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1995-2001&#44; 2002-2008 y 2009-2015&#46; Las caracter&#237;sticas cl&#237;nicas incluyeron&#58; sexo&#44; localizaci&#243;n &#40;cuero cabelludo&#44; cara&#44; oreja y cuello&#41; y edad &#40;recogida como variable continua y tambi&#233;n en forma de intervalos&#58; &#8804;<span class="elsevierStyleHsp" style=""></span>60&#44; 61-74 y &#8805;<span class="elsevierStyleHsp" style=""></span>75 a&#241;os&#41;&#46; Los datos histol&#243;gicos incluyeron&#58; tipo histol&#243;gico &#40;lentigo maligno&#44; extensi&#243;n superficial&#44; nodular&#44; otros&#41;&#44; presencia de ulceraci&#243;n histol&#243;gica&#44; espesor tumoral &#40;recogido como variable continua y tambi&#233;n en forma de variable cualitativa ordinal con intervalos de espesor T1-T4&#41;&#44; presencia de componente invasivo del melanoma&#44; n&#250;mero de mitosis&#47;mm<span class="elsevierStyleSup">2</span>&#44; desarrollo de met&#225;stasis y estado vital del paciente&#46; El n&#250;mero de mitosis&#47;mm<span class="elsevierStyleSup">2</span> fue recogida en m&#225;s del 85&#37; de los pacientes con melanoma invasivo&#46; La t&#233;cnica usada para contabilizar el n&#250;mero de mitosis fue la llamada &#171;hot spot&#187;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">3</span></a>&#46; Se establecieron 3 intervalos definidos de n&#250;mero de mitosis &#40;0&#44; 1-5&#44; &#8805;<span class="elsevierStyleHsp" style=""></span>6 mitosis&#47;mm<span class="elsevierStyleSup">2</span>&#41;&#44; ya que otros autores han descrito la implicaci&#243;n pron&#243;stica y su posible relaci&#243;n con la positividad del ganglio centinela cuando se superan las 6 mitosis&#47;mm<span class="elsevierStyleSup">2</span><a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">4&#44;5</span></a>&#46; Algunos casos no reflejaban el n&#250;mero de mitosis en el informe anatomopatol&#243;gico&#44; por lo que dichas muestras fueron revisadas por 2 pat&#243;logos expertos en el diagn&#243;stico de lesiones melanoc&#237;ticas&#46; Tambi&#233;n se recogi&#243; la aparici&#243;n de met&#225;stasis y el estado vital de los pacientes&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">En los casos que se compararon variables cualitativas se usaron la prueba Chi-cuadrado y la prueba exacta de Fisher&#46; Tambi&#233;n se us&#243; la correcci&#243;n de &#171;Benjamini-Hochberg&#187; para obtener una mayor precisi&#243;n en los resultados obtenidos y disminuir el efecto de las comparaciones m&#250;ltiples&#46; En las comparaciones entre variables cualitativas y cuantitativas&#44; la comparaci&#243;n de medias se realiz&#243; mediante las pruebas t de Student o ANOVA&#44; seg&#250;n correspondiese&#46; El nivel de significaci&#243;n estad&#237;stica a alcanzar para todos los casos fue de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Los datos obtenidos se analizaron con el programa SPSS&#174; versi&#243;n 25 &#40;Illinois&#44; Inc&#59; EE&#46; UU&#46;&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Caracter&#237;sticas globales</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se identificaron un total de 280 pacientes que hab&#237;an sido diagnosticados y tratados de MCC en el intervalo 1995-2015&#46; Previamente se hab&#237;an excluido un total de 13 pacientes por no cumplir con los criterios descritos previamente&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se recogen los datos cl&#237;nicos&#44; histol&#243;gicos y evolutivos m&#225;s relevantes&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Hubo un cierto predominio femenino en nuestra muestra y la edad media de los pacientes fue de 71&#44;3 a&#241;os &#40;mediana&#58; 74 a&#241;os&#59; RIC&#58; 65-81 a&#241;os&#41;&#46; El grupo de pacientes de edad m&#225;s avanzada &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>75 a&#241;os&#41; fue el m&#225;s numeroso y englob&#243; a 127 &#40;45&#44;4&#37;&#41; pacientes&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">La localizaci&#243;n m&#225;s habitual fue la cara&#44; seguida a distancia en orden decreciente por el cuero cabelludo&#44; cuello y orejas&#46; Casi 3 de cada 4 melanomas estuvieron localizados en la cara&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se encontr&#243; un n&#250;mero elevado de melanomas <span class="elsevierStyleItalic">in situ&#58;</span> 101 &#40;36&#44;1&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; La mediana del espesor tumoral fue de 0&#44;4<span class="elsevierStyleHsp" style=""></span>mm &#40;intervalo&#58; 0-18<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; Tambi&#233;n llam&#243; la atenci&#243;n un n&#250;mero considerable de tumores gruesos&#58; 72 pacientes &#40;25&#44;7&#37;&#41; presentaron MCC con espesor tumoral T3-T4&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">El tipo histol&#243;gico predominante fue el lentigo maligno&#44; con 172 casos &#40;61&#44;4&#37;&#41;&#46; El segundo en frecuencia fue el melanoma de extensi&#243;n superficial&#44; seguido por el melanoma nodular&#46; Si tenemos en cuenta &#250;nicamente los melanomas invasivos&#44; 98 &#40;63&#44;7&#37;&#41; de ellos tuvo al menos 1 mitosis&#47;mm<span class="elsevierStyleSup">2</span>&#46; Adem&#225;s&#44; 34 &#40;22&#44;1&#37;&#41; de estos melanomas present&#243; un n&#250;mero elevado de mitosis &#8212;6 o m&#225;s&#8212;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Tras una mediana de seguimiento de 111 meses&#44; 51 pacientes &#40;18&#44;2&#37;&#41; presentaron una recidiva y 29 pacientes &#40;10&#44;4&#37;&#41; fallecieron a ra&#237;z del melanoma&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se recoge la localizaci&#243;n inicial de las met&#225;stasis encontradas&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Cambios evolutivos a lo largo del estudio</span><p id="par0060" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> se recoge la comparativa entre las distintas variables en funci&#243;n del periodo de tiempo estudiado&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">No se encontr&#243; un cambio de tendencia en cuanto al predominio del sexo femenino en nuestra muestra&#46; En todos los periodos de tiempo&#44; las mujeres representaron m&#225;s de la mitad de los pacientes&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Los pacientes con una edad m&#225;s avanzada &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>75 a&#241;os&#41; adquirieron un peso progresivamente mayor&#44; ya que aumentaron desde 27 casos &#40;32&#44;1&#37;&#41; en el periodo 1995-2001 hasta los 54 casos &#40;56&#44;8&#37;&#41; del &#250;ltimo periodo&#44; 2009-2015 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; La edad media de los pacientes aument&#243; desde los 68&#44;4 a&#241;os &#40;mediana&#58; 71 a&#241;os&#41; iniciales hasta los 72&#44;1 &#40;mediana&#58; 76 a&#241;os&#41; del &#250;ltimo periodo&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">En cuanto a la localizaci&#243;n del melanoma&#44; la cara fue siempre la m&#225;s frecuente&#46; Aunque no lleg&#243; a alcanzar significaci&#243;n estad&#237;stica&#44; se encontr&#243; un cierto aumento progresivo de melanomas en el cuero cabelludo&#44; mientras que los melanomas cervicales fueron cada vez menos frecuentes&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">El espesor tumoral se redujo significativamente desde los 2&#44;1<span class="elsevierStyleHsp" style=""></span>mm de media del intervalo 1995-2001 hasta los 0&#44;9<span class="elsevierStyleHsp" style=""></span>mm del &#250;ltimo intervalo 2009-2015 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#41;&#46; Los melanomas <span class="elsevierStyleItalic">in situ</span> aumentaron a su vez de forma progresiva a lo largo de los a&#241;os&#58; inicialmente englobaban 20 casos &#40;23&#44;8&#37; del total de MCC&#41;&#44; mientras que en los &#250;ltimos a&#241;os esta cifra lleg&#243; hasta los 45 casos &#40;47&#44;4&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#46; Por otro lado&#44; los melanomas T4&#44; con un mayor espesor&#44; se redujeron significativamente de forma progresiva&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Se encontr&#243; una tendencia hacia una menor frecuencia de ulceraci&#243;n histol&#243;gica de los MCC&#44; pasando de 24 casos &#40;28&#44;6&#37;&#41; en el periodo 1995-2001 hasta tan solo 15 casos &#40;15&#44;8&#37;&#41; en el periodo 2009-2015&#44; aunque estas cifras no alcanzaron significaci&#243;n estad&#237;stica &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;119&#41;&#46; En cuanto al tipo histol&#243;gico&#44; el tipo lentigo maligno fue siempre el predominante y se apreci&#243; una tendencia a una menor proporci&#243;n de melanomas nodulares conforme avanzaba el intervalo estudiado&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Los MCC con 6 o m&#225;s mitosis se redujeron significativamente a lo largo del estudio&#44; pasando de 15 casos &#40;30&#37;&#41; a &#250;nicamente 2 casos &#40;4&#44;8&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;013&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Los pacientes que desarrollaron met&#225;stasis fueron progresivamente menos frecuentes a lo largo del estudio&#58; 23 pacientes &#40;27&#44;4&#37;&#41; presentaron met&#225;stasis en el intervalo 1995-2001 frente a tan solo 10 pacientes &#40;10&#44;5&#37;&#41; en el intervalo 2009-2015 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;014&#41;&#46; De forma similar&#44; tambi&#233;n se redujo significativamente la mortalidad por melanoma&#44; pasando de 16 casos &#40;19&#37;&#41; en el periodo inicial a tan solo 4 casos &#40;2&#44;4&#37;&#41; en los &#250;ltimos a&#241;os