#243;stico e tratamento do melanoma e&#44; portanto&#44; piora do progn&#243;stico&#46; Essa situa&#231;&#227;o especial de adiamento do diagn&#243;stico &#233; oportunidade excepcional para investigar a biologia do melanoma&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar o impacto imediato e em m&#233;dio prazo do atraso no diagn&#243;stico do melanoma relacionado ao <span class="elsevierStyleItalic">lockdown</span> da COVID&#8208;19&#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 retrospectivo de melanomas diagnosticados entre 14 de mar&#231;o de 2019 e 13 de mar&#231;o de 2021&#46; Foram comparadas as caracter&#237;sticas dos melanomas diagnosticados durante um primeiro per&#237;odo de seis meses ap&#243;s a instaura&#231;&#227;o do <span class="elsevierStyleItalic">lockdown</span> e um segundo per&#237;odo ap&#243;s a recupera&#231;&#227;o da atividade normal com os mesmos per&#237;odos do ano anterior&#44; respectivamente&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Foram diagnosticados 119 melanomas&#46; N&#227;o houve diferen&#231;as em rela&#231;&#227;o &#224; idade&#44; sexo&#44; incid&#234;ncia&#44; localiza&#231;&#227;o&#44; presen&#231;a de ulcera&#231;&#227;o ou mitoses e taxa de melanoma <span class="elsevierStyleItalic">in situ</span>&#47;invasivo &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41;&#46; Ap&#243;s a recupera&#231;&#227;o da atividade normal&#44; a espessura de Breslow aumentou em compara&#231;&#227;o com o ano anterior &#40;2&#44;4 <span class="elsevierStyleItalic">vs</span>&#46; 1&#44;9<span class="elsevierStyleHsp" style=""></span>mm&#44; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; resultando em aumento significante seguindo os crit&#233;rios do AJCC 8&#170; ed&#46; &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#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">A principal limita&#231;&#227;o &#233; que este &#233; um estudo de centro &#250;nico&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">O lockdown causado pela COVID&#8208;19 implicou em atraso no diagn&#243;stico&#44; levando ao aumento em m&#233;dio prazo na espessura de Breslow e no aumento do est&#225;gio de melanomas invasivos&#46; Entretanto&#44; o adiamento da detec&#231;&#227;o n&#227;o resultou em maior progress&#227;o dos melanomas in situ para invasivos na presente institui&#231;&#227;o&#46;</p></span>"
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          4 => array:2 [
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            "titulo" => "Limita&#231;&#245;es do estudo"
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    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Como citar este artigo&#58; Gil&#8208;Pallares P&#44; Figueroa&#8208;Silva O&#44; Gil&#8208;Pallares ME&#44; V&#225;zquez&#8208;Bueno J&#193;&#44; Pi&#241;eyro&#8208;Molina F&#44; Monteagudo B&#44; et al&#46; Did COVID&#8208;19 lockdown diagnosis delay actually worsen melanoma prognosis&#63; An Bras Dermatol&#46; 2023&#59;98&#58;176&#8211;80&#46;</p>"
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      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Trabalho realizado no Departamento de Dermatologia&#44; Complejo Hospitalario Universitario de Ferrol in Ferrol&#44; Coruna&#44; Espanha&#46;</p>"
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          "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A espessura de Breslow dos melanomas invasivos n&#227;o diferiu significantemente durante o primeiro per&#237;odo &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41; &#40;A&#41;&#46; Entretanto&#44; aumento estatisticamente significante da espessura de Breslow foi observado no 2&#176; P20&#44; ap&#243;s a recupera&#231;&#227;o da atividade normal&#44; em compara&#231;&#227;o com o ano anterior &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; &#40;B&#41;&#46; Esses resultados sugerem que alguns melanomas invasivos sofreram atraso no diagn&#243;stico&#44; o que implicou em piora do progn&#243;stico&#46;</p>"
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \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;612&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><span class="elsevierStyleHsp" style=""></span>Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;48&#37;&#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">11 &#40;46&#37;&#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><td class="td" title="\n
                  \t\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 &#40;31&#37;&#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">11 &#40;37&#37;&#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><span class="elsevierStyleHsp" style=""></span>Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;52&#37;&#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 &#40;54&#37;&#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><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;69&#37;&#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">19 &#40;63&#37;&#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="elsevierStyleBold">Localiza&#231;&#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">0&#44;777&nbsp;\t\t\t\t\t\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;396&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><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">10 &#40;34&#37;&#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">7 &#40;29&#37;&#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><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;33&#37;&#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 &#40;30&#37;&#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><span class="elsevierStyleHsp" style=""></span>Tronco anterior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;7&#37;&#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">4 &#40;17&#37;&#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><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;6&#37;&#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 &#40;3&#37;&#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><span class="elsevierStyleHsp" style=""></span>Tronco posterior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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 &#40;31&#37;&#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">7 &#40;29&#37;&#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><td class="td" title="\n
                  \t\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 &#40;31&#37;&#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;27&#37;&#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><span class="elsevierStyleHsp" style=""></span>Extremidade superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;21&#37;&#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;13&#37;&#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><td class="td" title="\n
                  \t\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;11&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;7&#37;&#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><span class="elsevierStyleHsp" style=""></span>Extremidade inferior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;8&#37;&#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><td class="td" title="\n
                  \t\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 &#40;19&#37;&#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 &#40;20&#37;&#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><span class="elsevierStyleHsp" style=""></span>Acral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;4&#37;&#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><td class="td" title="\n
                  \t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;13&#37;&#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="elsevierStyleBold">Encaminhamento</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;250&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Espessura de Breslow &#40;mm&#44; m&#233;dia&#41;</span></td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Grupo de estadiamento pT &#40;AJCC 8</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleBold">ed&#46;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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