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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The influence of pregnancy on melanocytic nevi and malignant melanoma has been debated for years&#46; In clinical practice&#44; it is not uncommon to examine pregnant women alarmed by morphologic changes in one or more nevi&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Considering that women have been delaying pregnancy until their thirties&#44; forties&#44; or even fifties&#44; and that the incidence of malignant melanoma increases in these decades of life&#44; the likelihood of this type of cancer being diagnosed during pregnancy has increased&#44; as has the number of women who want to become pregnant or use oral contraceptives to avoid becoming pregnant after a diagnosis of malignant melanoma&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Malignant melanoma in women is rare before puberty but its incidence increases during childbearing years &#40;up to the fifth decade&#41; and reduces after menopause&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Certain changes in pigmentation&#44; such as melasma&#44; are associated with pregnancy&#44; oral contraceptive use&#44; and hormone replacement therapy &#40;HRT&#41;&#46; The recent finding that the estrogen receptor &#946; &#40;ER-&#946;&#41; is expressed in benign nevi&#44; dysplastic nevi&#44; malignant lentigos&#44; and malignant melanomas of different thicknesses<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;10</span></a> has led to speculation about the relationship between hormones&#44; nevi&#44; and malignant melanoma&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Melanocytic Nevi and Pregnancy</span><p id="par0020" class="elsevierStylePara elsevierViewall">Few studies have objectively evaluated changes in melanocytic nevi during pregnancy&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Commonly noted subjective changes include an increase in size or a darkening of pigmented skin lesions&#46; These self-perceived changes have been reported by between 10&#46;5&#37;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and 32&#46;5&#37;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> of pregnant women&#44; and affect lesions on the breasts and abdomen &#40;areas that expand during pregnancy&#41; and nonmelanocytic skin lesions such as dermatofibromas and acrochordons&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The first 2 prospective studies to report changes in melanocytic nevi during pregnancy were published in the 1990s&#46; In 1991&#44; Ellis<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> described objective nevus changes in 17 pregnant patients with dysplastic nevus syndrome during 22 pregnancies&#46; The patients had melanocytic nevi with atypical morphology &#40;diameter &#62;&#160;5<span class="elsevierStyleHsp" style=""></span>mm&#44; dyschromia&#44; and irregular&#44; poorly defined borders&#41; and histologic findings including cellular and architectural atypia&#46; The changes were documented photographically&#46; The author concluded that the rate of clinical nevus change was 3&#46;9 times higher in pregnant women than in nonpregnant women&#46; This observation is consistent with the nature of dysplastic nevus syndrome&#44; as atypical nevi are more prone to change&#44; and patients with this syndrome have a higher risk of developing melanoma&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In 1997&#44; Pennoyer et al<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> evaluated changes in the size of 129 nevi in 22 white women&#44; all of whom were pregnant&#46; They took photographs of all nevi measuring at least 2<span class="elsevierStyleHsp" style=""></span>mm that were located on the back in the first and third trimester of pregnancy&#46; The back was chosen because other areas of the body&#44; such as the abdomen and breasts&#44; expand during pregnancy and possibly cause changes in nevi&#46; Of the 129 nevi analyzed&#44; only 8 &#40;6&#46;2&#37;&#41; changed in diameter&#44; with 4 increasing by 1<span class="elsevierStyleHsp" style=""></span>mm and 4 decreasing by 1<span class="elsevierStyleHsp" style=""></span>mm&#46; According to the authors&#44; despite the small sample included in their study&#44; the results suggest that pregnancy is not associated with significant changes in the size of nevi on the back&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The first prospective studies of melanocytic nevi during pregnancy to use dermoscopy appeared in the early 2000s &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">In 2006&#44; Zampino et al<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> evaluated dermoscopic changes in melanocytic nevi during and after pregnancy&#46; They analyzed 86 nevi located on the back of 47 pregnant women using digital dermoscopy&#46; The nevi were evaluated 3 times&#58; during the first trimester&#44; during the third trimester&#44; and 6 months postpartum&#46; The dermoscopic changes detected were classified as follows&#58; a&#41; no significant changes in size &#40;eg&#44; small increase during pregnancy in areas prone to greater skin expansion but a return to normal postpartum&#41;&#59; b&#41; a decrease in overall pigmentation and the presence of a less prominent pigment network during pregnancy and particularly 6 months after delivery&#44; possibly explained by the fact that the participants reported less sun exposure during this period&#59; c&#41; an increase in the number of vascular structures &#40;dotted vessels and to a lesser degree comma-shaped vessels&#41; during pregnancy&#44; with a return to normal postpartum &#40;these changes were considered to be physiological alterations induced by pregnancy hormones&#41;&#59; and d&#41; an increase in total dermoscopy score&#44; calculated according to the ABCD rule proposed by Stolz&#160;et&#160;al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The increase in total dermoscopy score and changes in symmetry during pregnancy indicate that hormones exert an intrinsic influence on melanocytic activity&#44; leading to a slightly more irregular dermoscopic appearance that returns to normal postpartum&#46; The above findings are consistent with the observations of G&#252;nd&#252;z et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Strumia et al<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> evaluated the dermoscopic features of 56 nevi with a diameter of over 4<span class="elsevierStyleHsp" style=""></span>mm in 12 pregnant women examined during the second and third trimester&#46; In areas prone to expansion during pregnancy &#40;eg&#44; the breasts and the abdomen&#41;&#44; pigmented skin lesions with a reticular pattern grew in size but did not change shape&#44; while those with a globular pattern presented an increased number of peripheral brown globules&#46; No significant changes were noted in the size or color of nevi in areas that change only slightly during pregnancy &#40;eg&#44; the back&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Akt&#252;rk et al&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> also using dermoscopy&#44; analyzed 97 nevi in 56 pregnant women during the first and third trimester&#44; and found a statistically significant increase in both size and total dermoscopy score&#59; most of the nevi that grew were on the anterior surface of the trunk&#46; The authors also observed new dot formation in 6 lesions and the appearance of new nevi in 3 women in the third trimester&#46; Their results were similar to those reported by G&#252;nd&#252;z et al<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> and Strumia&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Rubegni et al<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> used digital dermoscopy to evaluate nevi in 35 pregnant women and an equal number of controls&#46; They analyzed all nevi larger than 4<span class="elsevierStyleHsp" style=""></span>mm before pregnancy and excluded pigmented skin lesions in acral parts and on the abdomen and breasts&#59; they also excluded ephelides and lesions with clinical or dermoscopic atypia&#46; They studied a total of 206 nevi between weeks 5 and 8 and between weeks 39 and 41 of pregnancy&#44; as well as 12 months after delivery&#46; They noted a thicker and more evident pigment network&#44; a darkening of globules &#40;lesions with a globular pattern&#41;&#44; and architectural disorder&#46; The pigment network and globules had returned to normal by 12 months postpartum but the architectural disorder persisted&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In a recent study&#44; Wyon et al<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> evaluated changes in melanocytic nevi during pregnancy using spectrophotometric intracutaneous analysis&#46; This method uses light between the visible and the near-infrared region&#44; allowing deeper penetration into the skin and subsequent computerized analysis of images obtained&#46; The authors compared images of 384 melanocytic nevi from 34 women in the first and third trimester of pregnancy with those of 163 melanocytic nevi from a control group of nonpregnant women&#46; They concluded that there were no significant differences between the 2 groups&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In summary&#44; melanocytic nevi can undergo reversible changes during pregnancy&#46; These include darkening&#44; a progressive reduction in thickness&#44; the appearance of a prominent reticular pattern or dots or globules&#44; and an increase in vascularization and size &#40;especially in areas prone to greater expansion such as the anterior surface of the trunk&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;17&#44;19&#44;20&#44;22&#44;23</span></a> Nonetheless&#44; any lesions that present changes suggestive of malignant transformation &#40;atypical pigmented network&#44; blue-whitish veil&#44; atypical vascular pattern&#44; etc&#46;&#41; should be biopsied immediately&#44; just as would be done in any patient&#46; Nevi in patients with dysplastic nevus syndrome should be analyzed by digital dermoscopy at the beginning of pregnancy and at 3-month intervals to screen for possible changes&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Melanoma and Hormonal and Reproductive Factors</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Malignant Melanoma Diagnosed During Pregnancy</span><p id="par0075" class="elsevierStylePara elsevierViewall">Although results obtained over the course of many years of investigation initially suggested that pregnancy might increase the risk of melanoma&#44;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#8211;27</span></a> current