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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El melanoma cut&#225;neo &#40;MC&#41; es un tumor maligno originado a partir de los melanocitos de la piel&#46; Su incidencia y mortalidad ha aumentado de forma progresiva durante las &#250;ltimas d&#233;cadas<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; El porcentaje de pacientes que desarrollar&#225;n met&#225;stasis depende en gran medida del espesor tumoral que&#44; de forma m&#225;s o menos variable&#44; se encuentra en relaci&#243;n con la precocidad en el diagn&#243;stico de la lesi&#243;n<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; La detecci&#243;n y el tratamiento precoz son fundamentales en el melanoma&#44; puesto que si el tumor se detecta en fases iniciales pueden obtenerse tasas de curaci&#243;n superiores al 90&#37;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">En la poblaci&#243;n general es importante identificar aquellos subgrupos con un riesgo elevado de padecer un melanoma por la posibilidad de aplicar medidas preventivas encaminadas a la detecci&#243;n temprana de la enfermedad&#44; y para conocer qu&#233; caracter&#237;sticas o factores espec&#237;ficos los ponen en riesgo para tratar de modificarlos&#44; siempre que esto sea factible&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La mayor parte de los esfuerzos por conocer qu&#233; factores de riesgo est&#225;n implicados en el melanoma cut&#225;neo se han realizado en poblaciones de origen anglosaj&#243;n o en el norte de Europa<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4&#44;5</span></a>&#46; Sin embargo&#44; tienen una aplicabilidad limitada en nuestro medio debido a que est&#225;n sometidos a factores ambientales distintos&#44; tales como la intensidad de la radiaci&#243;n ultravioleta&#44; y los rasgos pigmentarios tambi&#233;n son diferentes&#46; Tambi&#233;n se han realizado estudios en otros pa&#237;ses europeos del &#225;rea mediterr&#225;nea con menor incidencia de melanoma<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a>&#46; Los estudios m&#225;s importantes llevados a cabo hasta la fecha han sido reevaluados mediante varios metaan&#225;lisis&#44; en los que se ha podido establecer una estimaci&#243;n del valor que tiene cada uno de los factores de riesgo<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;10</span></a>&#46; En nuestro medio solo hay dos trabajos sobre factores de riesgo publicados&#44; realizados en una poblaci&#243;n de 116 pacientes diagnosticados de melanoma en Granada<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a>&#46; En estos trabajos se observ&#243; la importancia del fenotipo cut&#225;neo &#40;color del pelo&#44; n&#250;mero de nevos melanoc&#237;ticos&#44; fototipo&#41; y del grado de exposici&#243;n solar como factores de riesgo&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Con el objetivo de conocer los factores de riesgo de desarrollar un MC en nuestra poblaci&#243;n&#44; su relaci&#243;n con las caracter&#237;sticas fenot&#237;picas individuales y la exposici&#243;n solar&#44; se efectu&#243; un estudio de casos y controles en la poblaci&#243;n de nuestra &#225;rea de salud de la Comunidad Valenciana&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Sujetos y m&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Realizamos un estudio multiinstitucional observacional prospectivo de casos y controles&#46; La poblaci&#243;n de nuestro estudio estuvo formada por los todos los casos de melanoma incidentes tratados en los Servicios de Dermatolog&#237;a de los siguientes hospitales de la Comunidad Valenciana&#58; Instituto Valenciano de Oncolog&#237;a &#40;IVO&#41;&#44; Consorcio Hospital General Universitario de Valencia &#40;CHGUV&#41;&#44; Hospital de la Plana de Villarreal &#40;HLPC&#41;&#44; Hospital General Universitario de Alicante &#40;HGUA&#41; y Hospital Cl&#237;nico San Juan de Alicante &#40;HCSJA&#41;&#46; Fueron incluidos los pacientes con melanoma con confirmaci&#243;n histol&#243;gica y que recibieron el tratamiento definitivo en estos servicios entre enero de 2007 y junio de 2008&#46; Solo se incluyeron los 3 tipos anatomocl&#237;nicos m&#225;s frecuentes&#58; melanoma de extensi&#243;n superficial&#44; melanoma sobre lentigo maligno y melanoma nodular&#46; No se incluyeron los casos de melanoma lentiginoso acral por los diferentes factores de riesgo asociados&#46; El estudio fue aprobado por el comit&#233; de investigaci&#243;n del IVO&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Los individuos del grupo control incluidos en el estudio fueron seleccionados entre los acompa&#241;antes de los pacientes vistos en los servicios de dermatolog&#237;a&#44; excluyendo a los familiares de los pacientes con melanoma&#44; en la misma &#225;rea geogr&#225;fica&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se obtuvo el consentimiento por escrito para participar en el estudio de todos los pacientes&#46; La informaci&#243;n se recopil&#243; directamente de los pacientes y los controles mediante un cuestionario estandarizado con entrevista personal&#46; No se ocult&#243; al investigador si las encuestas eran realizadas por casos o controles&#46; El cuestionario fue elaborado mediante la adaptaci&#243;n de otro previamente validado en la literatura<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Las variables que fueron recogidas en el estudio pueden clasificarse en&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Epidemiol&#243;gicas&#58; sexo&#44; edad&#44; localidad de nacimiento&#44; nivel de estudios&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Fenot&#237;picas&#58; fototipo &#40;<span class="elsevierStyleSmallCaps">i-ii&#47;iii-iv</span>&#41;&#44; color de ojos &#40;oscuros&#47;claros&#41; y del pelo &#40;moreno&#47;casta&#241;o&#44; rubio o pelirrojo&#41;&#44; n&#250;mero de nevos melanoc&#237;ticos comunes &#40;ausencia&#47;pocos&#44; bastantes&#47;muchos&#41;&#44; n&#250;mero de ef&#233;lides en la cara &#40;ninguna&#47;pocas&#44; bastantes&#47;muchas&#41;&#44; n&#250;mero de ef&#233;lides en los brazos &#40;ninguna&#47;pocas&#44; bastantes&#47;muchas&#41;&#46; Para la clasificaci&#243;n del n&#250;mero de nevos melanoc&#237;ticos y del de ef&#233;lides se utilizaron los esquemas gr&#225;ficos cualitativos utilizados en el trabajo anteriormente mencionado<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Factores ambientales&#58; la informaci&#243;n en relaci&#243;n con la exposici&#243;n solar inclu&#237;a preguntas relativas a la exposici&#243;n solar durante toda la vida&#46; Se adjunt&#243; adem&#225;s en el cuestionario una tabla en la que se especificaba las horas de m&#225;xima exposici&#243;n solar de forma separada por periodos de vida&#58; en la infancia&#44; la adolescencia y la edad adulta&#46; Fueron recogidas la media de horas de exposici&#243;n solar laboral &#40;entre semana y fines de semana&#41;&#44; el n&#250;mero de horas de exposici&#243;n solar no laboral &#40;entre semana&#44; durante los fines de semana o en el periodo vacacional&#41;&#44; los antecedentes de quemaduras solares severas &#40;0-1&#44; 2-4&#44; &#8805;<span class="elsevierStyleHsp" style=""></span>5&#41;&#44; los antecedentes de exposici&#243;n a cabinas de bronceado &#40;0&#44; 1-10&#44; 11-20&#44; 21-60&#44; &#62;<span class="elsevierStyleHsp" style=""></span>60&#41;&#44; la edad de la primera exposici&#243;n a cabinas de rayos UVA &#40;&#60;<span class="elsevierStyleHsp" style=""></span>20&#44; 20-40&#44; &#8805;<span class="elsevierStyleHsp" style=""></span>41&#41; y la utilizaci&#243;n de fotoprotectores solares &#40;s&#237;&#47;no&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Antecedentes personales de queratosis act&#237;nicas o de c&#225;ncer cut&#225;neo no melanoma &#40;s&#237;&#47;no&#41; y antecedentes familiares de melanoma en primer grado o de otros c&#225;nceres &#40;s&#237;&#47;no&#41;&#46;</p></li></ul></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Casos</span><p id="par0065" class="elsevierStylePara elsevierViewall">Se incluyeron un total de 242 casos de MC diagnosticado en los siguientes hospitales de la Comunidad Valenciana&#58; 137 pacientes diagnosticados en el IVO &#40;56&#44;6&#37;&#41;&#44; 56 del CHGUV &#40;23&#44;1&#37;&#41;&#44; 26 del HGUA &#40;10&#44;7&#37;&#41;&#44; 13 del HCSJA &#40;5&#44;4&#37;&#41; y 10 del HLPC &#40;4&#44;1&#37;&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">El grupo estuvo constituido por 128 hombres &#40;52&#44;9&#37;&#41; y 114 mujeres &#40;47&#44;1&#37;&#41;&#46; La edad mediana era de 57 a&#241;os &#40;43-69&#41;&#46; El grupo estuvo formado por 227 espa&#241;oles &#40;93&#44;8&#37;&#41; y 15 extranjeros &#40;6&#44;2&#37;&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Controles</span><p id="par0075" class="elsevierStylePara elsevierViewall">En el grupo control se incluyeron 173 sujetos&#46; Entre estos 120 de los controles eran esposos&#47;esposas de pacientes con MC &#40;70&#44;7&#37;&#41;&#44; 24 eran amigos &#40;14&#44;2&#37;&#41; y 25 eran acompa&#241;antes de pacientes por otros motivos diferentes al MC &#40;15&#44;1&#37;&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">El grupo estuvo constituido por 61 hombres &#40;35&#44;3&#37;&#41; y 112 mujeres &#40;64&#44;7&#37;&#41;&#46; La edad mediana era de 54 a&#241;os &#40;42-64&#41; y un 98&#44;2&#37; eran de origen espa&#241;ol&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Se estudiaron las principales variables en el grupo de enfermos con melanoma y el grupo control para valorar la homogeneidad de ambos grupos mediante el test de la Ji- cuadrado&#46; El test exacto de Fisher fue utilizado para variables que con frecuencias esperadas de 5 o menos sujetos&#46; Se calcularon los valores de las <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41; mediante regresi&#243;n log&#237;stica&#44; tanto univariada como multivariada&#46; En el estudio multivariado se incluyeron los factores de riesgo significativos en el estudio univariado y se ajust&#243; por sexo&#46; La importancia relativa de los factores pron&#243;sticos se midi&#243; mediante el valor de Ji cuadrado&#44; basada en la prueba de Wald del coeficiente asociado con cada factor pron&#243;stico en el modelo de regresi&#243;n&#46; Los factores que obtuvieron mayores valores para la Ji cuadrado fueron m&#225;s significativos en cada modelo&#46; Los valores de probabilidad usados para la identificaci&#243;n de la heterogeneidad entre grupos se ajustaron para comparaciones m&#250;ltiples usando la correcci&#243;n de Bonferroni&#46; Fue considerada significativa la obtenci&#243;n de un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; El estudio estad&#237;stico se realiz&#243; con el paquete estad&#237;stico incluido en el programa SPSS<span class="elsevierStyleSup">&#174;</span>&#44; versi&#243;n 19&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0090" class="elsevierStylePara elsevierViewall">De los 415 participantes