Case and Research Letter
Dermoscopic characterization of longitudinal melanocytic lesions on acral skin
Caracterización dermatoscópica de lesiones melanocíticas longitudinales sobre la piel acral
L. Frances
, M. Blanes, M. Leiva-Salinas, J. Bañuls
Corresponding author
Section of Dermatology Department. Hospital General Universitario Alicante, Spain
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Frances, M. Blanes, M. Leiva-Salinas, J. Bañuls" "autores" => array:4 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Frances" "email" => array:1 [ 0 => "frances.rodriguez.laura@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Blanes" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Leiva-Salinas" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Bañuls" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Section of Dermatology Department. Hospital General Universitario Alicante, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Caracterización dermatoscópica de lesiones melanocíticas longitudinales sobre la piel acral" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1006 "Ancho" => 1301 "Tamanyo" => 307327 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) One melanoma <span class="elsevierStyleItalic">in situ</span> was found among the 9 reported lineal nevi. (B) Histological study of the lesion was consistent with melanoma <span class="elsevierStyleItalic">in situ</span> (H–E<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10). (C, D) The lesion showed a characteristic dermoscopic parallel ridge pattern.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Acquired melanocytic nevi usually exhibit an oval or round shape on all body skin surfaces. Although this morphology is also the most frequent among nevi localized on the sole of the foot, we have observed a group of lesions in this location with a marked disproportion between width and length. This particular appearance has not been previously described, and it could be mistaken for malignancy. We present a series of 9 patients with elongated plantar nevi and discuss their main clinical, dermoscopic and histopathological features. Interestingly, all the lesions presented with a linear appearance, with a length greater than 7<span class="elsevierStyleHsp" style=""></span>mm. Although this measurement has been considered highly suggestive of suspicious malignant lesions in the literature, we have only found one melanoma among our cases. We would like to highlight the importance of this particular presentation of acral melanocytic nevus to avoid an incorrect diagnosis of malignancy.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We describe the clinical and dermoscopic characteristics of nine patients with a clinical diagnosis of melanocytic sole nevi who presented between 2007 and 2013 at the Pigmented Lesion Unit of the Dermatology Department of the General Hospital of Alicante (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The dermoscopic evaluation was performed by DermLite Foto™ (3Gen, LLC, Dana Point, CA, U.S.A.) mounted on a digital camera (Canon G9 and G12™) and with a digital videodermoscope (MoleMax II™). Melanocytic lesions with suspicious clinical or dermoscopic features were excised and histopathologically evaluated and cases without evidence of malignancy underwent videodermoscopic follow-up. Characteristics of the cases are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The cases included 4 men and 5 women, ranging in age from 10 to 49 years old (median age 21) and all were Caucasian. The median length nevus was 17<span class="elsevierStyleHsp" style=""></span>mm, while the median width was 3.1<span class="elsevierStyleHsp" style=""></span>mm. Dermoscopy showed a combination of various types of acral benign dermoscopic patterns (parallel furrow and typical fibrillar patterns) in 8 out of the 9 nevi (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). These melanocytic nevi without dermoscopic signs of malignancy were all closely monitored (every 6 months) by videodermoscopy without evidence of neoplastic transformation. Melanoma <span class="elsevierStyleItalic">in situ</span> was detected in one out of ten patients, whose lesion had shown an atypical dermoscopic parallel ridge pattern (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). An analysis of the recorded images permitted us to observe a particular disproportion between length and width in these plantar skin nevi. Despite their large size (diameter<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>mm is considered a dermoscopic criterion of suspicion of malignancy) and asymmetry, we have observed that most nevi with this morphology are benign lesions.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The clinical morphology and histology of melanocytic nevi are conditioned by the anatomical location of the lesions. The pressure supported by plantar skin determines the expression of particular clinical, dermoscopic and histological features, making the diagnosis of plantar melanocytic lesions sometimes difficult in these areas.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In the difficult clinical dermoscopic evaluation of pigmented lesions on acral skin, the most useful feature to rule out a melanoma is the absence of a parallel ridge pattern.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> However, size has been also reported in the literature as a crucially important factor for the correct diagnosis of melanoma with nevoid features on the plantar area. Saida et al. studied 140 melanocytic lesions and only a few benign acquired melanocytic nevi on the sole were more than 7<span class="elsevierStyleHsp" style=""></span>mm in maximum diameter and none exceeded 9<span class="elsevierStyleHsp" style=""></span>mm.