clinical evidence does not support this hypothesis&#46; Numerous studies&#44; such as that of Daryanani et al&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> have provided evidence that the clinical course of disease&#44; together with prognosis and overall survival&#44; in pregnant women with localized malignant melanoma &#40;American Joint Committee on Cancer &#91;AJCC&#93; stages I-II&#41; is similar to that of nonpregnant women &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; In the case of a pregnant woman with malignant melanoma&#44; prognosis depends primarily on tumor thickness and on the presence or absence of ulceration&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">In a pooled analysis&#44; Karagas et al<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> reviewed 10 case-control studies &#40;total of 5590 women &#91;2391 cases and 3199 controls&#93;&#41; to evaluate the effect of pregnancy on the risk of developing malignant melanoma&#44; but found no association&#46; In another 2 studies&#44; however&#44; Reintgen et al<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> and Slinguff et al<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> found significantly shorter disease-free survival in pregnant women compared to nonpregnant women&#44; and they also reported that lymph node metastasis was the most common form of recurrence&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Several studies have shown an increase in tumor thickness in pregnant women compared to nonpregnant women&#44; probably due to delayed diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30&#8211;33</span></a> Early diagnosis is very important and suspicious lesions should be biopsied immediately&#44; without waiting until the end of the pregnancy&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Several well-controlled trials and studies involving large numbers of patients<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;30&#44;32&#44;34</span></a> have found no differences between women diagnosed with malignant melanoma during pregnancy and controls in terms of primary lesion site or histologic type&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Evaluation and Treatment of Malignant Melanoma Diagnosed During Pregnancy</span><p id="par0095" class="elsevierStylePara elsevierViewall">In general&#44; the evaluation of malignant melanoma is similar in pregnant and nonpregnant women&#44; with treatment depending on disease stage&#46; Nonetheless&#44; certain measures must be taken during a pregnancy to protect the fetus&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Localized melanomas diagnosed during pregnancy must be excised using local anesthesia and wide margins based on current recommendations&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">32&#44;35</span></a> Lidocaine is considered to be a safe local anesthetic for use during pregnancy<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> but general anesthesia should be avoided&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">If the tumor is associated with a high risk of recurrence&#44; a sentinel lymph node &#40;SLN&#41; biopsy may be considered for disease-staging purposes&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">36&#44;37</span></a> The safety of this procedure in pregnancy is a matter of debate&#46; Consent must be obtained from the patient following discussion of the potential risks&#44; benefits&#44; and limitations of the procedure&#46; Patients must be informed that SLN biopsy has not been proven to increase overall survival and therefore may not be necessary if the patient does not want treatment in the future&#46; The safest method for performing SLN biopsy in pregnant women has not been established&#44; with some medical centers and surgeons using a radiotracer &#40;eg&#44; technetium Tc 99m sulfur-colloid&#41;&#44; others using blue dye&#44; and others using a combination of the two&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> Although the risk for the mother and the fetus is relatively small&#44; the procedure does carry certain risks such as allergic reactions to the dye and fetal exposure to radiation&#46; Some doctors prefer to avoid using radiotracers during pregnancy<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> while others believe that the radiation dose to which the fetus is exposed is below the teratogenic threshold&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;36</span></a> Schwartz et al<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> showed the use of blue dye in pregnancy to be associated with a risk of anaphylaxis of between 0&#46;7&#37; and 1&#46;1&#37;&#46; To avoid this risk&#44; radiotracers can be used in isolation&#46; The fetus is exposed to a radiation dose of under 5&#160;mGy during SLN biopsy&#46; &#40;The Nuclear Medicine Society recommends performing a pregnancy test when a patient has to undergo any procedure in which the fetus would be exposed to a radiation dose of over 50&#160;mGy&#46;&#41; In the case of a pregnant woman in her second or third trimester&#44; it would be reasonable to postpone the biopsy until after delivery if the malignant melanoma has been excised with wide margins and if the patient is monitored regularly&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The safety of imaging techniques in pregnant women to screen for distant metastasis is also a matter of debate&#46; Chest radiography with radiation protection can be performed safely&#44; as can abdominal ultrasound imaging&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> Computed tomography &#40;CT&#41; with intravenous contrast and positron emission tomography are generally contraindicated as they emit high doses of radiation&#44; which would be absorbed by the fetus&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> Magnetic resonance imaging is safer than CT imaging&#44; but it is not recommended during the first trimester of pregnancy because the radiofrequency it employs heats tissues and exposes the fetus to excessive noise&#44; which can cause high-frequency hearing loss in neonates&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">There is very limited experience with the use of chemotherapy or interferon to treat advanced metastatic disease in pregnant women due to the limited effectiveness of these methods and the potential adverse effects for the fetus&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> In our review of the literature&#44; we found 36 reports of the use of dacarbazine in pregnant women&#44; 8 of whom were treated in the first trimester<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">43&#8211;47</span></a> and 28 of whom were treated during the second or third trimesters&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">47&#8211;52</span></a> In the first group&#44; there were 2 cases of congenital abnormalities &#40;microphthalmia and severe hyperopia&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> while in the second group&#44; there was 1 fetal death<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a> and 1 case of syndactyly&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> In all 4 cases&#44; dacarbazine had been administered in combination with other cytotoxic drugs&#46; Nonetheless&#44; the risk of secondary malignancy might be underestimated as the follow-up period for neonates exposed to chemotherapy in utero was very short &#40;mean of 14 months&#41;&#46; One report from Japan describes how a woman with stage III malignant melanoma treated with DAV-feron &#40;dacarbazine&#44; nimustine&#44; vincristine&#44; and interferon-beta&#41; during the second trimester of pregnancy gave birth to a healthy baby at 35 weeks&#44; with no signs of placental involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Radiotherapy during pregnancy can cause fetal malformations&#44; mental retardation&#44; and even death&#44; and it is poorly effective in malignant melanoma&#46; There has been 1 report of the use of radiotherapy in 2 patients with malignant melanoma and symptomatic brain metastases&#44; with no impact on the neonate&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">54</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Risk for the Fetus</span><p id="par0125" class="elsevierStylePara elsevierViewall">It has been estimated that malignant melanoma causes complications in 0&#46;1 to 2&#46;8 of every 1000 pregnancies&#46; In a review of the literature&#44; Alexander et al<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">55</span></a> found that placental and fetal metastasis was very rare in cancer in general&#44; with only 87 cases reported in the last 140 years&#46; Although malignant melanoma is not the most common tumor in pregnancy&#44; it probably carries the greatest risk of placental or fetal metastasis as it accounted for 27 &#40;31&#37;&#41; of the 87 cases reported&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The prognosis for the fetus in a pregnant woman with malignant melanoma depends on maternal stage of disease&#46; Prognosis is generally excellent&#44; except in cases of disseminated disease&#46; Transplacental transmission of malignant melanoma to the fetus is very rare and has only been described in women with distant metastasis&#46; It has been estimated that the fetus will be affected in just 25&#37; of cases in which there is placental involvement&#46; Prematurity is a common complication in children born to mothers with placental disease&#59; a mean gestational age of 34 weeks has been reported&#44; but with low mortality attributable to premature birth&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">55</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">When a fetus is affected by malignant melanoma metastasis&#44; the most common sites affected are the skin and the liver&#59; these metastases cause intrauterine or postpartum death in over 80&#37; of cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">55&#44;56</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">A thorough macroscopic and histologic investigation of the placenta of women with advanced disease is recommended to detect possible metastasis&#46; This investigation should include immunohistochemical studies &#40;S-100&#44; HMB-45&#44; Melan-A&#44; MART-1&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">55</span></a> Periodic follow-up for at least 24 months is recommended in the case of children without metastasis born to women with confirmed placental involvement&#46; Tests should include a baseline chest radiograph&#44; liver function tests&#44; lactate dehydrogenase testing&#44; and