seleccionados para el estudio 189 eran hombres &#40;45&#44;5&#37;&#41; y 226 eran mujeres &#40;54&#44;5&#37;&#41;&#44; con una edad mediana 56 a&#241;os &#40;intervalo intercuart&#237;lico de 43 y 67 a&#241;os&#41;&#46; Se encontraron diferencias estad&#237;sticamente significativas en la distribuci&#243;n de sexos entre los casos y controles &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46; Fue constatado un predominio de mujeres en el grupo control &#40;64&#44;7&#37;&#41; y de varones en el grupo con melanoma &#40;52&#44;9&#37;&#41;&#46; Respecto a la edad no se encontraron diferencias significativas por grupos de edad clasificados en menores o iguales de 40 a&#241;os y mayores 40 a&#241;os&#46; El 79&#44;5&#37; de los casos de melanoma y el 79&#44;8&#37; de los controles fueron de edad igual o superior a 41 a&#241;os&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> describe la distribuci&#243;n de las variables recogidas en el estudio&#46; Las variables fenot&#237;picas que presentaron diferencias significativas fueron&#58; el fototipo bajo &#40;<span class="elsevierStyleSmallCaps">i-ii</span>&#41;&#44; el color de pelo rubio o pelirrojo&#44; el color de ojos claro y la presencia de abundantes nevos melanoc&#237;ticos&#46; Mientras que un 50&#44;4&#37; de los pacientes con melanoma ten&#237;a un fototipo <span class="elsevierStyleSmallCaps">i-ii</span>&#44; solo un 29&#44;4&#37; de los controles ten&#237;a esta caracter&#237;stica&#46; Los pacientes con fototipo <span class="elsevierStyleSmallCaps">i-ii</span> presentaron el doble de riesgo de desarrollar un melanoma que los pacientes con fototipos <span class="elsevierStyleSmallCaps">iii&#47;iv</span> &#40;OR&#58; 2&#44;44&#59; IC 95&#37; OR&#58; 1&#44;60-3&#44;70&#41;&#46; Se encontr&#243; tambi&#233;n que las personas de pelo rubio o pelirrojas ten&#237;an una una OR de 2&#44;08 respecto a las de pelo casta&#241;o o negro &#40;IC 95&#37;&#58; 1&#44;40-3&#44;10&#41;&#46; El color de ojos claro present&#243; una OR de 1&#44;51 respecto al oscuro &#40;IC 95&#37;&#58; 1&#44;01-2&#44;27&#41;&#46; Aquellos con abundantes nevos melanoc&#237;ticos presentaron una OR de 3&#44;01 respecto a los pacientes sin nevos &#40;IC 95&#37;&#58; 1&#44;80- 5&#44;00&#41;&#46; No se encontraron diferencias significativas entre ambos grupos respecto a la presencia de abundantes ef&#233;lides en la cara o en los brazos&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">En relaci&#243;n con los antecedentes personales&#44; las variables que presentaron diferencias significativas fueron&#58; la historia de queratosis act&#237;nicas y la historia personal de c&#225;ncer cut&#225;neo no melanoma&#46; Un 16&#37; de los pacientes con melanoma presentaron antecedentes personales de queratosis act&#237;nicas frente a un 5&#44;4&#37; de los pacientes que las no tuvieron &#40;OR&#58; 3&#44;37&#44; IC 95&#37;&#58; 1&#44;58-7&#44;18&#41;&#46; La OR en los pacientes con antecedentes de c&#225;ncer cut&#225;neo no melanoma fue de 12&#44;10 respecto a los que no ten&#237;an este antecedente &#40;IC 95&#37;&#58; 2&#44;85-58&#44;45&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Entre los factores ambientales analizados no se encontraron diferencias significativas en las variables estudiadas&#44; que incluyeron&#58; utilizaci&#243;n de fotoprotectores&#44; fotoexposici&#243;n laboral frecuente&#44; exposici&#243;n solar no laboral entre semana&#44; fines de semana o en periodo vacacional&#44; antecedentes de exposici&#243;n a cabinas de bronceado&#44; edad de la primera exposici&#243;n a cabinas de rayos UVA y la historia de quemaduras solares no presentaron diferencias entre ambos grupos&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Tampoco se encontraron diferencias significativas al analizar los antecedentes familiares de melanoma o de cualquier otro tipo de c&#225;ncer&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Por orden de importancia&#44; de acuerdo con el valor de la Ji cuadrado &#40;prueba de Wald&#41;&#44; se observ&#243; que la presencia de abundantes nevos melanoc&#237;ticos&#44; el fototipo cut&#225;neo <span class="elsevierStyleSmallCaps">i&#47;ii</span>&#44; los antecedentes personales de c&#225;ncer cut&#225;neo no melanoma&#44; el color de pelo claro y los antecedentes de queratosis act&#237;nicas fueron las caracter&#237;sticas que m&#225;s se relacionaron con el desarrollo de melanoma&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Despu&#233;s de realizar el estudio multivariado ajustado por sexo&#44; el color de pelo&#44; el n&#250;mero de nevos melanoc&#237;ticos&#44; el fototipo cut&#225;neo y los antecedentes personales de queratosis act&#237;nica o c&#225;ncer cut&#225;neo no melanoma se mantuvieron en el modelo como las variables predictivas independientes relacionadas con el desarrollo de melanoma &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Los pacientes con antecedentes personales de c&#225;ncer cut&#225;neo no melanoma presentaron el mayor aumento de riesgo de MC &#40;OR&#58; 8&#44;14&#59; IC 95&#37;&#58; 1&#44;77-37&#44;33&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0125" class="elsevierStylePara elsevierViewall">En la valoraci&#243;n de los resultados de este estudio hay que tener en cuenta una serie de limitaciones&#46; Por un lado los posibles sesgos derivados de la selecci&#243;n del grupo control&#44; que fue ligeramente inferior al grupo de casos&#46; No se utilizaron medidas de emparejamiento para la selecci&#243;n de los controles&#44; aunque en el estudio multivariante se ajust&#243; para el sexo&#44; que representaba la principal diferencia epidemiol&#243;gica entre ambos grupos&#46; Tambi&#233;n se intentaron recoger el mayor n&#250;mero de variables que pudieran actuar como factores de confusi&#243;n para poder ser tratadas en la fase de an&#225;lisis&#46; El grupo mayoritario de controles &#40;70&#37;&#41; se obtuvo entre esposos&#47;esposas de pacientes con melanoma&#46; Esto pudo haber tenido alg&#250;n impacto en la obtenci&#243;n de diferencias significativas&#44; sobre todo en la valoraci&#243;n de las medidas de exposici&#243;n solar&#44; por tener h&#225;bitos de exposici&#243;n solar similares&#46; Por otra parte&#44; cabe se&#241;alar que todos los datos fueron recogidos utilizando un cuestionario estandarizado&#44; aunque realizado por diferentes observadores&#44; existiendo la posibilidad de un sesgo de clasificaci&#243;n en la exploraci&#243;n f&#237;sica&#46; Se asume el sesgo de memoria que pueden tener los pacientes para recordar el n&#250;mero de quemaduras y de tiempo de fotoexposici&#243;n&#46; Por otra parte&#44; la solidez de los resultados mostrados est&#225; avalada por la correcci&#243;n del valor de la p para comparaciones m&#250;ltiples mediante la prueba de Bonferroni&#44; que minimiza la probabilidad de encontrar hallazgos significativos debidos al azar por evaluar muchas variables&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Estudios epidemiol&#243;gicos previos en poblaciones del norte de Europa han establecido que los individuos de piel&#44; pelo y ojos claros tienen mayor riesgo de MC que los sujetos con rasgos m&#225;s oscuros<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#8211;16</span></a>&#46; Nuestros resultados en una poblaci&#243;n mediterr&#225;nea muestran que solo la presencia de un fototipo <span class="elsevierStyleSmallCaps">i-ii</span> y el color de pelo claro aparecen como factores de riesgo estad&#237;sticamente significativos&#46; Estos datos apoyan la importancia de las caracter&#237;sticas pigmentarias individuales como factores de riesgo del MC tambi&#233;n en la poblaci&#243;n mediterr&#225;nea&#44; con rasgos m&#225;s oscuros y con menor incidencia de melanoma que en las poblaciones n&#243;rdicas y anglosajonas&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Algunos autores han descrito que el pelo rubio o pelirrojo son factores de riesgo para el desarrollo de MC<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a>&#44; mientras que para otros no son factores de riesgo independientes al ajustar por los factores de confusi&#243;n<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#8211;21</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Aunque el color de ojos fue un factor de riesgo en el estudio bivariante&#44; no se mantuvo como una variable significativa despu&#233;s de ajustar las variables en el estudio multivariante&#46; Tampoco encontramos diferencias significativas en el n&#250;mero de ef&#233;lides&#46; Sin embargo&#44; se ha postulado que todos estos caracteres est&#225;n relacionados entre s&#237;&#44; y son probablemente dependientes de la sensibilidad al sol que presentan los individuos con fototipos bajos &#40;<span class="elsevierStyleSmallCaps">i-ii</span>&#41;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">El n&#250;mero de nevos melanoc&#237;ticos ha sido descrito como un factor de riesgo mayor para el desarrollo de MC en ni&#241;os y adultos<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46; Coincidiendo con otros autores&#44; nuestro estudio mostr&#243; un riesgo positivo asociado a MC en los pacientes con mayor n&#250;mero de nevos melanoc&#237;ticos&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Existen datos controvertidos publicados en relaci&#243;n con el riesgo de MC y el tipo de exposici&#243;n solar&#44; seg&#250;n sea cr&#243;nica o intermitente&#46; Algunos estudios sugieren un mayor riesgo asociado a la exposici&#243;n solar intermitente<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;18&#44;19&#44;22</span></a>&#46; Los resultados de nuestro estudio sugirieron un aumento del riesgo de MC asociado con la exposici&#243;n solar intensa en pacientes con historia previa de quemaduras solares&#44; pero que no fue significativa&#46; Similar a nuestros resultados&#44; otros estudios del &#225;rea mediterr&#225;nea no han demostrado asociaci&#243;n entre las quemaduras y el riesgo de melanoma<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;20&#44;23</span></a>&#46; Esta variaci&#243;n en la asociaci&#243;n apoya que la influencia de las quemaduras sobre el riesgo de MC puede estar influenciada por la latitud&#44; fototipos m&#225;s resistentes a la exposici&#243;n solar o incluso conductas diferentes&#44; protegi&#233;ndose m&#225;s de la exposici&#243;n solar&#46; Sin embargo&#44; tampoco puede descartarse una infraestimaci&#243;n al valorar el n&#250;mero de quemaduras por los pacientes&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Tambi&#233;n encontramos un incremento del riesgo de MC en los pacientes sometidos a una exposici&#243;n solar cr&#243;nica laboral&#44; que sin embargo no fue significativa&#46; Esto podr&#237;a ser debido&#44; al menos en parte&#44; a la evaluaci&#243;n conjunta de los diferentes tipos de MC&#44; en particular el lentigo maligno respecto a las otras dos variantes&#44; que tienen unas caracter&#237;sticas epidemiol&#243;gicas