del estudio &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">El territorio de cabeza y cuello representa el 9&#37; de la superficie corporal&#44; sin embargo&#44; en esta zona aparecen entre un 12 y un 30&#37; del total de melanomas cut&#225;neos<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#8211;10</span></a>&#46; Pese a la evidente importancia de esta localizaci&#243;n&#44; no hemos encontrado trabajos focalizados en el MCC en el contexto de la poblaci&#243;n espa&#241;ola y debemos comparar nuestros resultados bien con series internacionales o con datos parciales de otras series de melanoma realizadas en Espa&#241;a&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En poblaciones europeas-cauc&#225;sicas&#44; incluyendo Espa&#241;a&#44; suele describirse un predominio femenino entre los pacientes con melanoma<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">11&#8211;13</span></a>&#46; En cuanto al MCC&#44; algunos estudios reflejan que estos melanomas se asocian m&#225;s frecuentemente al sexo masculino respecto a los melanomas de otras zonas<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">14</span></a>&#46; Sin embargo&#44; los resultados en las distintas series son dispares y en las &#250;ltimas d&#233;cadas encontramos tanto trabajos donde hay un predominio femenino<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#44;15</span></a> como otros donde predominan los varones<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">16&#44;17</span></a>&#46; En nuestra serie las mujeres superaron discretamente a los varones&#44; con un 53&#44;9&#37; de los casos&#46; Esto coincide con el predominio femenino encontrado en el estudio realizado por Arranz-S&#225;nchez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">12</span></a> en la poblaci&#243;n de Madrid entre 1990 y 2004&#44; con un 60&#37; de los MCC diagnosticados en mujeres&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">El MCC afecta a una poblaci&#243;n con una edad media mayor respecto al resto de melanomas&#44; independientemente del subtipo histol&#243;gico<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;18</span></a>&#46; La edad media al diagn&#243;stico en el MCC var&#237;a de 64 a 71 a&#241;os frente a los 50-58 a&#241;os de edad media del resto de melanomas cut&#225;neos<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;7&#44;14</span></a>&#46; En nuestro estudio&#44; los pacientes presentaron una edad media de 71&#44;3 a&#241;os y casi la mitad de los pacientes present&#243; una edad de 75 o m&#225;s a&#241;os&#46; Estos datos van en la l&#237;nea de lo encontrado en un estudio poblacional realizado en un centro oncol&#243;gico de la Comunidad Valenciana donde se reflej&#243; c&#243;mo los pacientes de mayor edad &#8212;mayores de 65 a&#241;os en este caso&#8212; engloban a m&#225;s del 50&#37; del total de MCC<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">19</span></a>&#46; En nuestra serie&#44; encontramos que el grupo de pacientes de edad m&#225;s avanzada &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>75 a&#241;os&#41; alcanz&#243; un porcentaje cada vez m&#225;s significativo a lo largo del periodo de estudio en nuestra serie&#46; En el periodo 2009-2015 este grupo de pacientes representaba el 56&#44;8&#37; del total de MCC&#44; mientras que en el periodo 1995-2001 solo representaba el 32&#44;1&#37;&#46; Esto coincide con el aumento de la edad media de los pacientes diagnosticados de melanoma observado en otros pa&#237;ses<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a> y en el caso del MCC probablemente se debe al alto porcentaje de melanomas tipo lentigo maligno&#44; asociado al efecto acumulativo de la exposici&#243;n solar cr&#243;nica&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">La cara represent&#243; la localizaci&#243;n m&#225;s frecuente en nuestro estudio&#46; En todas las series de MCC consultadas aparece la cara como localizaci&#243;n m&#225;s prevalente&#58; entre el 53&#44;2 y el 78&#44;5&#37; de los MCC est&#225;n localizados en la zona facial<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;6&#44;7&#44;15</span></a>&#46; Esto no es de extra&#241;ar al tratarse de un &#225;rea amplia que recibe una intensa cantidad de radiaci&#243;n ultravioleta&#46; Aunque no lleg&#243; a alcanzar significaci&#243;n estad&#237;stica&#44; los melanomas de cuello se redujeron progresivamente a lo largo del estudio&#44; mientras que los de cuero cabelludo aumentaron&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Casi 2 de cada 3 MCC de nuestra serie correspondieron al tipo histol&#243;gico lentigo maligno&#46; Le siguieron en frecuencia el melanoma de extensi&#243;n superficial y el melanoma nodular&#46; Cl&#225;sicamente se ha descrito c&#243;mo el lentigo maligno se asocia al territorio de cabeza y cuello y la mayor parte de trabajos refleja que constituye el tipo histol&#243;gico predominante en esta zona<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;6&#44;7&#44;18&#44;21</span></a>&#46; No obstante&#44; en algunas series de MCC predominan los melanomas de extensi&#243;n superficial<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">16&#44;17</span></a>&#44; y en nuestro trabajo ocuparon el segundo lugar en frecuencia con un porcentaje considerable de casos &#40;18&#44;9&#37;&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">El 36&#44;1&#37; de los MCC de nuestra serie fueron melanomas <span class="elsevierStyleItalic">in situ&#46;</span> Otros trabajos de MCC reflejan un porcentaje variable de melanomas <span class="elsevierStyleItalic">in situ</span> que comprende desde el 32 hasta el 49&#44;5&#37;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;7&#44;22</span></a>&#46; Esto representa un porcentaje mayor de melanomas <span class="elsevierStyleItalic">in situ</span> en cabeza y cuello respecto al resto de localizaciones&#58; el Registro Nacional de Melanoma Cut&#225;neo refleja que el porcentaje de melanomas <span class="elsevierStyleItalic">in situ</span> se sit&#250;a en el 16&#37;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a>&#46; Asimismo&#44; encontramos m&#225;s del doble de melanomas <span class="elsevierStyleItalic">in situ</span> en el periodo 2009-2015 frente al periodo inicial 1995-2001&#44; lo que refleja el aumento progresivo de melanomas <span class="elsevierStyleItalic">in situ</span> a lo largo de las 2 &#250;ltimas d&#233;cadas&#46; Esta tendencia se ha observado tanto en MCC como en los melanomas de otras localizaciones<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">12&#44;13&#44;23</span></a> y probablemente pueda explicarse por un diagn&#243;stico cada vez m&#225;s precoz por el uso de la dermatoscopia y por un seguimiento protocolizado de pacientes en riesgo&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">El espesor tumoral medio fue de 1&#44;6<span class="elsevierStyleHsp" style=""></span>mm&#46; Este se redujo significativamente a lo largo del estudio&#44; pasando de 2&#44;1<span class="elsevierStyleHsp" style=""></span>mm &#40;intervalo&#58; 1995-2001&#41; a 0&#44;9<span class="elsevierStyleHsp" style=""></span>mm &#40;intervalo&#58; 2009-2015&#41;&#46; Esta reducci&#243;n en el espesor tumoral medio supone una tendencia que se ha registrado a nivel global a lo largo de las &#250;ltimas d&#233;cadas<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">12&#44;23</span></a>&#44; aunque la mayor parte son estudios que no est&#225;n limitados al MCC como el nuestro&#46; Un estudio con 98&#46;498 pacientes basado en varios registros <span class="elsevierStyleItalic">Surveillance&#44; Epidemiology and End Results</span> &#40;SEER&#41; de EE&#46; UU&#46;&#44; constat&#243; una reducci&#243;n del espesor tumoral medio de 0&#44;77 a 0&#44;65<span class="elsevierStyleHsp" style=""></span>mm en un intervalo de 20 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a>&#46; El conjunto de melanomas T3 y T4 supuso un porcentaje considerable &#40;25&#44;7&#37;&#41; del total de MCC de nuestra muestra&#46; Esta heterogeneidad en el espesor tumoral en el MCC &#8212;elevada frecuencia tanto de melanomas <span class="elsevierStyleItalic">in situ</span> como de melanomas gruesos&#8212; tambi&#233;n ha sido descrita por otros autores<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">7</span></a>&#44; y parece reflejar la coexistencia de numerosos melanomas tipo lentigo maligno junto con otros melanomas de r&#225;pido crecimiento&#44; como el melanoma nodular&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">El n&#250;mero de mitosis por mm<span class="elsevierStyleSup">2</span> representa un marcador cuantificable de la proliferaci&#243;n celular tumoral en el melanoma&#44; se ha relacionado estrechamente con la supervivencia y numerosos estudios lo consideran un factor pron&#243;stico independiente<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">3&#44;25&#44;26</span></a>&#46; Son escasos los trabajos que describen este hallazgo histol&#243;gico en el MCC<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">27&#8211;29</span></a>&#46; Shen et al&#46; encontraron que los MCC se asocian a un elevado n&#250;mero de mitosis<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">28</span></a>&#44; mientras que otros circunscriben este elevado n&#250;mero de mitosis a los melanomas de cuero cabelludo<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">30</span></a>&#46; En nuestra muestra&#44; el 63&#44;6&#37; de MCC presentaron &#8805;<span class="elsevierStyleHsp" style=""></span>1 mitosis&#47;mm<span class="elsevierStyleSup">2</span>&#46; Xie et al&#46; reflejaron en una amplia serie de pacientes con MCC que el 65&#37; del total de MCC