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> There is widespread agreement that size of acral lesions is an important clinical criterion when considering malignancy, and nevi with diameters over 7<span class="elsevierStyleHsp" style=""></span>mm are at least suspicious.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> It is important to note that five of our cases presented congenital nevi. Congenital lesions usually show a larger diameter and are diverse in size, and they show more heterogeneous color and shape than acquired melanocytic nevi. In addition, acral nevi have characteristic dermoscopic features such as a globulostreak pattern, a homogeneous pattern, and a nontypical pattern.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion, we have identified a subgroup of patients who presented with pigmented lesions located on the soles with a marked disproportion between length and width, with a diameter greater than 7<span class="elsevierStyleHsp" style=""></span>mm. We do not know the pathogenesis of the particular morphology of the nevi in our series, but we hypothesize that the distribution of melanocytes following the lines of Blaschko on the acral skin could be responsible for this particular shape. These pigmented nevi showed variable dermoscopic findings, without any particular location on the sole. Although this larger size is regarded as a suspicious finding in itself, we suggest that nevi with this particular morphology are benign lesions in most cases when associated with typical dermoscopic criteria. We recommend the early extirpation of all suspicious nevi presenting a parallel ridge pattern of any size and morphology, and a close follow-up of elongated lesions over 7<span class="elsevierStyleHsp" style=""></span>mm in their maximum diameter with benign parallel furrow dermoscopic pattern (and its variants), until these particular melanocytic lesions have been better characterized.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1022 "Ancho" => 1301 "Tamanyo" => 187648 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical (A, B) and dermoscopic findings (C, D) of 2 of the 9 longitudinal nevi on the sole.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1006 "Ancho" => 1301 "Tamanyo" => 307327 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) One melanoma <span class="elsevierStyleItalic">in situ</span> was found among the 9 reported lineal nevi. (B) Histological study of the lesion was consistent with melanoma <span class="elsevierStyleItalic">in situ</span> (H–E<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10). (C, D) The lesion showed a characteristic dermoscopic parallel ridge pattern.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "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="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age (years)/sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Congenital/Adquired \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Location \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dimensions(lengh<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>width) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dermoscopy acral pattern \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Histology \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time of follow-up \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">43/woman \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Congenital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Forefoot, right sole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fibrillar pattern \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Intradermal melanocytic nevus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">47/man \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Adquired \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Forefoot, right sole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Parallel furrow pattern<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>fibrillar pattern \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No: follow up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">24/woman \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Adquired \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">First finger, right foot \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lattice-like pattern \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Combined melanocytic nevi \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">13/woman \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Congenital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">First finger, right foot \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Parallel furrow pattern \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No: follow up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">49/woman \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Adquired \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Midfoot \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Parallel ridge pattern \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">In situ</span> melanoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">40/woman \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Adquired \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Forefoot, right