diferentes&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">No encontramos diferencias significativas al analizar diferencias en la exposici&#243;n solar diaria realizada entre semana&#44; fines de semana o durante el periodo vacacional&#46; Uno de los motivos puede ser el tama&#241;o muestral insuficiente de nuestro estudio para evaluar posibles diferencias entre estos grupos&#46; Tambi&#233;n creemos que la exposici&#243;n solar puede ser una variable dif&#237;cil de medir objetivamente&#44; ya que nuestro medio est&#225; sometido a una intensa exposici&#243;n solar de forma continua&#44; por lo que puede ser dif&#237;cil diferenciar la exposici&#243;n solar cr&#243;nica de la exposici&#243;n solar recreativa intermitente&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">La relaci&#243;n con la exposici&#243;n solar cr&#243;nica se hace evidente al evaluar el riesgo relacionado con la presencia de queratosis act&#237;nicas y de c&#225;ncer cut&#225;neo no melanoma&#44; respuestas biol&#243;gicas relacionadas estrechamente con una importante exposici&#243;n cr&#243;nica acumulada al sol<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#46; En nuestra serie encontramos un aumento del riesgo de MC en los pacientes con estos antecedentes&#46; Tambi&#233;n se han confirmado en diversos estudios como importantes marcadores de riesgo&#44; demostrando la importancia de la exposici&#243;n solar acumulada en la etiopatogenia del MC<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Tampoco conseguimos demostrar la importancia de la ausencia de fotoprotectores como factor de riesgo&#46; En otras series hemos encontrado resultados similares&#46; Holman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> y Osterlind et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> no encontraron modificaci&#243;n del riesgo&#46; Beitner et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> comunicaron un exceso parad&#243;jico del riesgo en sujetos que utilizaban fotoprotectores con frecuencia&#44; sugiriendo que estos productos permitir&#237;an a los individuos una exposici&#243;n m&#225;s prolongada al sol&#44; o que alg&#250;n agente qu&#237;mico de estos compuestos podr&#237;a incrementar el riesgo del MC&#46; Sin embargo&#44; muchos de estos estudios incluyeron a sujetos que no dispon&#237;an de fotoprotectores eficaces durante su exposici&#243;n solar en la juventud&#44; y no fueron controlados como factor de confusi&#243;n el tipo de exposici&#243;n solar realizada ni el tipo de fotoprotector&#46; En un metaan&#225;lisis realizado se encontr&#243; un incremento del riesgo de MC asociado a la utilizaci&#243;n de fotoprotectores en los pa&#237;ses con latitudes<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>40&#176; sobre el ecuador<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#46; Sin embargo&#44; esta asociaci&#243;n no fue significativa en pa&#237;ses con latitudes menores sobre el ecuador&#46; Estas diferencias podr&#237;an deberse m&#225;s al fototipo cut&#225;neo que a diferencias en la radiaci&#243;n UV&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">No encontramos asociaci&#243;n con la utilizaci&#243;n de rayos UVA&#44; aunque solo una peque&#241;a proporci&#243;n de nuestro estudio los hab&#237;a utilizado en alguna ocasi&#243;n &#40;13&#44;7&#37;&#41;&#46; Los resultados iniciales en la literatura fueron controvertidos&#46; As&#237;&#44; un estudio multic&#233;ntrico realizado en 5 pa&#237;ses europeos no demostr&#243; una asociaci&#243;n significativa<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&#46; Sin embargo&#44; otro metaan&#225;lisis reciente s&#237; que demostr&#243; un riesgo de 1&#44;15 de MC &#40;IC 95&#37;&#44; 1&#44;00-1&#44;31&#41;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#46; Este riesgo no se asoci&#243; con la dosis recibida&#44; aunque s&#237; se observ&#243; un riesgo significativo cuando la primera exposici&#243;n era en menores de 35 a&#241;os&#44; motivo por el cual la OMS lo ha clasificado como carcin&#243;geno&#46; Parecen necesarios nuevos estudios en la poblaci&#243;n espa&#241;ola que aclaren posibles diferencias relacionadas con la idiosincrasia de nuestro pa&#237;s&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; este estudio de casos y controles sobre factores de riesgo de MC apoya la importancia de una serie de factores que indican predisposici&#243;n gen&#233;tica &#40;color de pelo y fototipo&#41; y ambientales relacionados con la exposici&#243;n solar&#46; Los pacientes con m&#250;ltiples nevos melanoc&#237;ticos adquiridos&#44; y tambi&#233;n aquellos con marcadores de da&#241;o solar cr&#243;nico &#40;queratosis act&#237;nicas y c&#225;ncer cut&#225;neo no melanoma&#41;&#44; presentaron un significativo aumento del riesgo&#46; El valor destacado del antecedente personal de c&#225;ncer cut&#225;neo no melanoma como factor de riesgo subraya la importancia de la exploraci&#243;n f&#237;sica y la educaci&#243;n sanitaria de los pacientes que hayan padecido un c&#225;ncer de este tipo para ayudar a la detecci&#243;n precoz del melanoma cut&#225;neo&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0185" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Financiaci&#243;n</span><p id="par0190" class="elsevierStylePara elsevierViewall">Este estudio ha sido realizado gracias a una Ayuda para el Desarrollo de Proyectos de Investigaci&#243;n de la Conselleria de Sanitat de la Generalitat Valenciana&#59; n&#250;mero de expediente&#58; AP-098&#47;07&#46;</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">En la poblaci&#243;n general es importante identificar aquellos subgrupos con un riesgo elevado de padecer un melanoma cut&#225;neo&#44; por la posibilidad de aplicar medidas preventivas y de detecci&#243;n temprana de la enfermedad&#46; La mayor&#237;a de los estudios realizados que eval&#250;an estos factores de riesgo tienen una aplicabilidad limitada en nuestro medio&#44; debido a que las poblaciones estudiadas est&#225;n sometidas a distintos factores ambientales y los rasgos pigmentarios son diferentes&#46;</p> <span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Identificar qu&#233; caracter&#237;sticas fenot&#237;picas individuales y relacionadas con la exposici&#243;n solar son factores de riesgo para desarrollar un melanoma cut&#225;neo en la poblaci&#243;n de la Comunidad Valenciana&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Realizamos un estudio multiinstitucional observacional de casos y controles&#46; Fueron incluidos 242 casos de melanoma incidentes tratados en 5 hospitales&#44; y 173 controles recogidos entre los acompa&#241;antes de los pacientes entre enero de 2007 y junio de 2008&#46; La informaci&#243;n fue recogida mediante un cuestionario estandarizado y validado&#46; Fue calculada la <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41; para cada variable y ajustada mediante regresi&#243;n log&#237;stica m&#250;ltiple&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los fototipos <span class="elsevierStyleSmallCaps">i-ii</span>&#44; el color de pelo rubio o pelirrojo&#44; el color de ojos claro&#44; la presencia de abundantes nevos melanoc&#237;ticos y los antecedentes personales de queratosis act&#237;nicas o de c&#225;ncer cut&#225;neo no melanoma fueron los factores de riesgo estad&#237;sticamente significativos&#46; Tras el estudio multivariado solo el color de pelo rubio o pelirrojo &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;9&#41;&#44; la presencia de m&#250;ltiples nevos melanoc&#237;ticos &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;1&#41;&#44; los fototipos <span class="elsevierStyleSmallCaps">i-ii</span> &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;1&#41; y los antecedentes personales de queratosis act&#237;nicas &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;5&#41; o de c&#225;ncer cut&#225;neo no melanoma &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#44;1&#41; se mantuvieron en el modelo como las variables predictivas independientes relacionadas con el desarrollo de melanoma&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Nuestro estudio apoya la importancia de una serie de factores que indican predisposici&#243;n gen&#233;tica &#40;color de pelo y fototipo&#41; y ambientales relacionados con la exposici&#243;n solar&#46; Los pacientes con m&#250;ltiples nevos melanoc&#237;ticos adquiridos&#44; y tambi&#233;n aquellos con marcadores de da&#241;o solar cr&#243;nico &#40;queratosis act&#237;nicas y c&#225;ncer cut&#225;neo no melanoma&#41;&#44; presentaron un significativo aumento del riesgo&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">It is important to identify subgroups within the general population that have an elevated risk of developing cutaneous melanoma because preventive and early-detection measures are useful in this setting&#46; The findings of most studies that have evaluated risk factors for cutaneous melanoma are of limited application in Spain because the populations studied have different pigmentary traits and are subject to different environmental factors&#46;</p> <span class="elsevierStyleSectionTitle">Objective</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To identify the phenotypic characteristics and amount of exposure to sunlight that constitute risk factors for cutaneous melanoma in the population of the Autonomous Community of Valencia&#44; Spain&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">We performed a multicenter observational case-control study&#46; In total&#44; the study included 242 patients with melanoma undergoing treatment in 5 hospitals and 173 controls enrolled from among the companions of the patients between January 2007 and June 2008&#46; The information was collected by means of a standardized&#44; validated questionnaire&#46; The odds ratio &#40;OR&#41; was calculated for each variable and adjusted using a multiple logistic regression model&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The risk factors found to be statistically significant were skin phototypes I and II&#44; blond or red hair&#44; light eye color&#44; abundant melanocytic nevi&#44; and a personal history of actinic keratosis or nonmelanoma skin cancer&#46; After the multivariate analysis&#44; only blond or red hair &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;9&#41;&#44; multiple melanocytic nevi &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;1&#41;&#44; skin phototypes <span class="elsevierStyleSmallCaps">i</span> and <span class="elsevierStyleSmallCaps">ii</span> &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;1&#41;&#44; and a personal history of actinic keratosis &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;5&#41; or nonmelanoma skin cancer &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#46;1&#41; maintained significance in the model as independent predictive variables for melanoma&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Our study supports the importance of certain factors