presentaban un n&#250;mero de mitosis igual o superior a uno&#44; cifra casi superponible a la encontrada en nuestro estudio&#46; En ese trabajo describieron tambi&#233;n que el 30&#44;4&#37; de los pacientes presentaban 5 o m&#225;s mitosis&#47;mm<span class="elsevierStyleSup">2</span>&#44; cifra similar al porcentaje de pacientes con mayor actividad mit&#243;tica &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>6 mitosis&#47;mm<span class="elsevierStyleSup">2</span>&#41; encontrado en nuestra serie&#46; Estas cifras son superiores a las descritas en los melanomas cut&#225;neos de otras zonas<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a>&#46; Por otro lado&#44; encontramos que los melanomas con alta actividad mit&#243;tica fueron cada vez menos frecuentes en nuestro estudio&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">En &#250;ltimo lugar&#44; cabe destacar c&#243;mo el pron&#243;stico de los pacientes con MCC ha ido mejorando en las 2 &#250;ltimas d&#233;cadas&#58; se ha reducido significativamente el desarrollo de met&#225;stasis y tambi&#233;n el n&#250;mero de muertes por melanoma&#46; Es llamativa la reducci&#243;n en la mortalidad por melanoma pasando del 19&#37; de muertes por melanoma en el periodo 1995-2001 hasta el 2&#44;4&#37; del &#250;ltimo periodo 2009-2015&#46; Este hecho pueda ser posiblemente explicado por la reducci&#243;n en el espesor tumoral medio&#44; as&#237; como un menor n&#250;mero de mitosis y presencia de ulceraci&#243;n&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusiones</span><p id="par0145" class="elsevierStylePara elsevierViewall">En este trabajo presentamos los datos de una muestra amplia de pacientes diagnosticados de MCC en un hospital terciario de la poblaci&#243;n madrile&#241;a&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas cl&#237;nico-histol&#243;gicas de nuestra muestra coinciden en buena parte con lo ya publicado en la literatura&#58; la localizaci&#243;n predominante es la cara y existe un elevado porcentaje de melanomas tipo lentigo maligno&#46; Un porcentaje significativo de los melanomas invasivos present&#243; una elevada actividad mit&#243;tica &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>6 mitosis&#47;mm<span class="elsevierStyleSup">2</span>&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">El MCC afecta a una poblaci&#243;n con una edad media cada vez mayor&#44; lo que refleja la necesidad de nuevos estudios focalizados en el melanoma de este territorio al encontrarnos en el marco de una sociedad cada vez m&#225;s envejecida&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Nuestro trabajo refleja c&#243;mo los MCC han presentado un espesor cada vez menor&#44; as&#237; como una menor probabilidad de met&#225;stasis y de muerte por melanoma respecto al inicio del estudio&#46;</p></span></span>"
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              "titulo" => "Cambios evolutivos a lo largo del estudio"
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          "titulo" => "Discusi&#243;n"
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    "fechaRecibido" => "2019-08-01"
    "fechaAceptado" => "2019-12-02"
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            0 => "Melanoma"
            1 => "Melanoma de cabeza y cuello"
            2 => "Epidemiolog&#237;a"
            3 => "Lentigo maligno"
            4 => "Actividad mit&#243;tica"
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            0 => "Melanoma"
            1 => "Head and neck melanoma"
            2 => "Epidemiology"
            3 => "Lentigo maligna"
            4 => "Mitotic rate"
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    "resumen" => array:2 [
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Los estudios epidemiol&#243;gicos sobre el melanoma cut&#225;neo de cabeza y cuello &#40;MCC&#41; en la poblaci&#243;n espa&#241;ola son escasos&#46; El objetivo de este estudio es describir las caracter&#237;sticas cl&#237;nico-patol&#243;gicas de una muestra representativa de MCC y analizar los cambios observados en un periodo de 21 a&#241;os&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio descriptivo&#44; transversal y retrospectivo que incluy&#243; a 280 pacientes diagnosticados de MCC en el Hospital General Universitario Gregorio Mara&#241;&#243;n&#44; Madrid&#44; entre el 1 de enero de 1995 y el 31 de diciembre de 2015&#46; Se analizaron las principales variables cl&#237;nico-patol&#243;gicas y se compararon en 3 periodos&#58; 1995-2001&#44; 2002-2008 y 2009-2015&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La edad media en el diagn&#243;stico fue de 71&#44;3 a&#241;os &#40;mediana&#58; 74 a&#241;os&#59; rango intercuart&#237;lico &#91;RIC&#93;&#58; 65-81 a&#241;os&#41;&#46; La cara fue la localizaci&#243;n m&#225;s frecuente&#44; seguida por el cuero cabelludo&#46; El tipo histol&#243;gico predominante fue el lentigo maligno &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>172&#44; 64&#37;&#41;&#46; El espesor tumoral medio fue de 1&#44;6<span class="elsevierStyleHsp" style=""></span>mm &#40;mediana&#58; 0&#44;4<span class="elsevierStyleHsp" style=""></span>mm&#59; RIC&#58; 0-2&#44;1<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; Tras una mediana de seguimiento de 111 meses&#44; 51 pacientes &#40;18&#44;2&#37;&#41; presentaron una recidiva y 29 pacientes &#40;10&#44;4&#37;&#41; fallecieron a ra&#237;z del melanoma&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En el periodo de tiempo estudiado se observ&#243; un aumento significativo de los pacientes con 75 o m&#225;s a&#241;os de edad &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; del porcentaje de melanomas <span class="elsevierStyleItalic">in situ</span> &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#44; mientras que se redujo el espesor tumoral medio &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#41;&#44; el n&#250;mero de casos con 6 o m&#225;s mitosis &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;013&#41;&#44; el porcentaje de pacientes con met&#225;stasis &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;014&#41; y la mortalidad por melanoma &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El MCC afecta a una poblaci&#243;n de edad media avanzada&#44; la localizaci&#243;n predominante es la cara y existe un elevado porcentaje de lentigo maligno&#46; Los pacientes con MCC han presentado un espesor cada vez menor&#44; as&#237; como una menor probabilidad de met&#225;stasis y de muerte por melanoma respecto al inicio del estudio&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objetivos"
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          1 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Material y m&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Resultados"
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            "titulo" => "Conclusiones"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Objectives</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Few epidemiological studies have analyzed cutaneous head and neck melanoma &#40;CHNM&#41; in the Spanish population&#46; The aim of this study was to describe the clinical and histologic features of a representative sample of CHNM in Spain and to analyze changes observed over a period of 21 years&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Material and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Descriptive&#44; retrospective&#44; cross-sectional study of 280 patients diagnosed with CHNM at <span class="elsevierStyleItalic">Hospital General Universitario Gregorio Mara&#241;&#243;n</span> in Madrid&#44; Spain&#44; between January 1&#44; 1995&#44; and December 31&#44; 2015&#46; The main clinical and histologic features were analyzed and compared between 3 periods&#58; 1995-2001&#44; 2002-2008&#44; and 2009-2015&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Mean age at diagnosis was 71&#46;3 years &#40;median&#44; 74 years&#59; interquartile range &#91;IQR&#93;&#44; 65-81 years&#41;&#46; The most common location was the face&#44; followed by the scalp&#46; The main histologic subtype was lentigo maligna &#40;n&#61;172&#44; 64&#37;&#41;&#46; Mean tumor thickness was 1&#46;6&#160;mm &#40;median&#44; 0&#46;4<span class="elsevierStyleHsp" style=""></span>mm&#59; IQR&#44; 0-2&#46;1<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; Median follow-up was 111 months&#59; in this time 51 patients experienced CHNM recurrence &#40;18&#46;2&#37;&#41; and 29 died of the disease &#40;10&#46;4&#37;&#41;&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">In the years analyzed&#44; we observed a significant increase in the number and percentage of patients aged 75 years or older &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;001&#41; and in the percentage of melanomas in situ &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;003&#41;&#46; We also observed a significant decrease in mean tumor thickness &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;018&#41;&#44; the number of cases with 6 or more mitotic figures &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;013&#41;&#44; the percentage of patients with metastasis &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;014&#41;&#44; and melanoma-specific mortality &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;005&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">CHNM affects elderly patients and is preferentially located on the face&#46; The predominant subtype is lentigo maligna&#46; Patients presented with thinner tumors over time and are now less likely to develop metastasis and to die of melanoma&#46;</p></span>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>61-74 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>75 a&#241;os&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>Varones&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">204 &#40;72&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cuero cabelludo&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">37 &#40;13&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">22 &#40;7&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17 &#40;6&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\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">101 &#40;36&#44;1&#41;&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\ttable-entry\n