a thorough skin examination&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Due to the rarity of congenital and infantile malignant melanoma&#44; there are no clinical guidelines on how to treat this disease in children born to mothers with placental metastasis&#46; There are also no publications on adjuvant treatment with high doses of interferon alpha in these children&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">55</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Malignant Melanoma Diagnosed Before Pregnancy</span><p id="par0150" class="elsevierStylePara elsevierViewall">Several studies performed in small series of patients have concluded that the prognosis of women who become pregnant after being diagnosed with localized malignant melanoma does not change&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30&#44;32</span></a> Advice on future pregnancy varies from one specialist to the next&#44; with some recommending not becoming pregnant&#46; A considerable proportion of patients with localized malignant melanoma &#40;AJCC stages I-II&#41; may experience recurrence&#46; While approximately 50&#37; of recurrences in patients with thick lesions occur within 3 years&#44; they may occur later in some cases &#40;up to 10 years after diagnosis&#41;&#44; even in patients with thin lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">The time a woman who has had malignant melanoma should be advised to wait before becoming pregnant varies from case to case&#44; and primarily depends on the risk of recurrence &#40;tumor thickness and ulceration&#41;&#44; the age of the patient&#44; and the patient&#39;s desire to become pregnant&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> This time ranges between 0 and 5 years&#46; For example&#44; a 40-year-old woman with a malignant melanoma of 0&#46;3<span class="elsevierStyleHsp" style=""></span>mm thickness would not be advised to wait if she wanted to become pregnant and considered the risk &#40;1&#37; to 3&#37; for 5-year recurrence&#41; acceptable&#46; In contrast&#44; a 21-year-old woman with a 4&#46;0-mm malignant melanoma would be advised to wait for 3 to 5 years &#40;period with the greatest risk of recurrence&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Individual case management is recommended in all cases and all possible risks should be discussed in order for the patient to take an informed decision&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Malignant Melanoma Diagnosed After Pregnancy</span><p id="par0165" class="elsevierStylePara elsevierViewall">Previous pregnancy does not appear to influence the survival of women diagnosed with localized malignant melanoma&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> It has been suggested&#44; however&#44; that women who have had multiple pregnancies &#40;5 or more&#41; before a diagnosis of malignant melanoma have a survival advantage&#44;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">57&#8211;59</span></a> but few studies have investigated this&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Use of Oral Contraceptives or Hormone Replacement Therapy and Risk of Developing Malignant Melanoma</span><p id="par0170" class="elsevierStylePara elsevierViewall">The association between oral contraceptive use and the risk of developing malignant melanoma has been discussed in several studies&#44; with inconsistent findings&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Various epidemiological studies<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29&#44;60&#8211;81</span></a> have shown that the use of oral contraceptives does not increase the risk of malignant melanoma&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">In their pooled analysis of 5590 women from 10 studies&#44; Karagas et al<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> did not find an increased risk of malignant melanoma among oral contraceptive users&#46; Meanwhile&#44; there is no specific information on whether or not the use of oral contraceptives increases the risk of recurrence in women with an established diagnosis of malignant melanoma&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Although few studies have investigated the association between HRT and malignant melanoma&#44;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">60&#44;62&#44;65&#44;68&#44;69&#44;72&#44;77&#44;82</span></a> to date no epidemiological evidence has shown an increased risk of malignant melanoma in women on HRT&#46; The use of oral contraceptives or HRT is not contraindicated in patients with a thin lesion and a low risk of recurrence&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;83&#44;84</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">As far as clinical and experimental evidence is concerned&#44; no clear association has been shown between hormones&#44; nevi&#44; and malignant melanoma&#46; Indeed most of the clinical evidence suggests that there is no association&#58; it has not been clearly established that nevi undergo significant physiological changes during pregnancy&#59; controlled studies have shown that pregnancy does not affect prognosis in malignant melanoma&#59; and epidemiological studies have shown no effect for exogenous hormones &#40;contraceptives and HRT&#41; on the risk of malignant melanoma&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;88&#44;89</span></a> Of interest are the recent findings that ER-&#946; is the predominant estrogen receptor in melanocytic lesions<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;10</span></a> and that it is strongly expressed in severely dysplastic nevi and malignant lentigos compared to thick malignant melanomas&#46; Further studies&#44; however&#44; are required in this area to determine the relevance of these findings&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusions</span><p id="par0195" class="elsevierStylePara elsevierViewall">Although slight changes can occur in the diameter and dermoscopic features of nevi during pregnancy&#44; above all in areas prone to greater expansion such as the anterior surface of the trunk&#44; the nevi concerned generally return to normal postpartum&#46; Nevertheless&#44; any lesions that present features suggestive of possible transformation to malignant melanoma &#40;atypical pigmented network&#44; blue-whitish veil&#44; atypical vascular pattern&#44; etc&#46;&#41; should be biopsied immediately&#44; just as would be done in any patient&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Women with dysplastic nevus syndrome experience more clinical changes in nevi when they are pregnant&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">More prospective studies on changes in nevi during pregnancy are needed&#44; and these should preferably involve clinical examination&#44; photographs&#44; and digital dermoscopic images&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Based on the results of a small number of well-controlled studies&#44; prognosis in malignant melanoma is the same whether a women is diagnosed with the disease before&#44; during&#44; or after pregnancy&#46; No significant differences in 5-year-survival have been demonstrated between pregnant and nonpregnant women&#44; and hence therapeutic abortion is not recommended as an option for increasing survival&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">The prognosis for a fetus in a woman with malignant melanoma depends on the stage of maternal disease&#46; Fetal metastases are rare and may only occur in women with widely disseminated disease&#46; It has been estimated that fetal metastasis occurs in just 25&#37; of cases of placental involvement&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">The treatment of a thin malignant melanoma&#8212;excision with wide surgical margins&#44; local anesthetic&#44; and close clinical monitoring&#8212;is the same in pregnant and nonpregnant patients&#46; Nonetheless&#44; in the case of pregnant patients who are candidates for SLN biopsy or imaging studies for assessing disease stage or screening for distant metastases&#44; the approach varies enormously from one center to the next and decisions should be taken on a case-by-case basis&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">The recommended time a woman should wait before becoming pregnant after a malignant melanoma varies from one patient to the next and depends primarily on the risk of recurrence &#40;tumor thickness&#44; ulceration&#44; SLN metastasis&#41;&#44; age of the patient&#44; and the patient&#39;s desire to become pregnant&#46; There is no one answer and patients should be well informed about the risks associated with their disease in order to taken an informed decision&#46; Women with high-risk malignant melanoma and an increased risk of recurrence should be advised to wait for 3 to 5 years before becoming pregnant&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Oral contraceptive use does not increase the risk of malignant melanoma in women&#46; Meanwhile&#44; there is no specific information on whether or not the use of oral contraceptives increases the risk of recurrence in women with an established diagnosis of malignant melanoma&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Although few studies have been performed in this area&#44; HRT does not appear to increase the risk of developing malignant melanoma&#44; but it is not known whether or not it influences the risk of recurrence&#46; The use of oral contraceptives or HRT is not contraindicated in patients with thin malignant melanomas in the absence of reasonable alternatives&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of Interest</span><p id="par0240" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "titulo" => "Introduction"
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          "identificador" => "sec0010"
          "titulo" => "Melanocytic Nevi and Pregnancy"
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        6 => array:3 [
          "identificador" => "sec0015"
          "titulo" => "Melanoma and Hormonal and Reproductive Factors"
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            0 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Malignant Melanoma Diagnosed During Pregnancy"
            ]
            1 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Evaluation and Treatment of Malignant Melanoma Diagnosed During Pregnancy"
            ]
            2 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Risk for the Fetus"
            ]
            3 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Malignant Melanoma Diagnosed Before Pregnancy"
            ]
