Cases and Research Letters
The Perimeter Technique in the Surgical Treatment of Lentigo Maligna and Lentigo Maligna Melanoma
Técnica de delimitación del perímetro en el tratamiento quirúrgico del lentigo maligno y el lentigo maligno melanoma
B. García Bracamonte
, S.I. Palencia-Pérez, G. Petiti, F. Vanaclocha-Sebastián
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Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, Spain
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García Bracamonte, S.I. Palencia-Pérez, G. Petiti, F. Vanaclocha-Sebastián" "autores" => array:4 [ 0 => array:4 [ "nombre" => "B." "apellidos" => "García Bracamonte" "email" => array:1 [ 0 => "beagarcia50@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "S.I." "apellidos" => "Palencia-Pérez" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Petiti" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Vanaclocha-Sebastián" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Técnica de delimitación del perímetro en el tratamiento quirúrgico del lentigo maligno y el lentigo maligno melanoma" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1637 "Ancho" => 1500 "Tamanyo" => 365747 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A-D, Excision of a strip of skin around the lesion, by sectors, and suture of the defect.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The treatment of choice for lentigo maligna (LM) and for lentigo maligna melanoma (LMM) is still complete excision of the tumor with adequate surgical margins. Conventionally, surgical margins of 0.5<span class="elsevierStyleHsp" style=""></span>cm for LM and of 1<span class="elsevierStyleHsp" style=""></span>cm for thin LMM with a Breslow depth<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mm have been recommended. However, numerous reports have demonstrated the need for wider margins, as the subclinical extension of the melanocytic dysplasia in LM can be greater than predicted.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1-4</span></a> Techniques with 3-dimensional histological control of the margins have been found to be better than conventional surgery as they are followed by fewer recurrences.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> Since 2008, the National Comprehensive Cancer Network recommends the use of these techniques whenever possible.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Our first patient was an 84-year-old woman who presented an irregularly pigmented lesion of 2.5<span class="elsevierStyleHsp" style=""></span>cm that had been present for 4 years on her left cheek; biopsy confirmed LM. The so-called spaghetti technique (initial delimitation of the perimeter of the lesion) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) was chosen. This technique consists of the excision of a strip of tissue with a breadth of about 3<span class="elsevierStyleHsp" style=""></span>mm around the perimeter of the lesion; the wound is then sutured and the patient can go home with a closed wound to await the histology report (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The specimen is fixed in formol by sectors and marked so that the pathologist can process it as usual and take vertical sections after embedding the tissue in paraffin. If necessary, based on findings, the surgical margins can be enlarged until free margins are achieved. Complete excision of the lesion is then performed, with closure of the defect using a flap if indicated. In this patient, free margins were achieved with excision of the first strip of tissue and complete excision of the lesion could be performed the following week.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Our second patient was a 69-year-old man with a 2-cm LM on the forehead. In this case, a polygonal excision was designed to match the outline of the lesion and the skinfolds of the forehead (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). It was necessary to extend the margin in the superior zone in a second operation (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B). Complete excision of the lesion and closure of the defect was performed 20 days after the first operation.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The spaghetti technique is not new, but rather the further development of an idea proposed by Johnson in 1997 and that envisaged a different strategy in the treatment of LM. First the surgical margins of the LM are established, as if the lesion was a picture and we are drawing its frame. Next, the lesion is then removed with full assurance that excision is complete.