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                  \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"><span class="elsevierStyleHsp" style=""></span>T3&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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T4&nbsp;\t\t\t\t\t\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">31 &#40;11&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Media &#40;mm&#41;&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;6&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\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mediana &#40;mm&#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;4&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="2" 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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ulceraci&#243;n histol&#243;gica</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ausente&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">218 &#40;77&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Presente&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\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\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>Extensi&#243;n superficial&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">53 &#40;18&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nodular&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
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otros&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">16 &#40;5&#44;8&#41;&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\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;36&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1-5&nbsp;\t\t\t\t\t\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">64 &#40;41&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \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
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " 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">219 &#40;81&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;18&#44;2&#41;&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\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estado vital</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vivo&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">202 &#40;72&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Muerte por melanoma&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">29 &#40;10&#44;4&#41;&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\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Frecuencia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Porcentaje&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Recurrencia local&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\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">27&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ganglio centinela&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Extensi&#243;n linf&#225;tico-ganglionar&nbsp;\t\t\t\t\t\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">16&nbsp;\t\t\t\t\t\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">31&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pulmonar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A distancia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\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">29&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total&nbsp;\t\t\t\t\t\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">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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            "rol" => "short"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Se indica desviaci&#243;n est&#225;ndar en caso de medias y rango intercuart&#237;lico en el caso de medianas&#46;</p>"
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            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">A&#241;o de diagn&#243;stico</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">1995-2001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2002-2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2009-2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Valor de p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo</span></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;849&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujer&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46 &#40;54&#44;8&#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">56 &#40;55&#44;4&#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">49 &#40;51&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Var&#243;n&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;45&#44;2&#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">45 &#40;44&#44;6&#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">46 &#40;48&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" 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  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Edad &#40;intervalos&#41;</span></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;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>60 a&#241;os&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;21&#44;4&#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">10 &#40;9&#44;9&#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">20 &#40;21&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>61-74 a&#241;os&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;46&#44;4&#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">45 &#40;44&#44;6&#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">21 &#40;22&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>75 a&#241;os&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;32&#44;1&#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">46 &#40;45&#44;5&#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">54 &#40;56&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Edad &#40;media&#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">68&#44;4 &#40;14&#44;83&#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">73 &#40;11&#44;80&#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">72&#44;1 &#40;14&#44;83&#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">0&#44;264&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Edad &#40;mediana&#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">71 &#40;63-80&#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"><span class="elsevierStyleHsp" style=""></span>Cuero cabelludo&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Oreja&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cuello&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">In situ</span>&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Invasivo&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Espesor tumoral &#40;intervalos&#41;</span></td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tis <span class="elsevierStyleItalic">&#40;in situ&#41;</span>&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T1&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T2&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T3&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T4&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Espesor tumoral &#40;media&#44; mm&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tipo histol&#243;gico</span></td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lentigo maligno&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Extensi&#243;n superficial&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nodular&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Ulceraci&#243;n</span></td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Mitosis&#47;mm</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span></td><td class="td" title="\n
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                  \t\t\t\t">20 &#40;32&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;38&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1-5&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>6&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Met&#225;stasis</span></td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">61 &#40;72&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">83 &#40;82&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">85 &#40;89&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23 &#40;27&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18 &#40;17&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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Melanoma cutáneo de cabeza y cuello: evolución de las características clínico-patológicas en un hospital terciario de Madrid (1995-2015)
Cutaneous Head and Neck Melanoma: Changes in Clinical and Histologic Features From 1995 to 2015 in a Tertiary Hospital in Madrid, Spain
I. Hernández Aragüésa,
Autor para correspondencia
ignaciohdezaragues@gmail.com

Autor para correspondencia.