            4 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Malignant Melanoma Diagnosed After Pregnancy"
            ]
            5 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Use of Oral Contraceptives or Hormone Replacement Therapy and Risk of Developing Malignant Melanoma"
            ]
          ]
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        7 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Conclusions"
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        8 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conflicts of Interest"
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          "titulo" => "References"
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    "fechaRecibido" => "2010-06-17"
    "fechaAceptado" => "2011-02-09"
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          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec82568"
          "palabras" => array:5 [
            0 => "Melanoma"
            1 => "Pregnancy"
            2 => "Melanocytic nevi"
            3 => "Hormones"
            4 => "Reproductive factors"
          ]
        ]
      ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec82567"
          "palabras" => array:5 [
            0 => "Melanoma"
            1 => "Embarazo"
            2 => "Nevus melanoc&#237;ticos"
            3 => "Hormonas"
            4 => "Factores reproductivos"
          ]
        ]
      ]
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        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Malignant melanoma is among the malignant tumors whose incidence has risen markedly in recent decades&#46; For many years the medical community debated the potential adverse effects of female hormones &#40;whether of exogenous or pregnancy-related endogenous origin&#41;&#44; on melanocytic nevi and malignant melanoma&#46; Given that women have been delaying pregnancy until their thirties or forties and that the incidence of malignant melanoma increases in those decades&#44; the likelihood of this tumor developing during pregnancy has increased&#46; Recent clinical and experimental evidence has suggested that pregnancy does not affect prognosis in malignant melanoma and that it does not seem to lead to significant changes in nevi&#46; This review examines the relationship between malignant melanoma and hormonal and reproductive factors&#46; Evidence was located by MEDLINE search &#40;in PubMed and Ovid&#41; for articles in English and Spanish for the period from 1966 to March 2010&#59; additional sources were found through the reference lists of the identified articles&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El melanoma maligno &#40;MM&#41; es uno de los tumores malignos que m&#225;s ha aumentado su incidencia en las &#250;ltimas d&#233;cadas&#46; Durante muchos a&#241;os hubo controversia en la comunidad m&#233;dica en relaci&#243;n con el efecto potencialmente adverso de las hormonas femeninas &#40;ex&#243;genas o end&#243;genas asociadas al embarazo&#41; sobre los nevus melanoc&#237;ticos y el MM&#46; Considerando que las mujeres han retrasado la maternidad hasta la tercera y cuarta d&#233;cadas de la vida&#44; y que la incidencia de MM aumenta en estas d&#233;cadas&#44; la probabilidad de aparici&#243;n de un MM durante el embarazo es mayor&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Evidencias cl&#237;nicas y experimentales recientes permiten sugerir que el embarazo no influye en el pron&#243;stico del MM&#44; y que no parece causar cambios significativos en los nevus&#46; La finalidad de este art&#237;culo es revisar la asociaci&#243;n entre MM&#44; nevus y factores hormonales y reproductivos&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; una b&#250;squeda de art&#237;culos utilizando la base bibliogr&#225;fica Medline y los buscadores &#8220;Pubmed&#8221; y &#8220;Ovid&#8221;&#44; en ingl&#233;s y espa&#241;ol&#44; en el periodo de 1966 a marzo del 2010&#46; Los art&#237;culos fueron revisados y se consiguieron referencias adicionales de las bibliograf&#237;as&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Borges V&#44; et al&#46; Nevus&#44; melanoma y embarazo&#46; Actas Dermosifiliograr&#46; 2011&#59;102&#58;650-657&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; SIA&#44; spectrophotometric intracutaneous analysis&#59; TDS&#44; total dermoscopy score&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Study&#47;Method&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">No&#46; of Patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Lesion Site&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Period&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Main Observations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Strumia et al&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> 2002&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Back&#44; breast&#44; abdomen&#44; forearm</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2nd and 3rd trimesters</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Increase in size &#40;in areas that expand&#41;</td></tr><tr title="table-row"><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">Dermoscopy&nbsp;\t\t\t\t\t\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">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">G&#252;nd&#252;z et al&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> 2003&nbsp;\t\t\t\t\t\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">21&nbsp;\t\t\t\t\t\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">Back&#44; face&#44; neck&nbsp;\t\t\t\t\t\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">1st and 3rd trimesters&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#37;&#58; Increase in TDS during 3rd trimester and decrease in TDS 6 mo postpartum</td></tr><tr title="table-row"><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">Dermoscopy&nbsp;\t\t\t\t\t\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">21&nbsp;\t\t\t\t\t\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></tr><tr title="table-row"><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">Zampino et al&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> 2006&nbsp;\t\t\t\t\t\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">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Back</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1st and 3rd trimesters and postpartum</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No changes in size&#59; increase in TDS and vascular structures in 3rd trimester&#44; with return to normal postpartum</td></tr><tr title="table-row"><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">Digital dermoscopy&nbsp;\t\t\t\t\t\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">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Akt&#252;rk et al&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> 2007&nbsp;\t\t\t\t\t\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">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anterior trunk&#44; face&#44; and lower limbs</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1st and 3rd trimesters</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Increase in size and TDS between 1st and 3rd trimesters &#40;areas that expand&#41;</td></tr><tr title="table-row"><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">Dermoscopy&nbsp;\t\t\t\t\t\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">97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wyon et al&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> 2007&nbsp;\t\t\t\t\t\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">34 pregnant women &#40;381 nevi&#41; vs 21 controls &#40;163 nevi&#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">Back and legs&nbsp;\t\t\t\t\t\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">1st and 3rd trimesters&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No significant changes</td></tr><tr title="table-row"><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">SIA&nbsp;\t\t\t\t\t\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="" 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" 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">Rubegni et al&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> 2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 pregnant women &#40;206 nevi&#41; vs 35 controls</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Excluded acral parts&#44; abdomen and breasts</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">Weeks 5-8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">More evident pigment network and darkening of globules &#40;returned to normal 12 mo postpartum&#41; and architectural disorder &#40;persisted&#41;</td></tr><tr title="table-row"><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">Digital dermoscopy&nbsp;\t\t\t\t\t\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">Weeks 39-41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 mo postpartum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab181881.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Prospective Studies With Objective Evaluation of Melanocytic Nevi During Pregnancy&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "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"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">No&#46; of Patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Follow-up Time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Effect of Pregnancy on Survival&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reintgen et al&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> 1985&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 y &#40;mean&#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">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">McManamny et al&#44;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">87</span></a> 1989&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\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 mo-20 y&nbsp;\t\t\t\t\t\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">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wong et al&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> 1989&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&nbsp;\t\t\t\t\t\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">Not reported&nbsp;\t\t\t\t\t\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">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Slingluff et al&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> 1990&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&nbsp;\t\t\t\t\t\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 y &#40;mean&#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">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MacKie et al&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> 1991&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&nbsp;\t\t\t\t\t\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">Not reported&nbsp;\t\t\t\t\t\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">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Daryanani et al&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> 2003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\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">109 mo &#40;mean&#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">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lens et al&#44;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">86</span></a> 2004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">185&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;6 y&nbsp;\t\t\t\t\t\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">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">O&#8217;Meara et al&#44;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">85</span></a> 2005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">149&nbsp;\t\t\t\t\t\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">Not reported&nbsp;\t\t\t\t\t\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">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Case-Control Studies of Localized Melanoma Diagnosed During Pregnancy&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:89 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Behavior of melanocytic nevi during pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;L&#46; S&#225;nchez"
                            1 => "L&#46;D&#46; Figueroa"
                            2 => "E&#46; Rodr&#237;guez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Dermatopathol"
                        "fecha" => "1984"
                        "volumen" => "6"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "89"
                        "paginaFinal" => "91"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6703262"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does pregnancy alter melanocytic nevi&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;M&#46; Grin"
                            1 => "A&#46;I&#46; Rojas"
                            2 => "J&#46;M&#46; Grant-Kels"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cutan Pathol"
                        "fecha" => "2001"
                        "volumen" => "28"
                        "paginaInicial" => "389"
                        "paginaFinal" => "392"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11493375"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermatoscopic follow-up of changing melanocytic skin lesion during pregnancy&#58; from nevus to melanoma&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; Zalaudek"
                            1 => "I&#46;H&#46; Wolf"
                            2 => "R&#46; Hofmann-Wellenhof"
                            3 => "B&#46; Leinweber"
                            4 => "A&#46;D&#46; Stefani"
                            5 => "G&#46; Argenziano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Melanoma Res"
                        "fecha" => "2004"
                        "volumen" => "14"
                        "paginaInicial" => "323"
                        "paginaFinal" => "325"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15305165"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Current management of patients with melanoma who are pregnant&#44; want to get pregnant&#44; or do not want to get pregnant"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;L&#46; Schwartz"
                            1 => "E&#46;L&#46; Mozurkewich"
                            2 => "T&#46;M&#46; Jonhson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/cncr.11342"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "2003"
                        "volumen" => "97"
                        "paginaInicial" => "2130"
                        "paginaFinal" => "2133"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12712462"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Grant-Kels&#46; Hormones&#44; nevi and Melanoma&#58; An approach to the patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46;S&#46; Driscoll"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2007.08.045"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2007"
                        "volumen" => "57"
                        "paginaInicial" => "919"
                        "paginaFinal" => "931"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18021848"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pediatric melanoma&#58; risk factor and survival analysis of the surveillance&#44; epidemiology and end results database"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;J&#46; Strouse"
                            1 => "T&#46;R&#46; Fears"
                            2 => "M&#46;A&#46; Tucker"
                            3 => "A&#46;S&#46; Waune"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1200/JCO.2005.02.899"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Oncol"
                        "fecha" => "2005"
                        "volumen" => "23"
                        "paginaInicial" => "4735"
                        "paginaFinal" => "4741"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16034049"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oestrogen receptor-beta expression in melanocytic lesions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Schmidt"
                            1 => "L&#46;B&#46; Nanney"
                            2 => "A&#46;S&#46; Boyd"
                            3 => "L&#46;E&#46; King"
                            4 => "D&#46;L&#46; Ellis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1600-0625.2006.00502.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Exp Dermatol"
                        "fecha" => "2006"
                        "volumen" => "15"
                        "paginaInicial" => "971"
                        "paginaFinal" => "980"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17083364"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Expression of estrogen receptor beta in normal skin&#44; melanocytic nevi and malignant melanomas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Ohata"
                            1 => "T&#46; Tadokoro"
                            2 => "S&#46; Itami"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1346-8138.2008.00447.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Dermatol"
                        "fecha" => "2008"
                        "volumen" => "35"
                        "paginaInicial" => "215"
                        "paginaFinal" => "221"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18419678"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estrogen receptor expression in cutaneous melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;S&#46; Driscoll"
                            1 => "J&#46;M&#46; Grant-Kels"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archdermatol.2008.539"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "2009"
                        "volumen" => "145"
                        "paginaInicial" => "73"
                        "paginaFinal" => "75"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19153347"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estrogen receptor expression in cutaneous melanoma&#58; a real-time reverse transcriptase-polymerase chain reaction and immunohistochemical study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "V&#46; de Giorgi"
                            1 => "C&#46; Mavilia"
                            2 => "D&#46; Massi"
                            3 => "A&#46; Gozzini"
                            4 => "P&#46; Aragona"
                            5 => "A&#46; Tanini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archdermatol.2008.537"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "2008"
                        "volumen" => "145"
                        "paginaInicial" => "30"
                        "paginaFinal" => "36"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19153340"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Do hormones influence melanoma&#63; Facts and controversies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Gupta"
                            1 => "M&#46;S&#46; Driscoll"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clindermatol.2010.04.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Dermatol"
                        "fecha" => "2010"
                        "volumen" => "28"
                        "paginaInicial" => "287"
                        "paginaFinal" => "292"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20541681"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A histopathologic evaluation of nevocellular nevi in pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Foucar"
                            1 => "T&#46;J&#46; Bentley"
                            2 => "D&#46;W&#46; Laube"
                            3 => "J&#46; Rosai"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "1985"
                        "volumen" => "121"
                        "paginaInicial" => "350"
                        "paginaFinal" => "354"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3977356"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pregnancy and sex steroid hormone effects on nevi of patients with the dysplastic nevus syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46;L&#46; Ellis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "1991"
                        "volumen" => "25"
                        "paginaInicial" => "467"
                        "paginaFinal" => "482"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1918487"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Changes in size of melanocytic nevi during pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;W&#46; Pennoyer"
                            1 => "C&#46;M&#46; Grin"
                            2 => "M&#46;S&#46; Driscoll"
                            3 => "S&#46;M&#46; Dry"
                            4 => "S&#46;J&#46; Walsh"
                            5 => "J&#46;P&#46; Gelineau"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "1997"
                        "volumen" => "36"
                        "paginaInicial" => "378"
                        "paginaFinal" => "382"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Are melanocytic nevi influenced by pregnancy&#63; A dermoscopic evaluation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2006.32362.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2006"