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The initial proposal involved a square or polygonal excision to facilitate the cutting and orientation of the surgical specimen, but depending on the site of the lesion, rounded or polygonal forms are now possible with the use of photographs or marker sutures to indicate the orientation of the specimen.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7-9</span></a> It is a simple technique that can be performed by any dermatologist.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Mohs micrographic surgery and other techniques of sequential (stepped) excision with the examination of sections taken from the fresh or paraffin-embedded specimen are of proven efficacy<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3,4,10</span></a> but are only performed in specialized centers. In Mohs micrographic surgery, the interpretation of the frozen sections by the pathologist can be very difficult and occasionally the wound must be left open while waiting for the results of examining paraffin-embedded sections.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The technique described in this paper, in which the initial step is to locate the margins, can be very useful in treatment centers where Mohs micrographic surgery is not available or in certain circumstances, such as recurrent tumors with poorly defined borders, older patients or patients living at a distance from the hospital, and lesions whose size means that a flap will be required to close the defect, thereby distorting the margins. The spaghetti technique has several advantages. Routine pathology processing systems can be used and the dermatologist needs no special training. No wounds are left open (meaning that the patient can be discharged without the need for special measures), and there is time to design the reconstruction technique according to the histological findings and the size of the defect, both of which will be known before the final procedure. One of the limitations of this technique is that foci of invasive malignant melanoma cells may be present within the LM, and the excision must therefore reach a deep plane. Another problem is that the complete excision of the lesion will be delayed by days or weeks, and the reason for this must be explained to the patient.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: García Bracamonte B, Palencia-Pérez SI, Petiti G, Vanaclocha-Sebastián F. Técnica de delimitación del perímetro en el tratamiento quirúrgico del lentigo maligno y el lentigo maligno melanoma. Actas Dermosifiliogr.2012;103:748-750.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 736 "Ancho" => 915 "Tamanyo" => 72816 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Technique to establish the perimeter of the lesion and allow histological study of the specimen by sectors.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1637 "Ancho" => 1500 "Tamanyo" => 365747 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A-D, Excision of a strip of skin around the lesion, by sectors, and suture of the defect.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 581 "Ancho" => 1401 "Tamanyo" => 128279 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A, Design of a pentagonal strip of skin to be excised and analyzed. B, Appearance of the lesion at 10 days, prior to a second operation to locate the superior margin of the lesion.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Staged excision of lentigo maligna and lentigo maligna melanoma: a 10-year experience" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.W. Bosbous" 1 => "W.W. Dzwierzynski" 2 => "M. Neuburg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/PRS.0b013e3181bcf002" "Revista" => array:6 [ "tituloSerie" => "Plast Reconstr Surg" "fecha" => "2009" "volumen" => "124" "paginaInicial" => "1947" "paginaFinal" => "1955" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19952650" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical margins for lentigo maligna and lentigo maligna melanoma. The technique of mapped serial excision" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.C. Huilgol" 1 => "D. Selva" 2 => "C. Chen" 3 => "D.C. Hill" 4 => "C.L. James" 5 => "A. Gramp" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.140.9.1087" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2004" "volumen" => "140" "paginaInicial" => "1087" "paginaFinal" => "1092" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15381549" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Staged excision for lentigo maligna