that indicate genetic predisposition &#40;hair color and skin phototype&#41; and environmental factors associated with exposure to sunlight&#46; Patients with multiple acquired melanocytic nevi and patients with markers of chronic skin sun damage &#40;actinic keratosis and nonmelanoma cancer&#41; presented a significant increase in risk&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Nivel de estudios</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Escuela superior &#8805;<span class="elsevierStyleHsp" style=""></span>14<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Fenot&#237;picas</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Fototipo</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Claro &#40;I-II&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Oscuro &#40;III-IV&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Color de pelo</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;40-3&#44;10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Rubio &#47;pelirrojo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Casta&#241;o&#47;negro<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Color de ojos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Claros&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Oscuros<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\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">142&nbsp;\t\t\t\t\t\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&#44;7&#37;&nbsp;\t\t\t\t\t\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">118&nbsp;\t\t\t\t\t\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">68&#44;2&#37;&nbsp;\t\t\t\t\t\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ef&#233;lides en cara</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46;S&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;97&nbsp;\t\t\t\t\t\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">1&#44;11-3&#44;51&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Muchas&#47;abundantes&nbsp;\t\t\t\t\t\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">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  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;8&#37;&nbsp;\t\t\t\t\t\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">19&nbsp;\t\t\t\t\t\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">11&#44;1&#37;&nbsp;\t\t\t\t\t\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Pocas &#47;ninguna<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\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">190&nbsp;\t\t\t\t\t\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">80&#44;2&#37;&nbsp;\t\t\t\t\t\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">152&nbsp;\t\t\t\t\t\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&#44;9&#37;&nbsp;\t\t\t\t\t\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ef&#233;lides en brazos</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46;S&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;28&nbsp;\t\t\t\t\t\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">1&#44;26-4&#44;13&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Muchas&#47;abundantes&nbsp;\t\t\t\t\t\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">48&nbsp;\t\t\t\t\t\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">20&#44;3&#37;&nbsp;\t\t\t\t\t\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">17&nbsp;\t\t\t\t\t\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">10&#37;&nbsp;\t\t\t\t\t\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Pocas&#47;ninguna<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\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">189&nbsp;\t\t\t\t\t\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">90&#37;&nbsp;\t\t\t\t\t\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">153&nbsp;\t\t\t\t\t\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">79&#44;7&#37;&nbsp;\t\t\t\t\t\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">N&#46;&#176; nevos melanoc&#237;ticos</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\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">3&#44;01&nbsp;\t\t\t\t\t\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">1&#44;80-5&#44;00&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Muchos&#47;bastantes&nbsp;\t\t\t\t\t\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">81&nbsp;\t\t\t\t\t\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">34&#44;3&#37;&nbsp;\t\t\t\t\t\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">24&nbsp;\t\t\t\t\t\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">14&#44;8&#37;&nbsp;\t\t\t\t\t\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Pocos&#47;algunos<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="8" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Ambientales</span>&nbsp;\t\t\t\t\t\t\n
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                  \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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">N&#46;&#176; quemaduras solares con ampollas</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">N&#46;S&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>0-1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;13-2&#44;54&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>2-4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;38-0&#44;88&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>5<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">N&#46;&#176; horas exposici&#243;n solar diarias los fines de semana</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>h<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">N&#46;&#176; horas de exposici&#243;n solar diarias entre semana</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">N&#46;&#176; horas de exposici&#243;n solar diarias en vacaciones</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Fotoprotectores</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>S&#237;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Exposici&#243;n a cabinas de bronceado</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>No<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">138&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Edad primera exposici&#243;n a cabinas de bronceado</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \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">N&#46;S&#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="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \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">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;1&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;42&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;41-5&#44;02&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
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                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11&#44;8&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;54-1&#44;88&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Nunca<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">197&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">86&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">138&nbsp;\t\t\t\t\t\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
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                  \t\t\t\t">85&#44;2&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></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"><span class="elsevierStyleBold">Antecedentes personales</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \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
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;021&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&#44;37&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#44;58-7&#44;18&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\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">38&nbsp;\t\t\t\t\t\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">16&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " 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
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                  \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
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                  \t\t\t\t">199&nbsp;\t\t\t\t\t\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
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                  \t\t\t\t">84&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">159&nbsp;\t\t\t\t\t\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
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                  \t\t\t\t">94&#44;6&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \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
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">12&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;85-51&#44;31&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">12&#44;9&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>No<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></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"><span class="elsevierStyleBold">Antecedentes familiares</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>No<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">An&#225;lisis multivariante</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">IC 95&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fototipo I-II &#40;vs&#46; III-IV&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;33-3&#44;91&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">Color de pelo rubio&#47;pelirrojo &#40;vs&#46; casta&#241;o-oscuro&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;21-3&#44;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Color de ojos claros &#40;vs&#46; oscuros&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;56-1&#44;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Muchos&#47;bastantes nevos melanoc&#237;ticos &#40;vs&#46; pocos-algunos&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;78-5&#44;46&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
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                  \t\t\t\t">3&#44;51&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;32-9&#44;34&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Antecedentes de c&#225;ncer cut&#225;neo no melanoma &#40;vs&#46; ausencia&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#44;14&nbsp;\t\t\t\t\t\t\n
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Original
Estudio multicéntrico de casos y controles sobre factores de riesgo de desarrollar un melanoma cutáneo en la Comunidad Valenciana
Multicenter Case-Control Study of Risk Factors for Cutaneous Melanoma in Valencia, Spain
I. Ballestera, V. Oliverb, J. Bañulsa, M. Moragónc, F. Valcuended, R. Botella-Estradae, E. Nagoree,
Autor para correspondencia
eduyame@meditex.es

Autor para correspondencia.
a Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España
b Servicio de Dermatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
c Servicio de Dermatología, Hospital Universitario San Juan de Alicante, Alicante, España
d Servicio de Dermatología, Hospital La Plana de Villarreal, Alicante, España
e Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
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Los estudios m&#225;s importantes llevados a cabo hasta la fecha han sido reevaluados mediante varios metaan&#225;lisis&#44; en los que se ha podido establecer una estimaci&#243;n del valor que tiene cada uno de los factores de riesgo<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;10</span></a>&#46; En nuestro medio solo hay dos trabajos sobre factores de riesgo publicados&#44; realizados en una poblaci&#243;n de 116 pacientes diagnosticados de melanoma en Granada<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a>&#46; En estos trabajos se observ&#243; la importancia del fenotipo cut&#225;neo &#40;color del pelo&#44; n&#250;mero de nevos melanoc&#237;ticos&#44; fototipo&#41; y del grado de exposici&#243;n solar como factores de riesgo&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Con el objetivo de conocer los factores de riesgo de desarrollar un MC en nuestra poblaci&#243;n&#44; su relaci&#243;n con las caracter&#237;sticas fenot&#237;picas individuales y la exposici&#243;n solar&#44; se efectu&#243; un estudio de casos y controles en la poblaci&#243;n de nuestra &#225;rea de salud de la Comunidad Valenciana&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Sujetos y m&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Realizamos un estudio multiinstitucional observacional prospectivo de casos y controles&#46; La poblaci&#243;n de nuestro estudio estuvo formada por los todos los casos de melanoma incidentes tratados en los Servicios de Dermatolog&#237;a de los siguientes hospitales de la Comunidad Valenciana&#58; Instituto Valenciano de Oncolog&#237;a &#40;IVO&#41;&#44; Consorcio Hospital General Universitario de Valencia &#40;CHGUV&#41;&#44; Hospital de la Plana de Villarreal &#40;HLPC&#41;&#44; Hospital General Universitario de Alicante &#40;HGUA&#41; y Hospital Cl&#237;nico San Juan de Alicante &#40;HCSJA&#41;&#46; Fueron incluidos los pacientes con melanoma con confirmaci&#243;n histol&#243;gica y que recibieron el tratamiento definitivo en estos servicios entre enero de 2007 y junio de 2008&#46; Solo se incluyeron los 3 tipos anatomocl&#237;nicos m&#225;s frecuentes&#58; melanoma de extensi&#243;n superficial&#44; melanoma sobre lentigo maligno y melanoma nodular&#46; No se incluyeron los casos de melanoma lentiginoso acral por los diferentes factores de riesgo asociados&#46; El estudio fue aprobado por el comit&#233; de investigaci&#243;n del IVO&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Los individuos del grupo control incluidos en el estudio fueron seleccionados entre los acompa&#241;antes de los pacientes vistos en los servicios de dermatolog&#237;a&#44; excluyendo a los familiares de los pacientes con melanoma&#44; en la misma &#225;rea geogr&#225;fica&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se obtuvo el consentimiento por escrito para participar en el estudio de todos los pacientes&#46; La informaci&#243;n se recopil&#243; directamente de los pacientes y los controles mediante un cuestionario estandarizado con entrevista personal&#46; No se ocult&#243; al investigador si las encuestas eran realizadas por casos o controles&#46; El cuestionario fue elaborado mediante la adaptaci&#243;n de otro previamente validado en la literatura<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Las variables que fueron recogidas en el estudio pueden clasificarse en&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Epidemiol&#243;gicas&#58; sexo&#44; edad&#44; localidad de nacimiento&#44; nivel de estudios&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Fenot&#237;picas&#58; fototipo &#40;<span class="elsevierStyleSmallCaps">i-ii&#47;iii-iv</span>&#41;&#44; color de ojos &#40;oscuros&#47;claros&#41; y del pelo &#40;moreno&#47;casta&#241;o&#44; rubio o pelirrojo&#41;&#44; n&#250;mero de nevos melanoc&#237;ticos comunes &#40;ausencia&#47;pocos&#44; bastantes&#47;muchos&#41;&#44; n&#250;mero de ef&#233;lides en la cara &#40;ninguna&#47;pocas&#44; bastantes&#47;muchas&#41;&#44; n&#250;mero de ef&#233;lides en los brazos &#40;ninguna&#47;pocas&#44; bastantes&#47;muchas&#41;&#46; Para la clasificaci&#243;n del n&#250;mero de nevos melanoc&#237;ticos y del de ef&#233;lides se utilizaron los esquemas gr&#225;ficos cualitativos utilizados en el trabajo anteriormente mencionado<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Factores ambientales&#58; la informaci&#243;n en relaci&#243;n con la exposici&#243;n solar inclu&#237;a preguntas relativas a la exposici&#243;n solar durante toda la vida&#46; Se adjunt&#243; adem&#225;s en el cuestionario una tabla en la que se especificaba las horas de m&#225;xima exposici&#243;n solar de forma separada por periodos de vida&#58; en la infancia&#44; la adolescencia y la edad adulta&#46; Fueron recogidas la media de horas de exposici&#243;n solar laboral &#40;entre semana y fines de semana&#41;&#44; el n&#250;mero de horas de exposici&#243;n solar no laboral &#40;entre semana&#44; durante los fines de semana o en el periodo vacacional&#41;&#44; los antecedentes de quemaduras solares severas &#40;0-1&#44; 2-4&#44; &#8805;<span class="elsevierStyleHsp" style=""></span>5&#41;&#44; los antecedentes de exposici&#243;n a cabinas de bronceado &#40;0&#44; 1-10&#44; 11-20&#44; 21-60&#44; &#62;<span class="elsevierStyleHsp" style=""></span>60&#41;&#44; la edad de la primera exposici&#243;n a cabinas de rayos UVA &#40;&#60;<span class="elsevierStyleHsp" style=""></span>20&#44; 20-40&#44; &#8805;<span class="elsevierStyleHsp" style=""></span>41&#41; y la utilizaci&#243;n de fotoprotectores solares &#40;s&#237;&#47;no&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Antecedentes personales de queratosis act&#237;nicas o de c&#225;ncer cut&#225;neo no melanoma &#40;s&#237;&#47;no&#41; y antecedentes familiares de melanoma en primer grado o de otros c&#225;nceres &#40;s&#237;&#47;no&#41;&#46;</p></li></ul></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Casos</span><p id="par0065" class="elsevierStylePara elsevierViewall">Se incluyeron un total de 242 casos de MC diagnosticado en los siguientes hospitales de la Comunidad Valenciana&#58; 137 pacientes diagnosticados en el IVO &#40;56&#44;6&#37;&#41;&#44; 56 del CHGUV &#40;23&#44;1&#37;&#41;&#44; 26 del HGUA &#40;10&#44;7&#37;&#41;&#44; 13 del HCSJA &#40;5&#44;4&#37;&#41; y 10 del HLPC &#40;4&#44;1&#37;&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">El grupo estuvo constituido por 128 hombres &#40;52&#44;9&#37;&#41; y 114 mujeres &#40;47&#44;1&#37;&#41;&#46; La edad mediana era de 57 a&#241;os &#40;43-69&#41;&#46; El grupo estuvo formado por 227 espa&#241;oles &#40;93&#44;8&#37;&#41; y 15 extranjeros &#40;6&#44;2&#37;&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Controles</span><p id="par0075" class="elsevierStylePara elsevierViewall">En el grupo control se incluyeron 173 sujetos&#46; Entre estos 120 de los controles eran esposos&#47;esposas de pacientes con MC &#40;70&#44;7&#37;&#41;&#44; 24 eran amigos &#40;14&#44;2&#37;&#41; y 25 eran acompa&#241;antes de pacientes por otros motivos diferentes al MC &#40;15&#44;1&#37;&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">El grupo estuvo constituido por 61 hombres &#40;35&#44;3&#37;&#41; y 112 mujeres &#40;64&#44;7&#37;&#41;&#46; La edad mediana era de 54 a&#241;os &#40;42-64&#41; y un 98&#44;2&#37; eran de origen espa&#241;ol&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Se estudiaron las principales variables en el grupo de enfermos con melanoma y el grupo control para valorar la homogeneidad de ambos grupos mediante el test de la Ji- cuadrado&#46; El test exacto de Fisher fue utilizado para variables que con frecuencias esperadas de 5 o menos sujetos&#46; Se calcularon los valores de las <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41; mediante regresi&#243;n log&#237;stica&#44; tanto univariada como multivariada&#46; En el estudio multivariado se incluyeron los factores de riesgo significativos en el estudio univariado y se ajust&#243; por sexo&#46; La importancia relativa de los factores pron&#243;sticos se midi&#243; mediante el valor de Ji cuadrado&#44; basada en la prueba de Wald del coeficiente asociado con cada factor pron&#243;stico en el modelo de regresi&#243;n&#46; Los factores que obtuvieron mayores valores para la Ji cuadrado fueron m&#225;s significativos en cada modelo&#46; Los valores de probabilidad usados para la identificaci&#243;n de la heterogeneidad entre grupos se ajustaron para comparaciones m&#250;ltiples usando la correcci&#243;n de Bonferroni&#46; Fue considerada significativa la obtenci&#243;n de un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; El estudio estad&#237;stico se realiz&#243; con el paquete estad&#237;stico incluido en el programa SPSS<span class="elsevierStyleSup">&#174;</span>&#44; versi&#243;n 19&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0090" class="elsevierStylePara elsevierViewall">De los 415 participantes seleccionados para el estudio 189 eran hombres &#40;45&#44;5&#37;&#41; y 226 eran mujeres &#40;54&#44;5&#37;&#41;&#44; con una edad mediana 56 a&#241;os &#40;intervalo intercuart&#237;lico de 43 y 67 a&#241;os&#41;&#46; Se encontraron diferencias estad&#237;sticamente significativas en la distribuci&#243;n de sexos entre los casos y controles &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46; Fue constatado un predominio de mujeres en el grupo control &#40;64&#44;7&#37;&#41; y de varones en el grupo con melanoma &#40;52&#44;9&#37;&#41;&#46; Respecto a la edad no se encontraron diferencias significativas por grupos de edad clasificados en menores o iguales de 40 a&#241;os y mayores 40 a&#241;os&#46; El 79&#44;5&#37; de los casos de melanoma y el 79&#44;8&#37; de los controles fueron de edad igual o superior a 41 a&#241;os&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> describe la distribuci&#243;n de las variables recogidas en el estudio&#46; Las variables fenot&#237;picas que presentaron diferencias significativas fueron&#58; el fototipo bajo &#40;<span class="elsevierStyleSmallCaps">i-ii</span>&#41;&#44; el color de pelo rubio o pelirrojo&#44; el color de ojos claro y la presencia de abundantes nevos melanoc&#237;ticos&#46; Mientras