, J.A. Avilés Izquierdob, R. Suárez Fernándezb
a Servicio de Dermatología, Hospital San Pedro, Logroño, La Rioja, España
b Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España
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manera llegan a ser afectadas&#44; con el objetivo de poder mejorar las estrategias de prevenci&#243;n y&#47;o el diagn&#243;stico precoz&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Por todo ello&#44; en este estudio queremos reflejar las principales caracter&#237;sticas cl&#237;nico-histol&#243;gicas&#44; as&#237; como la probabilidad de met&#225;stasis y muerte por melanoma&#44; y los principales cambios observados en todas estas variables que han sufrido los pacientes con MCC a lo largo de un periodo de 21 a&#241;os en el contexto de una poblaci&#243;n espa&#241;ola&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Material y m&#233;todos</span><p id="par0015" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio retrospectivo que incluy&#243; a todos los pacientes diagnosticados de un melanoma localizado en la cabeza o el cuello&#44; con confirmaci&#243;n histol&#243;gica&#44; en el HGU Gregorio Mara&#241;&#243;n de Madrid y en los centros sanitarios asociados al mismo&#44; en el periodo comprendido entre el 1 de enero de 1995 y el 31 de diciembre de 2015&#46; Se incluyeron tanto los melanomas <span class="elsevierStyleItalic">in situ</span> &#40;estadio Tis&#41; como los invasivos&#46; Se excluyeron de este estudio los melanomas localizados a nivel de mucosas o partes blandas&#44; los melanomas metast&#225;sicos sin un tumor primario conocido y los pacientes sin informaci&#243;n del espesor tumoral o del seguimiento&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Los datos cl&#237;nicos se obtuvieron de las historias cl&#237;nicas de los pacientes&#44; los datos histopatol&#243;gicos de los correspondientes informes elaborados por el servicio de anatom&#237;a patol&#243;gica y se registraron en una base de datos espec&#237;fica para el estudio de forma anonimizada&#46; Se establecieron 3 intervalos iguales de a&#241;os para facilitar el an&#225;lisis segmentado de los pacientes a lo largo del periodo de seguimiento&#58; 1995-2001&#44; 2002-2008 y 2009-2015&#46; Las caracter&#237;sticas cl&#237;nicas incluyeron&#58; sexo&#44; localizaci&#243;n &#40;cuero cabelludo&#44; cara&#44; oreja y cuello&#41; y edad &#40;recogida como variable continua y tambi&#233;n en forma de intervalos&#58; &#8804;<span class="elsevierStyleHsp" style=""></span>60&#44; 61-74 y &#8805;<span class="elsevierStyleHsp" style=""></span>75 a&#241;os&#41;&#46; Los datos histol&#243;gicos incluyeron&#58; tipo histol&#243;gico &#40;lentigo maligno&#44; extensi&#243;n superficial&#44; nodular&#44; otros&#41;&#44; presencia de ulceraci&#243;n histol&#243;gica&#44; espesor tumoral &#40;recogido como variable continua y tambi&#233;n en forma de variable cualitativa ordinal con intervalos de espesor T1-T4&#41;&#44; presencia de componente invasivo del melanoma&#44; n&#250;mero de mitosis&#47;mm<span class="elsevierStyleSup">2</span>&#44; desarrollo de met&#225;stasis y estado vital del paciente&#46; El n&#250;mero de mitosis&#47;mm<span class="elsevierStyleSup">2</span> fue recogida en m&#225;s del 85&#37; de los pacientes con melanoma invasivo&#46; La t&#233;cnica usada para contabilizar el n&#250;mero de mitosis fue la llamada &#171;hot spot&#187;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">3</span></a>&#46; Se establecieron 3 intervalos definidos de n&#250;mero de mitosis &#40;0&#44; 1-5&#44; &#8805;<span class="elsevierStyleHsp" style=""></span>6 mitosis&#47;mm<span class="elsevierStyleSup">2</span>&#41;&#44; ya que otros autores han descrito la implicaci&#243;n pron&#243;stica y su posible relaci&#243;n con la positividad del ganglio centinela cuando se superan las 6 mitosis&#47;mm<span class="elsevierStyleSup">2</span><a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">4&#44;5</span></a>&#46; Algunos casos no reflejaban el n&#250;mero de mitosis en el informe anatomopatol&#243;gico&#44; por lo que dichas muestras fueron revisadas por 2 pat&#243;logos expertos en el diagn&#243;stico de lesiones melanoc&#237;ticas&#46; Tambi&#233;n se recogi&#243; la aparici&#243;n de met&#225;stasis y el estado vital de los pacientes&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">En los casos que se compararon variables cualitativas se usaron la prueba Chi-cuadrado y la prueba exacta de Fisher&#46; Tambi&#233;n se us&#243; la correcci&#243;n de &#171;Benjamini-Hochberg&#187; para obtener una mayor precisi&#243;n en los resultados obtenidos y disminuir el efecto de las comparaciones m&#250;ltiples&#46; En las comparaciones entre variables cualitativas y cuantitativas&#44; la comparaci&#243;n de medias se realiz&#243; mediante las pruebas t de Student o ANOVA&#44; seg&#250;n correspondiese&#46; El nivel de significaci&#243;n estad&#237;stica a alcanzar para todos los casos fue de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Los datos obtenidos se analizaron con el programa SPSS&#174; versi&#243;n 25 &#40;Illinois&#44; Inc&#59; EE&#46; UU&#46;&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Caracter&#237;sticas globales</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se identificaron un total de 280 pacientes que hab&#237;an sido diagnosticados y tratados de MCC en el intervalo 1995-2015&#46; Previamente se hab&#237;an excluido un total de 13 pacientes por no cumplir con los criterios descritos previamente&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se recogen los datos cl&#237;nicos&#44; histol&#243;gicos y evolutivos m&#225;s relevantes&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Hubo un cierto predominio femenino en nuestra muestra y la edad media de los pacientes fue de 71&#44;3 a&#241;os &#40;mediana&#58; 74 a&#241;os&#59; RIC&#58; 65-81 a&#241;os&#41;&#46; El grupo de pacientes de edad m&#225;s avanzada &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>75 a&#241;os&#41; fue el m&#225;s numeroso y englob&#243; a 127 &#40;45&#44;4&#37;&#41; pacientes&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">La localizaci&#243;n m&#225;s habitual fue la cara&#44; seguida a distancia en orden decreciente por el cuero cabelludo&#44; cuello y orejas&#46; Casi 3 de cada 4 melanomas estuvieron localizados en la cara&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se encontr&#243; un n&#250;mero elevado de melanomas <span class="elsevierStyleItalic">in situ&#58;</span> 101 &#40;36&#44;1&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; La mediana del espesor tumoral fue de 0&#44;4<span class="elsevierStyleHsp" style=""></span>mm &#40;intervalo&#58; 0-18<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; Tambi&#233;n llam&#243; la atenci&#243;n un n&#250;mero considerable de tumores gruesos&#58; 72 pacientes &#40;25&#44;7&#37;&#41; presentaron MCC con espesor tumoral T3-T4&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">El tipo histol&#243;gico predominante fue el lentigo maligno&#44; con 172 casos &#40;61&#44;4&#37;&#41;&#46; El segundo en frecuencia fue el melanoma de extensi&#243;n superficial&#44; seguido por el melanoma nodular&#46; Si tenemos en cuenta &#250;nicamente los melanomas invasivos&#44; 98 &#40;63&#44;7&#37;&#41; de ellos tuvo al menos 1 mitosis&#47;mm<span class="elsevierStyleSup">2</span>&#46; Adem&#225;s&#44; 34 &#40;22&#44;1&#37;&#41; de estos melanomas present&#243; un n&#250;mero elevado de mitosis &#8212;6 o m&#225;s&#8212;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Tras una mediana de seguimiento de 111 meses&#44; 51 pacientes &#40;18&#44;2&#37;&#41; presentaron una recidiva y 29 pacientes &#40;10&#44;4&#37;&#41; fallecieron a ra&#237;z del melanoma&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se recoge la localizaci&#243;n inicial de las met&#225;stasis encontradas&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Cambios evolutivos a lo largo del estudio</span><p id="par0060" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> se recoge la comparativa entre las distintas variables en funci&#243;n del periodo de tiempo estudiado&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">No se encontr&#243; un cambio de tendencia en cuanto al predominio del sexo femenino en nuestra muestra&#46; En todos los periodos de tiempo&#44; las mujeres representaron m&#225;s de la mitad de los pacientes&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Los pacientes con una edad m&#225;s avanzada &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>75 a&#241;os&#41; adquirieron un peso progresivamente mayor&#44; ya que aumentaron desde 27 casos &#40;32&#44;1&#37;&#41; en el periodo 1995-2001 hasta los 54 casos &#40;56&#44;8&#37;&#41; del &#250;ltimo periodo&#44; 2009-2015 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; La edad media de los pacientes aument&#243; desde los 68&#44;4 a&#241;os &#40;mediana&#58; 71 a&#241;os&#41; iniciales hasta los 72&#44;1 &#40;mediana&#58; 76 a&#241;os&#41; del &#250;ltimo periodo&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">En cuanto a la localizaci&#243;n del melanoma&#44; la cara fue siempre la m&#225;s frecuente&#46; Aunque no lleg&#243; a alcanzar significaci&#243;n estad&#237;stica&#44; se encontr&#243; un cierto aumento progresivo de melanomas en el cuero cabelludo&#44; mientras que los melanomas cervicales fueron cada vez menos frecuentes&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">El espesor tumoral se redujo significativamente desde los 2&#44;1<span class="elsevierStyleHsp" style=""></span>mm de media del intervalo 1995-2001 hasta los 0&#44;9<span class="elsevierStyleHsp" style=""></span>mm del &#250;ltimo intervalo 2009-2015 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#41;&#46; Los melanomas <span class="elsevierStyleItalic">in situ</span> aumentaron a su vez de forma progresiva a lo largo de los a&#241;os&#58; inicialmente englobaban 20 casos &#40;23&#44;8&#37; del total de MCC&#41;&#44; mientras que en los &#250;ltimos a&#241;os esta cifra lleg&#243; hasta los 45 casos &#40;47&#44;4&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#46; Por otro lado&#44; los melanomas T4&#44; con un mayor espesor&#44; se