and lentigo maligna melanoma: A retrospective analysis of 117 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Hazan" 1 => "S.W. Dusza" 2 => "R. Delgado" 3 => "K.J. Busam" 4 => "A.C. Halpern" 5 => "K.S. Nehal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2007.09.023" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2008" "volumen" => "58" "paginaInicial" => "142" "paginaFinal" => "148" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18029055" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of lentigo maligna and lentigo maligna melanoma with staged excision. A 5-year follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.L. Bub" 1 => "D. Berg" 2 => "A. Slee" 3 => "P.B. Odland" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.140.5.552" "Revista" => array:7 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2004" "volumen" => "140" "paginaInicial" => "552" "paginaFinal" => "558" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15148099" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0002939410005945" "estado" => "S300" "issn" => "00029394" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Conventional histology vs. three-dimensional histology in lentigo maligna melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Moehrle" 1 => "K. Dietz" 2 => "C. Garbe" 3 => "H. Breuninger" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BJM" "fecha" => "2006" "volumen" => "154" "paginaInicial" => "453" "paginaFinal" => "459" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Usefulness of the staged excisión for lentigo maligna and lentigo maligna melanoma: the Square procedure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T.M. Johnson" 1 => "J.T. Headington" 2 => "S.R. Baker" 3 => "L. Lowe" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1997" "volumen" => "37" "paginaInicial" => "758" "paginaFinal" => "764" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9366823" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The perimeter technique for lentigo maligna: an alternative to mohs micrographic surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.H. Mahoney" 1 => "M. Joseph" 2 => "C.L.F Temple" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/jso.20284" "Revista" => array:7 [ "tituloSerie" => "J Surg Oncol" "fecha" => "2005" "volumen" => "91" "paginaInicial" => "120" "paginaFinal" => "125" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16028282" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0161642010000503" "estado" => "S300" "issn" => "01616420" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical management of melanoma-in situ using a staged marginal and central excision technique" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.G. Möller" 1 => "E. Pappas-Politis" 2 => "J.S. Zager" 3 => "L.A. Santiago" 4 => "D. Yu" 5 => "A. Prakash" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Surg Oncol" "fecha" => "2009" "volumen" => "152" "paginaInicial" => "1526" "paginaFinal" => "1536" "itemHostRev" => array:3 [ "pii" => "S0002939408009483" "estado" => "S300" "issn" => "00029394" ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The spaghetti technique: an alternative to mohs surgery or staged surgery for problematic lentiginous melanoma (lentigo maligna and acral lentiginous melanoma)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Gaudy-Marqueste" 1 => "A.S. Perchenet" 2 => "A.M. Taséi" 3 => "N. Madjlessi" 4 => "G. Magalon" 5 => "M.A. Richard" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2010.03.014" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2011" "volumen" => "64" "paginaInicial" => "113" "paginaFinal" => "118" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21167406" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mohs micrographic surgery in the treatment of lentigo maligna and melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.L.F Temple" 1 => "J.P. Arlette" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/jso.20305" "Revista" => array:7 [ "tituloSerie" => "J Surg Oncol" "fecha" => "2006" "volumen" => "94" "paginaInicial" => "287" "paginaFinal" => "292" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16917877" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0002939410008391" "estado" => "S300" "issn" => "00029394" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010300000008/v1_201304241323/S1578219012002685/v1_201304241323/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010300000008/v1_201304241323/S1578219012002685/v1_201304241323/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012002685?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 15 | 10 | 25 |