que un 50&#44;4&#37; de los pacientes con melanoma ten&#237;a un fototipo <span class="elsevierStyleSmallCaps">i-ii</span>&#44; solo un 29&#44;4&#37; de los controles ten&#237;a esta caracter&#237;stica&#46; Los pacientes con fototipo <span class="elsevierStyleSmallCaps">i-ii</span> presentaron el doble de riesgo de desarrollar un melanoma que los pacientes con fototipos <span class="elsevierStyleSmallCaps">iii&#47;iv</span> &#40;OR&#58; 2&#44;44&#59; IC 95&#37; OR&#58; 1&#44;60-3&#44;70&#41;&#46; Se encontr&#243; tambi&#233;n que las personas de pelo rubio o pelirrojas ten&#237;an una una OR de 2&#44;08 respecto a las de pelo casta&#241;o o negro &#40;IC 95&#37;&#58; 1&#44;40-3&#44;10&#41;&#46; El color de ojos claro present&#243; una OR de 1&#44;51 respecto al oscuro &#40;IC 95&#37;&#58; 1&#44;01-2&#44;27&#41;&#46; Aquellos con abundantes nevos melanoc&#237;ticos presentaron una OR de 3&#44;01 respecto a los pacientes sin nevos &#40;IC 95&#37;&#58; 1&#44;80- 5&#44;00&#41;&#46; No se encontraron diferencias significativas entre ambos grupos respecto a la presencia de abundantes ef&#233;lides en la cara o en los brazos&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">En relaci&#243;n con los antecedentes personales&#44; las variables que presentaron diferencias significativas fueron&#58; la historia de queratosis act&#237;nicas y la historia personal de c&#225;ncer cut&#225;neo no melanoma&#46; Un 16&#37; de los pacientes con melanoma presentaron antecedentes personales de queratosis act&#237;nicas frente a un 5&#44;4&#37; de los pacientes que las no tuvieron &#40;OR&#58; 3&#44;37&#44; IC 95&#37;&#58; 1&#44;58-7&#44;18&#41;&#46; La OR en los pacientes con antecedentes de c&#225;ncer cut&#225;neo no melanoma fue de 12&#44;10 respecto a los que no ten&#237;an este antecedente &#40;IC 95&#37;&#58; 2&#44;85-58&#44;45&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Entre los factores ambientales analizados no se encontraron diferencias significativas en las variables estudiadas&#44; que incluyeron&#58; utilizaci&#243;n de fotoprotectores&#44; fotoexposici&#243;n laboral frecuente&#44; exposici&#243;n solar no laboral entre semana&#44; fines de semana o en periodo vacacional&#44; antecedentes de exposici&#243;n a cabinas de bronceado&#44; edad de la primera exposici&#243;n a cabinas de rayos UVA y la historia de quemaduras solares no presentaron diferencias entre ambos grupos&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Tampoco se encontraron diferencias significativas al analizar los antecedentes familiares de melanoma o de cualquier otro tipo de c&#225;ncer&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Por orden de importancia&#44; de acuerdo con el valor de la Ji cuadrado &#40;prueba de Wald&#41;&#44; se observ&#243; que la presencia de abundantes nevos melanoc&#237;ticos&#44; el fototipo cut&#225;neo <span class="elsevierStyleSmallCaps">i&#47;ii</span>&#44; los antecedentes personales de c&#225;ncer cut&#225;neo no melanoma&#44; el color de pelo claro y los antecedentes de queratosis act&#237;nicas fueron las caracter&#237;sticas que m&#225;s se relacionaron con el desarrollo de melanoma&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Despu&#233;s de realizar el estudio multivariado ajustado por sexo&#44; el color de pelo&#44; el n&#250;mero de nevos melanoc&#237;ticos&#44; el fototipo cut&#225;neo y los antecedentes personales de queratosis act&#237;nica o c&#225;ncer cut&#225;neo no melanoma se mantuvieron en el modelo como las variables predictivas independientes relacionadas con el desarrollo de melanoma &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Los pacientes con antecedentes personales de c&#225;ncer cut&#225;neo no melanoma presentaron el mayor aumento de riesgo de MC &#40;OR&#58; 8&#44;14&#59; IC 95&#37;&#58; 1&#44;77-37&#44;33&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0125" class="elsevierStylePara elsevierViewall">En la valoraci&#243;n de los resultados de este estudio hay que tener en cuenta una serie de limitaciones&#46; Por un lado los posibles sesgos derivados de la selecci&#243;n del grupo control&#44; que fue ligeramente inferior al grupo de casos&#46; No se utilizaron medidas de emparejamiento para la selecci&#243;n de los controles&#44; aunque en el estudio multivariante se ajust&#243; para el sexo&#44; que representaba la principal diferencia epidemiol&#243;gica entre ambos grupos&#46; Tambi&#233;n se intentaron recoger el mayor n&#250;mero de variables que pudieran actuar como factores de confusi&#243;n para poder ser tratadas en la fase de an&#225;lisis&#46; El grupo mayoritario de controles &#40;70&#37;&#41; se obtuvo entre esposos&#47;esposas de pacientes con melanoma&#46; Esto pudo haber tenido alg&#250;n impacto en la obtenci&#243;n de diferencias significativas&#44; sobre todo en la valoraci&#243;n de las medidas de exposici&#243;n solar&#44; por tener h&#225;bitos de exposici&#243;n solar similares&#46; Por otra parte&#44; cabe se&#241;alar que todos los datos fueron recogidos utilizando un cuestionario estandarizado&#44; aunque realizado por diferentes observadores&#44; existiendo la posibilidad de un sesgo de clasificaci&#243;n en la exploraci&#243;n f&#237;sica&#46; Se asume el sesgo de memoria que pueden tener los pacientes para recordar el n&#250;mero de quemaduras y de tiempo de fotoexposici&#243;n&#46; Por otra parte&#44; la solidez de los resultados mostrados est&#225; avalada por la correcci&#243;n del valor de la p para comparaciones m&#250;ltiples mediante la prueba de Bonferroni&#44; que minimiza la probabilidad de encontrar hallazgos significativos debidos al azar por evaluar muchas variables&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Estudios epidemiol&#243;gicos previos en poblaciones del norte de Europa han establecido que los individuos de piel&#44; pelo y ojos claros tienen mayor riesgo de MC que los sujetos con rasgos m&#225;s oscuros<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#8211;16</span></a>&#46; Nuestros resultados en una poblaci&#243;n mediterr&#225;nea muestran que solo la presencia de un fototipo <span class="elsevierStyleSmallCaps">i-ii</span> y el color de pelo claro aparecen como factores de riesgo estad&#237;sticamente significativos&#46; Estos datos apoyan la importancia de las caracter&#237;sticas pigmentarias individuales como factores de riesgo del MC tambi&#233;n en la poblaci&#243;n mediterr&#225;nea&#44; con rasgos m&#225;s oscuros y con menor incidencia de melanoma que en las poblaciones n&#243;rdicas y anglosajonas&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Algunos autores han descrito que el pelo rubio o pelirrojo son factores de riesgo para el desarrollo de MC<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a>&#44; mientras que para otros no son factores de riesgo independientes al ajustar por los factores de confusi&#243;n<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#8211;21</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Aunque el color de ojos fue un factor de riesgo en el estudio bivariante&#44; no se mantuvo como una variable significativa despu&#233;s de ajustar las variables en el estudio multivariante&#46; Tampoco encontramos diferencias significativas en el n&#250;mero de ef&#233;lides&#46; Sin embargo&#44; se ha postulado que todos estos caracteres est&#225;n relacionados entre s&#237;&#44; y son probablemente dependientes de la sensibilidad al sol que presentan los individuos con fototipos bajos &#40;<span class="elsevierStyleSmallCaps">i-ii</span>&#41;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">El n&#250;mero de nevos melanoc&#237;ticos ha sido descrito como un factor de riesgo mayor para el desarrollo de MC en ni&#241;os y adultos<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46; Coincidiendo con otros autores&#44; nuestro estudio mostr&#243; un riesgo positivo asociado a MC en los pacientes con mayor n&#250;mero de nevos melanoc&#237;ticos&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Existen datos controvertidos publicados en relaci&#243;n con el riesgo de MC y el tipo de exposici&#243;n solar&#44; seg&#250;n sea cr&#243;nica o intermitente&#46; Algunos estudios sugieren un mayor riesgo asociado a la exposici&#243;n solar intermitente<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;18&#44;19&#44;22</span></a>&#46; Los resultados de nuestro estudio sugirieron un aumento del riesgo de MC asociado con la exposici&#243;n solar intensa en pacientes con historia previa de quemaduras solares&#44; pero que no fue significativa&#46; Similar a nuestros resultados&#44; otros estudios del &#225;rea mediterr&#225;nea no han demostrado asociaci&#243;n entre las quemaduras y el riesgo de melanoma<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;20&#44;23</span></a>&#46; Esta variaci&#243;n en la asociaci&#243;n apoya que la influencia de las quemaduras sobre el riesgo de MC puede estar influenciada por la latitud&#44; fototipos m&#225;s resistentes a la exposici&#243;n solar o incluso conductas diferentes&#44; protegi&#233;ndose m&#225;s de la exposici&#243;n solar&#46; Sin embargo&#44; tampoco puede descartarse una infraestimaci&#243;n al valorar el n&#250;mero de quemaduras por los pacientes&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Tambi&#233;n encontramos un incremento del riesgo de MC en los pacientes sometidos a una exposici&#243;n solar cr&#243;nica laboral&#44; que sin embargo no fue significativa&#46; Esto podr&#237;a ser debido&#44; al menos en parte&#44; a la evaluaci&#243;n conjunta de los diferentes tipos de MC&#44; en particular el lentigo maligno respecto a las otras dos variantes&#44; que tienen unas caracter&#237;sticas epidemiol&#243;gicas diferentes&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">No encontramos diferencias significativas al analizar diferencias en la exposici&#243;n solar diaria realizada entre semana&#44; fines de semana o durante el periodo vacacional&#46; Uno de los motivos puede ser el tama&#241;o muestral insuficiente de nuestro estudio para evaluar posibles diferencias entre estos grupos&#46; Tambi&#233;n creemos que la exposici&#243;n solar puede ser una variable dif&#237;cil de medir objetivamente&#44; ya que nuestro medio est&#225; sometido a una intensa exposici&#243;n solar de forma continua&#44; por lo que puede ser dif&#237;cil diferenciar la exposici&#243;n solar cr&#243;nica de la exposici&#243;n solar recreativa intermitente&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">La relaci&#243;n con la exposici&#243;n solar cr&#243;nica se