                        "volumen" => "32"
                        "paginaInicial" => "1497"
                        "paginaFinal" => "1504"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ABCD rule of dermoscopy&#58; a new practical method of early recognition of malignant melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur J Dermatol"
                        "fecha" => "1994"
                        "volumen" => "4"
                        "paginaInicial" => "521"
                        "paginaFinal" => "527"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Analysis of melanocytic naevi by dermoscopy during pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
                        "fecha" => "2003"
                        "volumen" => "17"
                        "paginaInicial" => "349"
                        "paginaFinal" => "351"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Digital epiluminescence in nevi during pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "63901"
                      "Revista" => array:7 [
                        "tituloSerie" => "Dermatology"
                        "fecha" => "2002"
                        "volumen" => "205"
                        "paginaInicial" => "186"
                        "paginaFinal" => "187"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0886335007019888"
                          "estado" => "S300"
                          "issn" => "08863350"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermoscopy is a suitable method for the observation of the pregnancy-related changes in melanocytic nevi"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1468-3083.2007.02204.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
                        "fecha" => "2007"
                        "volumen" => "21"
                        "paginaInicial" => "1086"
                        "paginaFinal" => "1090"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Melanocytic skin lesions and pregnancy&#58; digital dermoscopy analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Skin Res Technol"
                        "fecha" => "2007"
                        "volumen" => "13"
                        "paginaInicial" => "145"
                        "paginaFinal" => "147"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spectrophotometric analysis of melanocytic nevi during pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2340/00015555-0227"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Derm Venerol"
                        "fecha" => "2007"
                        "volumen" => "87"
                        "paginaInicial" => "231"
                        "paginaFinal" => "237"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management and dermoscopy of fast-growing nevi in pregnancy&#58; case report and literature review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cutan Med Surg"
                        "fecha" => "2006"
                        "volumen" => "10"
                        "paginaInicial" => "249"
                        "paginaFinal" => "252"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Using dermoscopic criteria and patient-related factors for the management of pigmented melanocytic nevi"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archdermatol.2009.115"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "2009"
                        "volumen" => "145"
                        "paginaInicial" => "816"
                        "paginaFinal" => "826"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Theories regarding the cause of malignant melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Surg Gynecol Obstet"
                        "fecha" => "1980"
                        "volumen" => "150"
                        "paginaInicial" => "907"
                        "paginaFinal" => "917"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malignant melanoma in pregnancy&#46; Report of three cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Obstet Gynecol"
                        "fecha" => "1964"
                        "volumen" => "24"
                        "paginaInicial" => "451"
                        "paginaFinal" => "454"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malignant melanoma&#58; the adverse effect of pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Br J Plastic Surg"
                        "fecha" => "1981"
                        "volumen" => "34"
                        "paginaInicial" => "338"
                        "paginaFinal" => "339"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multiple primary melanoma in pregnancy&#58; a case report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Br J Plastic Surg"
                        "fecha" => "1983"
                        "volumen" => "36"
                        "paginaInicial" => "260"
                        "paginaFinal" => "261"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pregnancy and early-stage melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/cncr.11321"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "2003"
                        "volumen" => "97"
                        "paginaInicial" => "2248"
                        "paginaFinal" => "2253"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pregnancy history and incidence of melanoma in women&#58; a pooled analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10552-005-0281-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer Causes Control"
                        "fecha" => "2006"
                        "volumen" => "17"
                        "paginaInicial" => "11"
                        "paginaFinal" => "19"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malignant melanoma and pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "1985"
                        "volumen" => "55"
                        "paginaInicial" => "1340"
                        "paginaFinal" => "1344"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malignant melanoma arising during pregnancy&#58; a study of 100 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "1990"
                        "volumen" => "211"
                        "paginaInicial" => "552"
                        "paginaFinal" => "559"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lack of effect of pregnancy on outcome of melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "1991"
                        "volumen" => "337"
                        "paginaInicial" => "653"
                        "paginaFinal" => "655"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Increased thickness of pregnancy- associated melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "1995"
                        "volumen" => "132"
                        "paginaInicial" => "876"
                        "paginaFinal" => "883"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic significance of pregnancy in stage I melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Surg"
                        "fecha" => "1990"
                        "volumen" => "124"
                        "paginaInicial" => "1227"
                        "paginaFinal" => "1231"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pregnancy and dermatologic surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.det.2006.01.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Clin"
                        "fecha" => "2006"
                        "volumen" => "24"
                        "paginaInicial" => "205"
                        "paginaFinal" => "214"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sentinel lymph node biopsy during pregnancy&#58; initial clinical experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1245/s10434-006-9199-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg Oncol"
                        "fecha" => "2007"
                        "volumen" => "14"
                        "paginaInicial" => "218"
                        "paginaFinal" => "221"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Valoraci&#243;n inicial&#44; diagn&#243;stico&#44; estadificaci&#243;n&#44; tratamiento y seguimiento de los pacientes con melanoma maligno primario de la piel&#46; Documento de consenso de la &#8220;Xarxa de Centres de Melanoma de Catalunya i Balears&#8221;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Actas Dermosifilogr"
                        "fecha" => "2010"
                        "volumen" => "101"
                        "paginaInicial" => "129"
                        "paginaFinal" => "142"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Melanoma complicating pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Obstet Gynecol Clin North Am"
                        "fecha" => "1998"
                        "volumen" => "25"
                        "paginaInicial" => "407"
                        "paginaFinal" => "416"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical approaches to malignant melanoma&#58; practical guidelines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Clin"
                        "fecha" => "2002"
                        "volumen" => "20"
                        "paginaInicial" => "681"
                        "paginaFinal" => "699"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cancer in pregnancy&#58; gaps&#44; challenges and solutions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ctrv.2008.01.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer Treat Rev"
                        "fecha" => "2008"
                        "volumen" => "34"
                        "paginaInicial" => "302"
                        "paginaFinal" => "312"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Magnetic resonance imaging for stage IV melanoma during pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archderm.142.3.393-a"
                      "Revista" => array:5 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "2006"
                        "volumen" => "142"
                        "paginaInicial" => "393"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Special considerations for stage IV melanoma during pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archderm.141.9.1077"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "2005"
                        "volumen" => "141"
                        "paginaInicial" => "1077"
                        "paginaFinal" => "1078"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fetal outcome after in utero exposure to cancer chemotherapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Intern Med"