| 2024 Octubre | 128 | 42 | 170 |
| 2024 Septiembre | 156 | 22 | 178 |
| 2024 Agosto | 185 | 53 | 238 |
| 2024 Julio | 178 | 41 | 219 |
| 2024 Junio | 143 | 53 | 196 |
| 2024 Mayo | 155 | 37 | 192 |
| 2024 Abril | 119 | 23 | 142 |
| 2024 Marzo | 165 | 29 | 194 |
| 2024 Febrero | 127 | 43 | 170 |
| 2024 Enero | 127 | 37 | 164 |
| 2023 Diciembre | 175 | 28 | 203 |
| 2023 Noviembre | 161 | 32 | 193 |
| 2023 Octubre | 140 | 41 | 181 |
| 2023 Septiembre | 114 | 26 | 140 |
| 2023 Agosto | 131 | 21 | 152 |
| 2023 Julio | 82 | 35 | 117 |
| 2023 Junio | 97 | 29 | 126 |
| 2023 Mayo | 136 | 28 | 164 |
| 2023 Abril | 107 | 25 | 132 |
| 2023 Marzo | 98 | 29 | 127 |
| 2023 Febrero | 104 | 25 | 129 |
| 2023 Enero | 74 | 33 | 107 |
| 2022 Diciembre | 60 | 38 | 98 |
| 2022 Noviembre | 39 | 28 | 67 |
| 2022 Octubre | 27 | 23 | 50 |
| 2022 Septiembre | 34 | 35 | 69 |
| 2022 Agosto | 30 | 34 | 64 |
| 2022 Julio | 29 | 39 | 68 |
| 2022 Junio | 33 | 38 | 71 |
| 2022 Mayo | 60 | 52 | 112 |
| 2022 Abril | 85 | 45 | 130 |
| 2022 Marzo | 64 | 47 | 111 |
| 2022 Febrero | 61 | 22 | 83 |
| 2022 Enero | 58 | 35 | 93 |
| 2021 Diciembre | 51 | 41 | 92 |
| 2021 Noviembre | 59 | 58 | 117 |
| 2021 Octubre | 91 | 62 | 153 |
| 2021 Septiembre | 60 | 53 | 113 |
| 2021 Agosto | 41 | 35 | 76 |
| 2021 Julio | 34 | 36 | 70 |
| 2021 Junio | 43 | 32 | 75 |
| 2021 Mayo | 41 | 32 | 73 |
| 2021 Abril | 86 | 62 | 148 |
| 2021 Marzo | 86 | 30 | 116 |
| 2021 Febrero | 63 | 28 | 91 |
| 2021 Enero | 38 | 15 | 53 |
| 2020 Diciembre | 34 | 14 | 48 |
| 2020 Noviembre | 23 | 32 | 55 |
| 2020 Octubre | 18 | 11 | 29 |
| 2020 Septiembre | 35 | 22 | 57 |
| 2020 Agosto | 22 | 17 | 39 |
| 2020 Julio | 40 | 17 | 57 |
| 2020 Junio | 35 | 29 | 64 |
| 2020 Mayo | 21 | 27 | 48 |
| 2020 Abril | 44 | 26 | 70 |
| 2020 Marzo | 34 | 18 | 52 |
| 2020 Febrero | 5 | 1 | 6 |
| 2020 Enero | 4 | 3 | 7 |
| 2019 Diciembre | 8 | 8 | 16 |
| 2019 Noviembre | 4 | 3 | 7 |
| 2019 Octubre | 0 | 7 | 7 |
| 2019 Septiembre | 8 | 10 | 18 |
| 2019 Agosto | 4 | 8 | 12 |
| 2019 Julio | 2 | 11 | 13 |
| 2019 Junio | 6 | 34 | 40 |
| 2019 Mayo | 1 | 31 | 32 |
| 2019 Abril | 0 | 25 | 25 |
| 2019 Marzo | 2 | 9 | 11 |
| 2019 Febrero | 0 | 4 | 4 |
| 2019 Enero | 2 | 2 | 4 |
| 2018 Diciembre | 4 | 0 | 4 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 2 | 1 | 3 |
| 2018 Septiembre | 8 | 0 | 8 |
| 2018 Agosto | 0 | 4 | 4 |
| 2018 Julio | 0 | 3 | 3 |
| 2018 Junio | 0 | 3 | 3 |
| 2018 Mayo | 0 | 3 | 3 |
| 2018 Marzo | 4 | 10 | 14 |
| 2018 Febrero | 84 | 3 | 87 |
| 2018 Enero | 91 | 10 | 101 |
| 2017 Diciembre | 92 | 9 | 101 |
| 2017 Noviembre | 64 | 11 | 75 |
| 2017 Octubre | 55 | 7 | 62 |
| 2017 Septiembre | 74 | 18 | 92 |
| 2017 Agosto | 70 | 16 | 86 |
| 2017 Julio | 65 | 22 | 87 |
| 2017 Junio | 81 | 20 | 101 |
| 2017 Mayo | 65 | 17 | 82 |
| 2017 Abril | 64 | 18 | 82 |
| 2017 Marzo | 72 | 8 | 80 |
| 2017 Febrero | 40 | 10 | 50 |
| 2017 Enero | 33 | 13 | 46 |
| 2016 Diciembre | 66 | 13 | 79 |
| 2016 Noviembre | 106 | 17 | 123 |
| 2016 Octubre | 112 | 27 | 139 |
| 2016 Septiembre | 142 | 14 | 156 |
| 2016 Agosto | 102 | 19 | 121 |
| 2016 Julio | 51 | 15 | 66 |
| 2016 Junio | 14 | 10 | 24 |
| 2016 Mayo | 7 | 14 | 21 |
| 2016 Abril | 7 | 25 | 32 |
| 2016 Marzo | 7 | 18 | 25 |
| 2016 Febrero | 10 | 17 | 27 |
| 2016 Enero | 9 | 14 | 23 |
| 2015 Diciembre | 10 | 10 | 20 |
| 2015 Noviembre | 14 | 16 | 30 |
| 2015 Octubre | 15 | 9 | 24 |
| 2015 Septiembre | 9 | 8 | 17 |
| 2015 Agosto | 11 | 1 | 12 |
| 2015 Julio | 132 | 13 | 145 |
| 2015 Junio | 81 | 22 | 103 |
| 2015 Mayo | 89 | 10 | 99 |
| 2015 Abril | 98 | 12 | 110 |
| 2015 Marzo | 66 | 8 | 74 |
| 2015 Febrero | 60 | 15 | 75 |
| 2015 Enero | 65 | 12 | 77 |
| 2014 Diciembre | 54 | 18 | 72 |
| 2014 Noviembre | 54 | 6 | 60 |
| 2014 Octubre | 78 | 27 | 105 |
| 2014 Septiembre | 32 | 6 | 38 |
| 2014 Agosto | 32 | 7 | 39 |
| 2014 Julio | 20 | 9 | 29 |
| 2014 Junio | 53 | 7 | 60 |
| 2014 Mayo | 53 | 6 | 59 |
| 2014 Abril | 45 | 4 | 49 |
| 2014 Marzo | 34 | 10 | 44 |
| 2014 Febrero | 31 | 16 | 47 |
| 2014 Enero | 35 | 4 | 39 |
| 2013 Diciembre | 33 | 11 | 44 |
| 2013 Noviembre | 31 | 6 | 37 |
| 2013 Octubre | 29 | 4 | 33 |
| 2013 Septiembre | 23 | 13 | 36 |
| 2013 Agosto | 13 | 7 | 20 |
| 2013 Julio | 11 | 20 | 31 |
| 2013 Junio | 5 | 11 | 16 |
| 2013 Mayo | 8 | 11 | 19 |
| 2013 Abril | 9 | 18 | 27 |
| 2013 Marzo | 13 | 6 | 19 |
| 2013 Febrero | 28 | 6 | 34 |
| 2013 Enero | 28 | 5 | 33 |
| 2012 Diciembre | 35 | 9 | 44 |
| 2012 Noviembre | 2 | 0 | 2 |
| 2012 Octubre | 2 | 4 | 6 |
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