hace evidente al evaluar el riesgo relacionado con la presencia de queratosis act&#237;nicas y de c&#225;ncer cut&#225;neo no melanoma&#44; respuestas biol&#243;gicas relacionadas estrechamente con una importante exposici&#243;n cr&#243;nica acumulada al sol<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#46; En nuestra serie encontramos un aumento del riesgo de MC en los pacientes con estos antecedentes&#46; Tambi&#233;n se han confirmado en diversos estudios como importantes marcadores de riesgo&#44; demostrando la importancia de la exposici&#243;n solar acumulada en la etiopatogenia del MC<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Tampoco conseguimos demostrar la importancia de la ausencia de fotoprotectores como factor de riesgo&#46; En otras series hemos encontrado resultados similares&#46; Holman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> y Osterlind et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> no encontraron modificaci&#243;n del riesgo&#46; Beitner et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> comunicaron un exceso parad&#243;jico del riesgo en sujetos que utilizaban fotoprotectores con frecuencia&#44; sugiriendo que estos productos permitir&#237;an a los individuos una exposici&#243;n m&#225;s prolongada al sol&#44; o que alg&#250;n agente qu&#237;mico de estos compuestos podr&#237;a incrementar el riesgo del MC&#46; Sin embargo&#44; muchos de estos estudios incluyeron a sujetos que no dispon&#237;an de fotoprotectores eficaces durante su exposici&#243;n solar en la juventud&#44; y no fueron controlados como factor de confusi&#243;n el tipo de exposici&#243;n solar realizada ni el tipo de fotoprotector&#46; En un metaan&#225;lisis realizado se encontr&#243; un incremento del riesgo de MC asociado a la utilizaci&#243;n de fotoprotectores en los pa&#237;ses con latitudes<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>40&#176; sobre el ecuador<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#46; Sin embargo&#44; esta asociaci&#243;n no fue significativa en pa&#237;ses con latitudes menores sobre el ecuador&#46; Estas diferencias podr&#237;an deberse m&#225;s al fototipo cut&#225;neo que a diferencias en la radiaci&#243;n UV&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">No encontramos asociaci&#243;n con la utilizaci&#243;n de rayos UVA&#44; aunque solo una peque&#241;a proporci&#243;n de nuestro estudio los hab&#237;a utilizado en alguna ocasi&#243;n &#40;13&#44;7&#37;&#41;&#46; Los resultados iniciales en la literatura fueron controvertidos&#46; As&#237;&#44; un estudio multic&#233;ntrico realizado en 5 pa&#237;ses europeos no demostr&#243; una asociaci&#243;n significativa<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&#46; Sin embargo&#44; otro metaan&#225;lisis reciente s&#237; que demostr&#243; un riesgo de 1&#44;15 de MC &#40;IC 95&#37;&#44; 1&#44;00-1&#44;31&#41;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#46; Este riesgo no se asoci&#243; con la dosis recibida&#44; aunque s&#237; se observ&#243; un riesgo significativo cuando la primera exposici&#243;n era en menores de 35 a&#241;os&#44; motivo por el cual la OMS lo ha clasificado como carcin&#243;geno&#46; Parecen necesarios nuevos estudios en la poblaci&#243;n espa&#241;ola que aclaren posibles diferencias relacionadas con la idiosincrasia de nuestro pa&#237;s&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; este estudio de casos y controles sobre factores de riesgo de MC apoya la importancia de una serie de factores que indican predisposici&#243;n gen&#233;tica &#40;color de pelo y fototipo&#41; y ambientales relacionados con la exposici&#243;n solar&#46; Los pacientes con m&#250;ltiples nevos melanoc&#237;ticos adquiridos&#44; y tambi&#233;n aquellos con marcadores de da&#241;o solar cr&#243;nico &#40;queratosis act&#237;nicas y c&#225;ncer cut&#225;neo no melanoma&#41;&#44; presentaron un significativo aumento del riesgo&#46; El valor destacado del antecedente personal de c&#225;ncer cut&#225;neo no melanoma como factor de riesgo subraya la importancia de la exploraci&#243;n f&#237;sica y la educaci&#243;n sanitaria de los pacientes que hayan padecido un c&#225;ncer de este tipo para ayudar a la detecci&#243;n precoz del melanoma cut&#225;neo&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0185" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Financiaci&#243;n</span><p id="par0190" class="elsevierStylePara elsevierViewall">Este estudio ha sido realizado gracias a una Ayuda para el Desarrollo de Proyectos de Investigaci&#243;n de la Conselleria de Sanitat de la Generalitat Valenciana&#59; n&#250;mero de expediente&#58; AP-098&#47;07&#46;</p></span></span>"
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        0 => array:4 [
          "clase" => "keyword"
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            2 => "Epidemiology"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">En la poblaci&#243;n general es importante identificar aquellos subgrupos con un riesgo elevado de padecer un melanoma cut&#225;neo&#44; por la posibilidad de aplicar medidas preventivas y de detecci&#243;n temprana de la enfermedad&#46; La mayor&#237;a de los estudios realizados que eval&#250;an estos factores de riesgo tienen una aplicabilidad limitada en nuestro medio&#44; debido a que las poblaciones estudiadas est&#225;n sometidas a distintos factores ambientales y los rasgos pigmentarios son diferentes&#46;</p> <span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Identificar qu&#233; caracter&#237;sticas fenot&#237;picas individuales y relacionadas con la exposici&#243;n solar son factores de riesgo para desarrollar un melanoma cut&#225;neo en la poblaci&#243;n de la Comunidad Valenciana&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Realizamos un estudio multiinstitucional observacional de casos y controles&#46; Fueron incluidos 242 casos de melanoma incidentes tratados en 5 hospitales&#44; y 173 controles recogidos entre los acompa&#241;antes de los pacientes entre enero de 2007 y junio de 2008&#46; La informaci&#243;n fue recogida mediante un cuestionario estandarizado y validado&#46; Fue calculada la <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41; para cada variable y ajustada mediante regresi&#243;n log&#237;stica m&#250;ltiple&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los fototipos <span class="elsevierStyleSmallCaps">i-ii</span>&#44; el color de pelo rubio o pelirrojo&#44; el color de ojos claro&#44; la presencia de abundantes nevos melanoc&#237;ticos y los antecedentes personales de queratosis act&#237;nicas o de c&#225;ncer cut&#225;neo no melanoma fueron los factores de riesgo estad&#237;sticamente significativos&#46; Tras el estudio multivariado solo el color de pelo rubio o pelirrojo &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;9&#41;&#44; la presencia de m&#250;ltiples nevos melanoc&#237;ticos &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;1&#41;&#44; los fototipos <span class="elsevierStyleSmallCaps">i-ii</span> &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;1&#41; y los antecedentes personales de queratosis act&#237;nicas &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;5&#41; o de c&#225;ncer cut&#225;neo no melanoma &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#44;1&#41; se mantuvieron en el modelo como las variables predictivas independientes relacionadas con el desarrollo de melanoma&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Nuestro estudio apoya la importancia de una serie de factores que indican predisposici&#243;n gen&#233;tica &#40;color de pelo y fototipo&#41; y ambientales relacionados con la exposici&#243;n solar&#46; Los pacientes con m&#250;ltiples nevos melanoc&#237;ticos adquiridos&#44; y tambi&#233;n aquellos con marcadores de da&#241;o solar cr&#243;nico &#40;queratosis act&#237;nicas y c&#225;ncer cut&#225;neo no melanoma&#41;&#44; presentaron un significativo aumento del riesgo&#46;</p>"
      ]
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">It is important to identify subgroups within the general population that have an elevated risk of developing cutaneous melanoma because preventive and early-detection measures are useful in this setting&#46; The findings of most studies that have evaluated risk factors for cutaneous melanoma are of limited application in Spain because the populations studied have different pigmentary traits and are subject to different environmental factors&#46;</p> <span class="elsevierStyleSectionTitle">Objective</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To identify the phenotypic characteristics and amount of exposure to sunlight that constitute risk factors for cutaneous melanoma in the population of the Autonomous Community of Valencia&#44; Spain&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">We performed a multicenter observational case-control study&#46; In total&#44; the study included 242 patients with melanoma undergoing treatment in 5 hospitals and 173 controls enrolled from among the companions of the patients between January 2007 and June 2008&#46; The information was collected by means of a standardized&#44; validated questionnaire&#46; The odds ratio &#40;OR&#41; was calculated for each variable and adjusted using a multiple logistic regression model&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The risk factors found to be statistically significant were skin phototypes I and II&#44; blond or red hair&#44; light eye color&#44; abundant melanocytic nevi&#44; and a personal history of actinic keratosis or nonmelanoma skin cancer&#46; After the multivariate analysis&#44; only blond or red hair &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;9&#41;&#44; multiple melanocytic nevi &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;1&#41;&#44; skin phototypes <span class="elsevierStyleSmallCaps">i</span> and <span class="elsevierStyleSmallCaps">ii</span> &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;1&#41;&#44; and a personal history of actinic keratosis &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;5&#41; or nonmelanoma skin cancer &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#46;1&#41; maintained significance in the model as independent predictive variables for melanoma&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Our study supports the importance of certain factors that indicate genetic predisposition &#40;hair color and skin phototype&#41; and environmental factors associated with exposure to sunlight&#46; Patients with multiple acquired melanocytic nevi and patients with markers of chronic skin sun damage &#40;actinic keratosis and nonmelanoma cancer&#41; presented a significant increase in risk&#46;</p>"