redujeron significativamente de forma progresiva&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Se encontr&#243; una tendencia hacia una menor frecuencia de ulceraci&#243;n histol&#243;gica de los MCC&#44; pasando de 24 casos &#40;28&#44;6&#37;&#41; en el periodo 1995-2001 hasta tan solo 15 casos &#40;15&#44;8&#37;&#41; en el periodo 2009-2015&#44; aunque estas cifras no alcanzaron significaci&#243;n estad&#237;stica &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;119&#41;&#46; En cuanto al tipo histol&#243;gico&#44; el tipo lentigo maligno fue siempre el predominante y se apreci&#243; una tendencia a una menor proporci&#243;n de melanomas nodulares conforme avanzaba el intervalo estudiado&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Los MCC con 6 o m&#225;s mitosis se redujeron significativamente a lo largo del estudio&#44; pasando de 15 casos &#40;30&#37;&#41; a &#250;nicamente 2 casos &#40;4&#44;8&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;013&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Los pacientes que desarrollaron met&#225;stasis fueron progresivamente menos frecuentes a lo largo del estudio&#58; 23 pacientes &#40;27&#44;4&#37;&#41; presentaron met&#225;stasis en el intervalo 1995-2001 frente a tan solo 10 pacientes &#40;10&#44;5&#37;&#41; en el intervalo 2009-2015 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;014&#41;&#46; De forma similar&#44; tambi&#233;n se redujo significativamente la mortalidad por melanoma&#44; pasando de 16 casos &#40;19&#37;&#41; en el periodo inicial a tan solo 4 casos &#40;2&#44;4&#37;&#41; en los &#250;ltimos a&#241;os del estudio &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">El territorio de cabeza y cuello representa el 9&#37; de la superficie corporal&#44; sin embargo&#44; en esta zona aparecen entre un 12 y un 30&#37; del total de melanomas cut&#225;neos<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#8211;10</span></a>&#46; Pese a la evidente importancia de esta localizaci&#243;n&#44; no hemos encontrado trabajos focalizados en el MCC en el contexto de la poblaci&#243;n espa&#241;ola y debemos comparar nuestros resultados bien con series internacionales o con datos parciales de otras series de melanoma realizadas en Espa&#241;a&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En poblaciones europeas-cauc&#225;sicas&#44; incluyendo Espa&#241;a&#44; suele describirse un predominio femenino entre los pacientes con melanoma<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">11&#8211;13</span></a>&#46; En cuanto al MCC&#44; algunos estudios reflejan que estos melanomas se asocian m&#225;s frecuentemente al sexo masculino respecto a los melanomas de otras zonas<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">14</span></a>&#46; Sin embargo&#44; los resultados en las distintas series son dispares y en las &#250;ltimas d&#233;cadas encontramos tanto trabajos donde hay un predominio femenino<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#44;15</span></a> como otros donde predominan los varones<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">16&#44;17</span></a>&#46; En nuestra serie las mujeres superaron discretamente a los varones&#44; con un 53&#44;9&#37; de los casos&#46; Esto coincide con el predominio femenino encontrado en el estudio realizado por Arranz-S&#225;nchez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">12</span></a> en la poblaci&#243;n de Madrid entre 1990 y 2004&#44; con un 60&#37; de los MCC diagnosticados en mujeres&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">El MCC afecta a una poblaci&#243;n con una edad media mayor respecto al resto de melanomas&#44; independientemente del subtipo histol&#243;gico<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;18</span></a>&#46; La edad media al diagn&#243;stico en el MCC var&#237;a de 64 a 71 a&#241;os frente a los 50-58 a&#241;os de edad media del resto de melanomas cut&#225;neos<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;7&#44;14</span></a>&#46; En nuestro estudio&#44; los pacientes presentaron una edad media de 71&#44;3 a&#241;os y casi la mitad de los pacientes present&#243; una edad de 75 o m&#225;s a&#241;os&#46; Estos datos van en la l&#237;nea de lo encontrado en un estudio poblacional realizado en un centro oncol&#243;gico de la Comunidad Valenciana donde se reflej&#243; c&#243;mo los pacientes de mayor edad &#8212;mayores de 65 a&#241;os en este caso&#8212; engloban a m&#225;s del 50&#37; del total de MCC<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">19</span></a>&#46; En nuestra serie&#44; encontramos que el grupo de pacientes de edad m&#225;s avanzada &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>75 a&#241;os&#41; alcanz&#243; un porcentaje cada vez m&#225;s significativo a lo largo del periodo de estudio en nuestra serie&#46; En el periodo 2009-2015 este grupo de pacientes representaba el 56&#44;8&#37; del total de MCC&#44; mientras que en el periodo 1995-2001 solo representaba el 32&#44;1&#37;&#46; Esto coincide con el aumento de la edad media de los pacientes diagnosticados de melanoma observado en otros pa&#237;ses<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a> y en el caso del MCC probablemente se debe al alto porcentaje de melanomas tipo lentigo maligno&#44; asociado al efecto acumulativo de la exposici&#243;n solar cr&#243;nica&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">La cara represent&#243; la localizaci&#243;n m&#225;s frecuente en nuestro estudio&#46; En todas las series de MCC consultadas aparece la cara como localizaci&#243;n m&#225;s prevalente&#58; entre el 53&#44;2 y el 78&#44;5&#37; de los MCC est&#225;n localizados en la zona facial<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;6&#44;7&#44;15</span></a>&#46; Esto no es de extra&#241;ar al tratarse de un &#225;rea amplia que recibe una intensa cantidad de radiaci&#243;n ultravioleta&#46; Aunque no lleg&#243; a alcanzar significaci&#243;n estad&#237;stica&#44; los melanomas de cuello se redujeron progresivamente a lo largo del estudio&#44; mientras que los de cuero cabelludo aumentaron&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Casi 2 de cada 3 MCC de nuestra serie correspondieron al tipo histol&#243;gico lentigo maligno&#46; Le siguieron en frecuencia el melanoma de extensi&#243;n superficial y el melanoma nodular&#46; Cl&#225;sicamente se ha descrito c&#243;mo el lentigo maligno se asocia al territorio de cabeza y cuello y la mayor parte de trabajos refleja que constituye el tipo histol&#243;gico predominante en esta zona<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;6&#44;7&#44;18&#44;21</span></a>&#46; No obstante&#44; en algunas series de MCC predominan los melanomas de extensi&#243;n superficial<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">16&#44;17</span></a>&#44; y en nuestro trabajo ocuparon el segundo lugar en frecuencia con un porcentaje considerable de casos &#40;18&#44;9&#37;&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">El 36&#44;1&#37; de los MCC de nuestra serie fueron melanomas <span class="elsevierStyleItalic">in situ&#46;</span> Otros trabajos de MCC reflejan un porcentaje variable de melanomas <span class="elsevierStyleItalic">in situ</span> que comprende desde el 32 hasta el 49&#44;5&#37;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;7&#44;22</span></a>&#46; Esto representa un porcentaje mayor de melanomas <span class="elsevierStyleItalic">in situ</span> en cabeza y cuello respecto al resto de localizaciones&#58; el Registro Nacional de Melanoma Cut&#225;neo refleja que el porcentaje de melanomas <span class="elsevierStyleItalic">in situ</span> se sit&#250;a en el 16&#37;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a>&#46; Asimismo&#44; encontramos m&#225;s del doble de melanomas <span class="elsevierStyleItalic">in situ</span> en el periodo 2009-2015 frente al periodo inicial 1995-2001&#44; lo que refleja el aumento progresivo de melanomas <span class="elsevierStyleItalic">in situ</span> a lo largo de las 2 &#250;ltimas d&#233;cadas&#46; Esta tendencia se ha observado tanto en MCC como en los melanomas de otras localizaciones<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">12&#44;13&#44;23</span></a> y probablemente pueda explicarse por un diagn&#243;stico cada vez m&#225;s precoz por el uso de la dermatoscopia y por un seguimiento protocolizado de pacientes en riesgo&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">El espesor tumoral medio fue de 1&#44;6<span class="elsevierStyleHsp" style=""></span>mm&#46; Este se redujo significativamente a lo largo del estudio&#44; pasando de 2&#44;1<span class="elsevierStyleHsp" style=""></span>mm &#40;intervalo&#58; 1995-2001&#41; a 0&#44;9<span class="elsevierStyleHsp" style=""></span>mm &#40;intervalo&#58; 2009-2015&#41;&#46; Esta reducci&#243;n en el espesor tumoral medio supone una tendencia que se ha registrado a nivel global a lo largo de las &#250;ltimas d&#233;cadas<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">12&#44;23</span></a>&#44; aunque la mayor parte son estudios que no est&#225;n limitados al MCC como el nuestro&#46; Un estudio con 98&#46;498 pacientes basado en varios registros <span class="elsevierStyleItalic">Surveillance&#44; Epidemiology and End Results</span> &#40;SEER&#41; de EE&#46; UU&#46;&#44; constat&#243; una reducci&#243;n del espesor tumoral medio de 0&#44;77 a 0&#44;65<span class="elsevierStyleHsp" style=""></span>mm en un intervalo de 20 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a>&#46; El conjunto de melanomas T3 y T4 supuso un porcentaje considerable &#40;25&#44;7&#37;&#41; del total de MCC de nuestra muestra&#46; Esta heterogeneidad en el espesor tumoral en el MCC &#8212;elevada frecuencia tanto de melanomas <span class="elsevierStyleItalic">in situ</span> como de melanomas gruesos&#8212; tambi&#233;n ha sido descrita por otros autores<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">7</span></a>&#44; y parece reflejar la coexistencia de numerosos melanomas tipo lentigo maligno junto con otros melanomas de r&#225;pido crecimiento&#44; como el melanoma nodular&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">El n&#250;mero de mitosis por mm<span class="elsevierStyleSup">2</span> representa