                        "fecha" => "1992"
                        "volumen" => "152"
                        "paginaInicial" => "573"
                        "paginaFinal" => "576"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Microphtalmos associated with Dartmouth combination chemotherapy in pregnancy&#58; a case report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Reprod Med"
                        "fecha" => "2007"
                        "volumen" => "52"
                        "paginaInicial" => "575"
                        "paginaFinal" => "576"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metastatic melanoma&#58; chemotherapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Oncol"
                        "fecha" => "2002"
                        "volumen" => "29"
                        "paginaInicial" => "427"
                        "paginaFinal" => "445"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Growth and development of children of mothers treated with chemotherapy during pregnancy&#58; current status of 43 children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Hematol"
                        "fecha" => "1991"
                        "volumen" => "36"
                        "paginaInicial" => "243"
                        "paginaFinal" => "248"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hematological malignancy and pregnancy&#58; a single-institution experience of 21 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2257.2006.00781.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Lab Haematol"
                        "fecha" => "2006"
                        "volumen" => "28"
                        "paginaInicial" => "170"
                        "paginaFinal" => "176"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chemotherapy of malignant melanoma with dimethyl triazeno imidazole carboxamide &#40;DTIC&#41; and nitrosourea derivatives &#40;BCNU&#44; CCNU&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "1974"
                        "volumen" => "180"
                        "paginaInicial" => "167"
                        "paginaFinal" => "174"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metastatic melanoma in pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ir Med J"
                        "fecha" => "1990"
                        "volumen" => "83"
                        "paginaInicial" => "116"
                        "paginaFinal" => "117"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of chemotherapy during human pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S1470-2045(04)01466-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Oncol"
                        "fecha" => "2004"
                        "volumen" => "5"
                        "paginaInicial" => "283"
                        "paginaFinal" => "291"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chemotherapy for metastatic melanoma during pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1006/gyno.1997.4805"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gynecol Oncol"
                        "fecha" => "1997"
                        "volumen" => "66"
                        "paginaInicial" => "526"
                        "paginaFinal" => "530"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of metastatic melanoma during pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Br Med J"
                        "fecha" => "1998"
                        "volumen" => "316"
                        "paginaInicial" => "848"
                        "paginaFinal" => "849"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stage III melanoma treated with chemotherapy after surgery during the second trimester of pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archdermatol.2008.612"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "2009"
                        "volumen" => "145"
                        "paginaInicial" => "346"
                        "paginaFinal" => "348"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management and outcome of metastatic melanoma during pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2009.09240.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2010"
                        "volumen" => "162"
                        "paginaInicial" => "274"
                        "paginaFinal" => "281"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            54 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "55"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metastatic melanoma in pregnancy&#58; Risk of transplacental metastases in the infant"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1200/JCO.2003.12.149"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Oncol"
                        "fecha" => "2003"
                        "volumen" => "21"
                        "paginaInicial" => "2179"
                        "paginaFinal" => "2186"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "56"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Advanced metastatic melanoma during pregnancy&#58; a multidisciplinary challenge"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000251841"
                      "Revista" => array:6 [
                        "tituloSerie" => "Onkologie"
                        "fecha" => "2009"
                        "volumen" => "32"
                        "paginaInicial" => "748"
                        "paginaFinal" => "751"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            56 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "57"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Previous pregnancy as a protective factor against death from melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "1977"
                        "volumen" => "1"
                        "paginaInicial" => "451"
                        "paginaFinal" => "452"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            57 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "58"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prior pregnancy and melanoma survival"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "1986"
                        "volumen" => "122"
                        "paginaInicial" => "1097"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            58 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "59"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Endocrine influences on malignant melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-2008-1070504"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dtsch Med Wochenschr"
                        "fecha" => "1981"
                        "volumen" => "106"
                        "paginaInicial" => "1329"
                        "paginaFinal" => "1333"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            59 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "60"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malignant melanoma and oral contraceptive use among women in California"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Cancer"
                        "fecha" => "1997"
                        "volumen" => "36"
                        "paginaInicial" => "804"
                        "paginaFinal" => "809"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            60 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "61"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A case-control study of the possible association between oral contraceptives and malignant melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Cancer"
                        "fecha" => "1981"
                        "volumen" => "44"
                        "paginaInicial" => "45"
                        "paginaFinal" => "50"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            61 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "62"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous melanoma in relation to exogenous hormones and reproductive factors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Natl Cancer Inst"
                        "fecha" => "1983"
                        "volumen" => "70"
                        "paginaInicial" => "827"
                        "paginaFinal" => "831"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            62 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "63"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oral contraceptive&#58; use and the risk of cutaneous malignant melanoma in a case-control study of French women"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer Causes Control"
                        "fecha" => "1992"
                        "volumen" => "3"
                        "paginaInicial" => "199"
                        "paginaFinal" => "205"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            63 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "64"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oral contraceptive use and the risk of cutaneous malignant melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer Causes Control"
                        "fecha" => "1992"
                        "volumen" => "3"
                        "paginaInicial" => "547"
                        "paginaFinal" => "554"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            64 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "65"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oral contraceptive use and malignant melanoma in Australia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Cancer"
                        "fecha" => "1984"
                        "volumen" => "50"
                        "paginaInicial" => "681"
                        "paginaFinal" => "685"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            65 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "66"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oral contraceptives and malignant melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Cancer"
                        "fecha" => "1991"
                        "volumen" => "63"
                        "paginaInicial" => "430"
                        "paginaFinal" => "433"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            66 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "67"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous malignant melanoma in females&#58; the role of hormonal and reproductive factors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Epidemiol"
                        "fecha" => "1990"
                        "volumen" => "19"
                        "paginaInicial" => "522"