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                  \t\t\t\t">1&#44;60-3&#44;70&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Claro &#40;I-II&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Oscuro &#40;III-IV&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">117&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">49&#44;6&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">120&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#44;6&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Color de pelo</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">1&#44;40-3&#44;10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Rubio &#47;pelirrojo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Casta&#241;o&#47;negro<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Color de ojos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">N&#46;S&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Claros&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Oscuros<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">68&#44;2&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ef&#233;lides en cara</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \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
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                  \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">N&#46;S&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;97&nbsp;\t\t\t\t\t\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">1&#44;11-3&#44;51&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Muchas&#47;abundantes&nbsp;\t\t\t\t\t\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">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  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;8&#37;&nbsp;\t\t\t\t\t\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">19&nbsp;\t\t\t\t\t\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">11&#44;1&#37;&nbsp;\t\t\t\t\t\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
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                  \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Pocas &#47;ninguna<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\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">190&nbsp;\t\t\t\t\t\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">80&#44;2&#37;&nbsp;\t\t\t\t\t\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">152&nbsp;\t\t\t\t\t\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&#44;9&#37;&nbsp;\t\t\t\t\t\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ef&#233;lides en brazos</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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
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                  \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">N&#46;S&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;28&nbsp;\t\t\t\t\t\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">1&#44;26-4&#44;13&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Muchas&#47;abundantes&nbsp;\t\t\t\t\t\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">48&nbsp;\t\t\t\t\t\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">20&#44;3&#37;&nbsp;\t\t\t\t\t\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">17&nbsp;\t\t\t\t\t\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">10&#37;&nbsp;\t\t\t\t\t\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
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                  \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Pocas&#47;ninguna<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\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">189&nbsp;\t\t\t\t\t\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">90&#37;&nbsp;\t\t\t\t\t\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">153&nbsp;\t\t\t\t\t\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">79&#44;7&#37;&nbsp;\t\t\t\t\t\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
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                  \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">N&#46;&#176; nevos melanoc&#237;ticos</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \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
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                  \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
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\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">3&#44;01&nbsp;\t\t\t\t\t\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">1&#44;80-5&#44;00&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Muchos&#47;bastantes&nbsp;\t\t\t\t\t\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">81&nbsp;\t\t\t\t\t\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">34&#44;3&#37;&nbsp;\t\t\t\t\t\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">24&nbsp;\t\t\t\t\t\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">14&#44;8&#37;&nbsp;\t\t\t\t\t\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
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                  \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
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                  \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Pocos&#47;algunos<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\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">155&nbsp;\t\t\t\t\t\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">65&#44;7&#37;&nbsp;\t\t\t\t\t\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">138&nbsp;\t\t\t\t\t\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">85&#44;2&#37;&nbsp;\t\t\t\t\t\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
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                  \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
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                  \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
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                  \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  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></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"><span class="elsevierStyleBold">Ambientales</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \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
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                  \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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>2-4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">N&#46;&#176; horas exposici&#243;n solar diarias los fines de semana</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>h<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">N&#46;&#176; horas de exposici&#243;n solar diarias entre semana</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>h<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">N&#46;&#176; horas de exposici&#243;n solar diarias en vacaciones</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Trabajo en exteriores</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Edad primera exposici&#243;n a cabinas de bronceado</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></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
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                  \t\t\t\t"><span class="elsevierStyleBold">Antecedentes personales</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Queratosis actinicas</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>No<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">C&#225;ncer cut&#225;neo no melanoma</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>No<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Antecedentes familiares</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Antecedentes familiares de melanoma</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">90&#44;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Antecedentes familiares de c&#225;ncer no melanoma</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>No<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">133&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">55&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">106&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \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
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                  \t\t\t\t">Variables&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">An&#225;lisis multivariante</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">IC 95&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fototipo I-II &#40;vs&#46; III-IV&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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&#44;13&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \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">Color de pelo rubio&#47;pelirrojo &#40;vs&#46; casta&#241;o-oscuro&#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
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                  \t\t\t\t">1&#44;93&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;21-3&#44;09&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
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                  \t\t\t\t">Color de ojos claros &#40;vs&#46; oscuros&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;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">0&#44;56-1&#44;53&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">Muchos&#47;bastantes nevos melanoc&#237;ticos &#40;vs&#46; pocos-algunos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;78-5&#44;46&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">Presencia de queratosis act&#237;nicas &#40;vs&#46; ausencia&#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
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                  \t\t\t\t">3&#44;51&nbsp;\t\t\t\t\t\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
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Antecedentes de c&#225;ncer cut&#225;neo no melanoma &#40;vs&#46; ausencia&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#44;14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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