un marcador cuantificable de la proliferaci&#243;n celular tumoral en el melanoma&#44; se ha relacionado estrechamente con la supervivencia y numerosos estudios lo consideran un factor pron&#243;stico independiente<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">3&#44;25&#44;26</span></a>&#46; Son escasos los trabajos que describen este hallazgo histol&#243;gico en el MCC<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">27&#8211;29</span></a>&#46; Shen et al&#46; encontraron que los MCC se asocian a un elevado n&#250;mero de mitosis<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">28</span></a>&#44; mientras que otros circunscriben este elevado n&#250;mero de mitosis a los melanomas de cuero cabelludo<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">30</span></a>&#46; En nuestra muestra&#44; el 63&#44;6&#37; de MCC presentaron &#8805;<span class="elsevierStyleHsp" style=""></span>1 mitosis&#47;mm<span class="elsevierStyleSup">2</span>&#46; Xie et al&#46; reflejaron en una amplia serie de pacientes con MCC que el 65&#37; del total de MCC presentaban un n&#250;mero de mitosis igual o superior a uno&#44; cifra casi superponible a la encontrada en nuestro estudio&#46; En ese trabajo describieron tambi&#233;n que el 30&#44;4&#37; de los pacientes presentaban 5 o m&#225;s mitosis&#47;mm<span class="elsevierStyleSup">2</span>&#44; cifra similar al porcentaje de pacientes con mayor actividad mit&#243;tica &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>6 mitosis&#47;mm<span class="elsevierStyleSup">2</span>&#41; encontrado en nuestra serie&#46; Estas cifras son superiores a las descritas en los melanomas cut&#225;neos de otras zonas<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a>&#46; Por otro lado&#44; encontramos que los melanomas con alta actividad mit&#243;tica fueron cada vez menos frecuentes en nuestro estudio&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">En &#250;ltimo lugar&#44; cabe destacar c&#243;mo el pron&#243;stico de los pacientes con MCC ha ido mejorando en las 2 &#250;ltimas d&#233;cadas&#58; se ha reducido significativamente el desarrollo de met&#225;stasis y tambi&#233;n el n&#250;mero de muertes por melanoma&#46; Es llamativa la reducci&#243;n en la mortalidad por melanoma pasando del 19&#37; de muertes por melanoma en el periodo 1995-2001 hasta el 2&#44;4&#37; del &#250;ltimo periodo 2009-2015&#46; Este hecho pueda ser posiblemente explicado por la reducci&#243;n en el espesor tumoral medio&#44; as&#237; como un menor n&#250;mero de mitosis y presencia de ulceraci&#243;n&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusiones</span><p id="par0145" class="elsevierStylePara elsevierViewall">En este trabajo presentamos los datos de una muestra amplia de pacientes diagnosticados de MCC en un hospital terciario de la poblaci&#243;n madrile&#241;a&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas cl&#237;nico-histol&#243;gicas de nuestra muestra coinciden en buena parte con lo ya publicado en la literatura&#58; la localizaci&#243;n predominante es la cara y existe un elevado porcentaje de melanomas tipo lentigo maligno&#46; Un porcentaje significativo de los melanomas invasivos present&#243; una elevada actividad mit&#243;tica &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>6 mitosis&#47;mm<span class="elsevierStyleSup">2</span>&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">El MCC afecta a una poblaci&#243;n con una edad media cada vez mayor&#44; lo que refleja la necesidad de nuevos estudios focalizados en el melanoma de este territorio al encontrarnos en el marco de una sociedad cada vez m&#225;s envejecida&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Nuestro trabajo refleja c&#243;mo los MCC han presentado un espesor cada vez menor&#44; as&#237; como una menor probabilidad de met&#225;stasis y de muerte por melanoma respecto al inicio del estudio&#46;</p></span></span>"
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              "titulo" => "Cambios evolutivos a lo largo del estudio"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Los estudios epidemiol&#243;gicos sobre el melanoma cut&#225;neo de cabeza y cuello &#40;MCC&#41; en la poblaci&#243;n espa&#241;ola son escasos&#46; El objetivo de este estudio es describir las caracter&#237;sticas cl&#237;nico-patol&#243;gicas de una muestra representativa de MCC y analizar los cambios observados en un periodo de 21 a&#241;os&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio descriptivo&#44; transversal y retrospectivo que incluy&#243; a 280 pacientes diagnosticados de MCC en el Hospital General Universitario Gregorio Mara&#241;&#243;n&#44; Madrid&#44; entre el 1 de enero de 1995 y el 31 de diciembre de 2015&#46; Se analizaron las principales variables cl&#237;nico-patol&#243;gicas y se compararon en 3 periodos&#58; 1995-2001&#44; 2002-2008 y 2009-2015&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La edad media en el diagn&#243;stico fue de 71&#44;3 a&#241;os &#40;mediana&#58; 74 a&#241;os&#59; rango intercuart&#237;lico &#91;RIC&#93;&#58; 65-81 a&#241;os&#41;&#46; La cara fue la localizaci&#243;n m&#225;s frecuente&#44; seguida por el cuero cabelludo&#46; El tipo histol&#243;gico predominante fue el lentigo maligno &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>172&#44; 64&#37;&#41;&#46; El espesor tumoral medio fue de 1&#44;6<span class="elsevierStyleHsp" style=""></span>mm &#40;mediana&#58; 0&#44;4<span class="elsevierStyleHsp" style=""></span>mm&#59; RIC&#58; 0-2&#44;1<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; Tras una mediana de seguimiento de 111 meses&#44; 51 pacientes &#40;18&#44;2&#37;&#41; presentaron una recidiva y 29 pacientes &#40;10&#44;4&#37;&#41; fallecieron a ra&#237;z del melanoma&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En el periodo de tiempo estudiado se observ&#243; un aumento significativo de los pacientes con 75 o m&#225;s a&#241;os de edad &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; del porcentaje de melanomas <span class="elsevierStyleItalic">in situ</span> &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#44; mientras que se redujo el espesor tumoral medio &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#41;&#44; el n&#250;mero de casos con 6 o m&#225;s mitosis &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;013&#41;&#44; el porcentaje de pacientes con met&#225;stasis &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;014&#41; y la mortalidad por melanoma &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El MCC afecta a una poblaci&#243;n de edad media avanzada&#44; la localizaci&#243;n predominante es la cara y existe un elevado porcentaje de lentigo maligno&#46; Los pacientes con MCC han presentado un espesor cada vez menor&#44; as&#237; como una menor probabilidad de met&#225;stasis y de muerte por melanoma respecto al inicio del estudio&#46;</p></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Objectives</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Few epidemiological studies have analyzed cutaneous head and neck melanoma &#40;CHNM&#41; in the Spanish population&#46; The aim of this study was to describe the clinical and histologic features of a representative sample of CHNM in Spain and to analyze changes observed over a period of 21 years&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Material and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Descriptive&#44; retrospective&#44; cross-sectional study of 280 patients diagnosed with CHNM at <span class="elsevierStyleItalic">Hospital General Universitario Gregorio Mara&#241;&#243;n</span> in Madrid&#44; Spain&#44; between January 1&#44; 1995&#44; and December 31&#44; 2015&#46; The main clinical and histologic features were analyzed and compared between 3 periods&#58; 1995-2001&#44; 2002-2008&#44; and 2009-2015&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Mean age at diagnosis was 71&#46;3 years &#40;median&#44; 74 years&#59; interquartile range &#91;IQR&#93;&#44; 65-81 years&#41;&#46; The most common location was the face&#44; followed by the scalp&#46; The main histologic subtype was lentigo maligna &#40;n&#61;172&#44; 64&#37;&#41;&#46; Mean tumor thickness was 1&#46;6&#160;mm &#40;median&#44; 0&#46;4<span class="elsevierStyleHsp" style=""></span>mm&#59; IQR&#44; 0-2&#46;1<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; Median follow-up was 111 months&#59; in this time 51 patients experienced CHNM recurrence &#40;18&#46;2&#37;&#41; and 29 died of the disease &#40;10&#46;4&#37;&#41;&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">In the years analyzed&#44; we observed a significant increase in the number and percentage of patients aged 75 years or older &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;001&#41; and in the percentage of melanomas in situ &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;003&#41;&#46; We also observed a significant decrease in mean tumor thickness &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;018&#41;&#44; the number of cases with 6 or more mitotic figures &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;013&#41;&#44; the percentage of patients with metastasis &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;014&#41;&#44; and melanoma-specific mortality &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;005&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">CHNM affects elderly patients and is preferentially located on the face&#46; The predominant subtype is lentigo maligna&#46; Patients presented with thinner tumors over time and are now less likely to develop metastasis and to die of melanoma&#46;</p></span>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujeres&nbsp;\t\t\t\t\t\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">151 &#40;53&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Varones&nbsp;\t\t\t\t\t\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">129 &#40;46&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" 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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Localizaci&#243;n</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cara&nbsp;\t\t\t\t\t\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">204 &#40;72&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cuero cabelludo&nbsp;\t\t\t\t\t\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">37 &#40;13&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cuello&nbsp;\t\t\t\t\t\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">22 &#40;7&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Oreja&nbsp;\t\t\t\t\t\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">17 &#40;6&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" 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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Componente invasivo</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">In situ</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101 &#40;36&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Invasivo&nbsp;\t\t\t\t\t\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">179 &#40;63&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" 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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Espesor tumoral</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tis <span class="elsevierStyleItalic">&#40;in situ&#41;</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101 &#40;36&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T1&nbsp;\t\t\t\t\t\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">80 &#40;28&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T2&nbsp;\t\t\t\t\t\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">27 &#40;9&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T3&nbsp;\t\t\t\t\t\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">41 &#40;14&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T4&nbsp;\t\t\t\t\t\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">31 &#40;11&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Media &#40;mm&#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;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mediana &#40;mm&#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">0&#44;4&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="2" 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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ulceraci&#243;n histol&#243;gica</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ausente&nbsp;\t\t\t\t\t\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">218 &#40;77&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Presente&nbsp;\t\t\t\t\t\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">62 &#40;22&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" 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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tipo histol&#243;gico</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lentigo maligno&nbsp;\t\t\t\t\t\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">172 &#40;61&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Extensi&#243;n superficial&nbsp;\t\t\t\t\t\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">53 &#40;18&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nodular&nbsp;\t\t\t\t\t\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">39 &#40;13&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otros&nbsp;\t\t\t\t\t\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">16 &#40;5&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" 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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mitosis &#40;n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">154&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;36&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1-5&nbsp;\t\t\t\t\t\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">64 &#40;41&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;22&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" 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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Met&#225;stasis</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\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">219 &#40;81&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;18&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" 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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estado vital</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vivo&nbsp;\t\t\t\t\t\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">202 &#40;72&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Muerte por melanoma&nbsp;\t\t\t\t\t\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
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Muerte por otra causa&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">49 &#40;17&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Recurrencia local&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">14&nbsp;\t\t\t\t\t\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">27&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ganglio centinela&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">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Extensi&#243;n linf&#225;tico-ganglionar&nbsp;\t\t\t\t\t\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">16&nbsp;\t\t\t\t\t\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">31&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pulmonar&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A distancia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\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">29&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total&nbsp;\t\t\t\t\t\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">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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Localizaci&#243;n inicial de las met&#225;stasis</p>"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Se indica desviaci&#243;n est&#225;ndar en caso de medias y rango intercuart&#237;lico en el caso de medianas&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">1995-2001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2002-2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2009-2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Valor de p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo</span></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;849&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujer&#59; n &#40;&#37;&#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
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                  \t\t\t\t">46 &#40;54&#44;8&#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">56 &#40;55&#44;4&#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">49 &#40;51&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Var&#243;n&#59; n &#40;&#37;&#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">38 &#40;45&#44;2&#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">45 &#40;44&#44;6&#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">46 &#40;48&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" 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  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Edad &#40;intervalos&#41;</span></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;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>60 a&#241;os&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;21&#44;4&#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">10 &#40;9&#44;9&#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">20 &#40;21&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>61-74 a&#241;os&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;46&#44;4&#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
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                  \t\t\t\t"><span class="elsevierStyleItalic">Localizaci&#243;n</span></td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cuero cabelludo&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Oreja&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">In situ</span>&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Invasivo&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Espesor tumoral &#40;intervalos&#41;</span></td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tis <span class="elsevierStyleItalic">&#40;in situ&#41;</span>&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T1&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T2&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Espesor tumoral &#40;media&#44; mm&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Espesor tumoral &#40;mediana&#44; mm&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tipo histol&#243;gico</span></td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lentigo maligno&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Extensi&#243;n superficial&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nodular&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17 &#40;21&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;10&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;13&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Ulceraci&#243;n</span></td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">60 &#40;71&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">78 &#40;77&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">80 &#40;84&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24 &#40;28&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23 &#40;22&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;15&#44;8&#41;&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="elsevierStyleItalic">Mitosis&#47;mm</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span></td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>0&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;32&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;38&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1-5&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25 &#40;40&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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ISSN: 00017310
Idioma original: Español
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