sole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fibrillar pattern \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No: follow up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">55 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">10/man \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Congenital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Midfoot, left sole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Parallel furrow pattern<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>lattice-like pattern<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>broad, bluish-gray structureless \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No: follow up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">68 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">11/man \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Congenital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fourth finger, right foot \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Parallel furrow pattern<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>lattice-like pattern<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>broad, bluish-gray structureless \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Combined melanocytic nevi \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">8/man \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Congenital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Third finger, right foot \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Parallel furrow pattern<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>lattice-like pattern<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>broad, bluish-gray structureless \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Combined melanocytic nevi \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840237.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the cases of the nine elongated nevi on the sole.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Plantar melanoma that mimics melanocytic nevi: a report of 4 cases with lymph node metastases and with review of positive and negative controls" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 8 | 18 |
| 2024 October | 61 | 43 | 104 |
| 2024 September | 84 | 26 | 110 |
| 2024 August | 100 | 80 | 180 |
| 2024 July | 86 | 41 | 127 |
| 2024 June | 94 | 39 | 133 |
| 2024 May | 85 | 37 | 122 |
| 2024 April | 88 | 32 | 120 |
| 2024 March | 85 | 31 | 116 |
| 2024 February | 66 | 25 | 91 |
| 2024 January | 50 | 26 | 76 |
| 2023 December | 63 | 13 | 76 |
| 2023 November | 92 | 24 | 116 |
| 2023 October | 87 | 38 | 125 |
| 2023 September | 68 | 32 | 100 |
| 2023 August | 65 | 16 | 81 |
| 2023 July | 69 | 56 | 125 |
| 2023 June | 81 | 21 | 102 |
| 2023 May | 56 | 25 | 81 |
| 2023 April | 67 | 16 | 83 |
| 2023 March | 37 | 36 | 73 |
| 2023 February | 45 | 22 | 67 |
| 2023 January | 53 | 34 | 87 |
| 2022 December | 53 | 29 | 82 |
| 2022 November | 39 | 29 | 68 |
| 2022 October | 33 | 24 | 57 |
| 2022 September | 31 | 36 | 67 |
| 2022 August | 33 | 34 | 67 |
| 2022 July | 35 | 32 | 67 |
| 2022 June | 36 | 26 | 62 |
| 2022 May | 93 | 33 | 126 |
| 2022 April | 103 | 26 | 129 |
| 2022 March | 94 | 30 | 124 |
| 2022 February | 91 | 28 | 119 |
| 2022 January | 110 | 35 | 145 |
| 2021 December | 90 | 36 | 126 |
| 2021 November | 90 | 40 | 130 |
| 2021 October | 164 | 58 | 222 |
| 2021 September | 99 | 32 | 131 |
| 2021 August | 144 | 37 | 181 |
| 2021 July | 102 | 17 | 119 |
| 2021 June | 77 | 29 | 106 |
| 2021 May | 71 | 42 | 113 |
| 2021 April | 122 | 71 | 193 |
| 2021 March | 97 | 13 | 110 |
| 2021 February | 56 | 16 | 72 |
| 2021 January | 47 | 14 | 61 |
| 2020 December | 32 | 17 | 49 |
| 2020 November | 28 | 20 | 48 |
| 2020 October | 16 | 18 | 34 |
| 2020 September | 38 | 25 | 63 |
| 2020 August | 20 | 19 | 39 |
| 2020 July | 28 | 19 | 47 |
| 2020 June | 25 | 33 | 58 |
| 2020 May | 23 | 33 | 56 |
| 2020 April | 26 | 34 | 60 |
| 2020 March | 26 | 21 | 47 |
| 2020 February | 4 | 5 | 9 |
| 2020 January | 4 | 3 | 7 |
| 2019 December | 10 | 9 | 19 |
| 2019 November | 4 | 4 | 8 |
| 2019 October | 0 | 8 | 8 |
| 2019 September | 4 | 5 | 9 |
| 2019 August | 4 | 6 | 10 |
| 2019 July | 4 | 10 | 14 |
| 2019 June | 4 | 10 | 14 |
| 2019 May | 6 | 40 | 46 |
| 2019 April | 2 | 26 | 28 |
| 2019 March | 4 | 11 | 15 |
| 2019 February | 1 | 6 | 7 |
| 2019 January | 3 | 0 | 3 |
| 2018 December | 2 | 0 | 2 |
| 2018 October | 4 | 0 | 4 |
| 2018 September | 3 | 0 | 3 |
| 2018 March | 2 | 0 | 2 |
| 2018 February | 70 | 2 | 72 |
| 2018 January | 95 | 6 | 101 |
| 2017 December | 113 | 10 | 123 |
| 2017 November | 46 | 4 | 50 |
| 2017 October | 43 | 6 | 49 |
| 2017 September | 35 | 5 | 40 |
| 2017 August | 27 | 10 | 37 |
| 2017 July | 37 | 11 | 48 |
| 2017 June | 38 | 7 | 45 |
| 2017 May | 93 | 4 | 97 |
| 2017 April | 228 | 6 | 234 |
| 2017 March | 80 | 7 | 87 |
| 2017 February | 45 | 6 | 51 |
| 2017 January | 16 | 6 | 22 |
| 2016 December | 29 | 11 | 40 |
| 2016 November | 26 | 9 | 35 |
| 2016 October | 19 | 10 | 29 |
| 2016 September | 0 | 4 | 4 |
| 2016 July | 4 | 2 | 6 |
| 2016 June | 16 | 1 | 17 |
| 2016 May | 12 | 14 | 26 |
| 2016 April | 10 | 4 | 14 |
| 2016 March | 4 | 10 | 14 |
| 2016 February | 10 | 8 | 18 |
| 2016 January | 8 | 8 | 16 |
| 2015 December | 10 | 6 | 16 |
| 2015 November | 0 | 8 | 8 |
| 2015 October | 0 | 1 | 1 |
| 2015 September | 0 | 1 | 1 |
| 2015 August | 0 | 1 | 1 |
| 2015 July | 1 | 1 | 2 |
| 2015 June | 2 | 3 | 5 |
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