                        "paginaFinal" => "526"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            67 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "68"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Danish case-control study of cutaneous malignant melanoma&#46; Hormonal and reproductive factors in women"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cancer"
                        "fecha" => "1988"
                        "volumen" => "42"
                        "paginaInicial" => "821"
                        "paginaFinal" => "824"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            68 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "69"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reproductive factors&#44; oral contraceptives and risk of malignant melanoma&#46; Western Canada melanoma study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Cancer"
                        "fecha" => "1985"
                        "volumen" => "52"
                        "paginaInicial" => "901"
                        "paginaFinal" => "907"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            69 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "70"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hormonal factors and melanoma in women"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Med J Aust"
                        "fecha" => "1985"
                        "volumen" => "142"
                        "paginaInicial" => "446"
                        "paginaFinal" => "448"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            70 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "71"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lack of an elevated risk of malignant melanoma in relation to oral contraceptive use"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Natl Cancer Inst"
                        "fecha" => "1984"
                        "volumen" => "72"
                        "paginaInicial" => "617"
                        "paginaFinal" => "620"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S000293940800768X"
                          "estado" => "S300"
                          "issn" => "00029394"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            71 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "72"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous malignant melanoma in females&#58; exogenous sex hormones and reproductive factors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Cancer"
                        "fecha" => "1984"
                        "volumen" => "50"
                        "paginaInicial" => "673"
                        "paginaFinal" => "678"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            72 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "73"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oral contraceptive use and malignant melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Natl Cancer Inst"
                        "fecha" => "1982"
                        "volumen" => "68"
                        "paginaInicial" => "537"
                        "paginaFinal" => "539"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            73 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "74"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous melanoma in women&#46; Reproductive factors and oral contraceptive use"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Epidemiol"
                        "fecha" => "1995"
                        "volumen" => "141"
                        "paginaInicial" => "943"
                        "paginaFinal" => "950"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            74 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "75"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk of malignant melanoma in relation to drug intake&#44; alcohol&#44; smoking and hormonal factors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Cancer"
                        "fecha" => "1996"
                        "volumen" => "73"
                        "paginaInicial" => "1126"
                        "paginaFinal" => "1131"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            75 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "76"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hormonal and reproductive influences and risk of melanoma in women"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Epidemiol"
                        "fecha" => "1998"
                        "volumen" => "27"
                        "paginaInicial" => "751"
                        "paginaFinal" => "757"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            76 => array:3 [
              "identificador" => "bib0385"
              "etiqueta" => "77"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous malignant melanoma in women&#46; Phenotypic characteristics&#44; sun exposure and hormonal factors&#58; a case-control study from Italy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.annepidem.2004.10.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Epidemiol"
                        "fecha" => "2005"
                        "volumen" => "15"
                        "paginaInicial" => "545"
                        "paginaFinal" => "550"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            77 => array:3 [
              "identificador" => "bib0390"
              "etiqueta" => "78"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oral contraceptive use and the risk of melanoma in premenopausal women"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/sj.bjc.6690787"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Cancer"
                        "fecha" => "1999"
                        "volumen" => "81"
                        "paginaInicial" => "918"
                        "paginaFinal" => "923"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0395"
              "etiqueta" => "79"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Systematic review of case-control studies&#58; oral contraceptives show no effect on melanoma risk"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Public Health Rev"
                        "fecha" => "1997"
                        "volumen" => "25"
                        "paginaInicial" => "309"
                        "paginaFinal" => "315"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            79 => array:3 [
              "identificador" => "bib0400"
              "etiqueta" => "80"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oral contraceptives and skin cancer&#58; is there a link&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Clin Dermatol"
                        "fecha" => "2005"
                        "volumen" => "6"
                        "paginaInicial" => "349"
                        "paginaFinal" => "355"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            80 => array:3 [
              "identificador" => "bib0405"
              "etiqueta" => "81"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hormone replacement therapy and malignant melanoma&#58; to prescribe or not to prescribe&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Climateric"
                        "fecha" => "2002"
                        "volumen" => "5"
                        "paginaInicial" => "197"
                        "paginaFinal" => "200"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            81 => array:3 [
              "identificador" => "bib0410"
              "etiqueta" => "82"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cancer incidence and mortality in women receiving estrogen and estrogen-progestin replacement therapy&#58; long-term follow-up of a Swedish cohort"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/(SICI)1097-0215(19960729)67:3<327::AID-IJC4>3.0.CO;2-T"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cancer"
                        "fecha" => "1996"
                        "volumen" => "67"
                        "paginaInicial" => "327"
                        "paginaFinal" => "332"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            82 => array:3 [
              "identificador" => "bib0415"
              "etiqueta" => "83"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The relationship of pregnancy&#44; hormones and melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Semin Cutaneous Med Surg"
                        "fecha" => "1998"
                        "volumen" => "17"
                        "paginaInicial" => "167"
                        "paginaFinal" => "171"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            83 => array:3 [
              "identificador" => "bib0420"
              "etiqueta" => "84"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nevi and melanoma in the pregnant woman"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clindermatol.2008.09.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Dermatol"
                        "fecha" => "2009"
                        "volumen" => "27"
                        "paginaInicial" => "116"
                        "paginaFinal" => "121"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            84 => array:3 [
              "identificador" => "bib0425"
              "etiqueta" => "85"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malignant melanoma in pregnancy&#58; a population-based evaluation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/cncr.20925"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "2005"
                        "volumen" => "103"
                        "paginaInicial" => "1217"
                        "paginaFinal" => "1226"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            85 => array:3 [
              "identificador" => "bib0430"
              "etiqueta" => "86"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of pregnancy on survival in women with cutaneous malignant melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1200/JCO.2004.02.096"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Oncol"
                        "fecha" => "2004"
                        "volumen" => "22"
                        "paginaInicial" => "4369"
                        "paginaFinal" => "4375"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            86 => array:3 [
              "identificador" => "bib0435"
              "etiqueta" => "87"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Melanoma and pregnancy&#58; a long term follow-up"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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