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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">I recently read with interest the special article published in your journal by Moreno-Ram&#237;rez et al<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> on the proposed management of patients with melanoma and metastasis of the sentinel lymph node&#46; I could agree more with the majority of the proposals&#44; and I congratulate the authors on their efforts to put order on a controversial and continually changing topic&#46; However&#44; I disagree with the authors on at least one of the points supporting their proposal&#46; Table 3 of the article states that the &#8220;Frequency of surgical morbidity is greater in patients who undergo immediate lymph node dissection than in those who enter follow-up with therapeutic dissection&#8221;&#44; a statement the authors claim is supported by level 1b evidence&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">This statement is surprising because the corresponding citation refers the reader to the MSLT-II study&#44; in which no specific analysis was performed&#44; nor any conclusion drawn&#44; on the association between surgical morbidity and the moment at which lymphadenectomy is performed&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In fact&#44; discussion of adverse effects in the Results section of the cited article only mentions that &#8220;Adverse events were more common among patients after completion of lymph-node dissection than among patients in the observation group&#8221;&#44; and makes no mention of &#8220;follow-up with therapeutic dissection&#8221;&#44; suggesting that the findings of this study do not support the authors&#8217; statement&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">It is possible that Moreno-Ram&#237;rez et al are actually referring to the MSLT-I study&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> which shares the same first author with the MSLT-II study and compares morbidity associated with immediate versus delayed lymphadenectomy&#46; However&#44; if this is indeed the case&#44; the conclusion is the opposite to that presented&#46; The MSLT-I study<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> concludes that there is no higher incidence of dysesthesias in the immediate lymphadenectomy group&#44; and that lymphedema is significantly more frequent in the delayed versus the immediate lymphadenectomy group &#40;20&#46;4&#37; and 12&#46;4&#37;&#44; respectively&#59; p&#8239;&#61;&#8239;0&#46;04&#41;&#46; These findings are in direct contrast to the statement in the aforementioned Table 3&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In fact&#44; in the MSLT-I study multivariate analysis to identify risk factors for lymphedema revealed that body mass index and delayed lymphadenectomy were the only factors for which a trend towards an association was observed&#44; irrespective of the location &#40;axillary or inguinal&#41; of the lymphadenectomy&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">It should be taken into account that the MSLT-I study included cases of melanoma in which sentinel node biopsy was indicated&#44; while the MSLT-II study included patients with sentinel lymph node involvement&#46; This difference should not alter the conclusions about the time point at which lymphadenectomy is performed&#44; nor the corresponding level of evidence &#40;given the design of the study&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; without detracting from the article&#8217;s conclusions or the proposed decision-making algorithm&#44; it would be prudent&#44; and would better support the authors&#8217; argument&#44; to properly qualify and correct this point&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Pi&#241;ero-Madrona A&#46; Morbilidad relacionada con el momento de la linfadenectom&#237;a por afectaci&#243;n del ganglio centinela en el melanoma&#58; Una puntualizaci&#243;n a su evidencia&#46; Actas Dermosifiliogr&#46; 2021&#59;112&#58;97&#8211;98&#46;</p>"
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