Case Report
Primary Dermal Melanoma: A Case Report and a Review of the Literature
Melanoma dérmico primario: presentación de un caso y revisión de la literatura
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Lesión nodular bien delimitada localizada en la dermis y separada de la epidermis por una zona de Grenz, compuesta por melanocitos atípicos, en la que no se observan signos de regresión, ulceración ni componente epidérmico (hematoxilina-eosina x200). B. Detalle donde se aprecian células atípicas y figuras de mitosis: índice mitósico 2/mm<span class="elsevierStyleSup">2</span> (hematoxilina-eosina x400). C.Tinción HMB45.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. González-de Arriba, M.T. Bordel-Gómez, J.C. Solera, J. Sánchez-Estella" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "González-de Arriba" ] 1 => array:2 [ "nombre" => "M.T." "apellidos" => "Bordel-Gómez" ] 2 => array:2 [ "nombre" => "J.C." "apellidos" => "Solera" ] 3 => array:2 [ "nombre" => "J." 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González-de Arriba, M.T. Bordel-Gómez, J.C. Solera, J. Sánchez-Estella" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "González-de Arriba" "email" => array:1 [ 0 => "mgdearriba@yahoo.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M.T." "apellidos" => "Bordel-Gómez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J.C." "apellidos" => "Solera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Sánchez-Estella" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Dermatología, Complejo Asistencial de Zamora, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Anatomía Patológica, Complejo Asistencial de Zamora, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding Author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Melanoma dérmico primario: presentación de un caso y revisión de la literatura" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1113 "Ancho" => 1500 "Tamanyo" => 577383 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A, Clearly defined nodular lesion in the dermis, separated from the epidermis by a Grenz zone. The nodule is composed of atypical melanocytes and shows no signs of regression, ulceration, or any epidermal component (hematoxylin-eosin, original magnification ×200). B, Detail showing atypical cells and mitotic figures (mitotic index, 2/mm<span class="elsevierStyleSup">2</span>) (hematoxylin-eosin, original magnification ×400). C, HMB45 stain.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The term <span class="elsevierStyleItalic">primary dermal melanoma</span> (PDM) has been used to describe a subtype of melanoma which is confined to the dermis or to the subcutaneous cellular tissue and histologically simulates metastasis, but is nonetheless associated with an unexpectedly long survival.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In view of the controversy surrounding the origin of solitary foci of melanoma in the dermis or subcutaneous cellular tissue, some authors have preferred to continue using the term <span class="elsevierStyleItalic">solitary dermal melanoma</span> (SDM), although those authors have also reported a longer survival, similar to that of intermediate-thickness primary melanomas.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We present the case of a 76-year-old woman with a PDM mimicking an apocrine hidrocystoma. We also review the most relevant articles on this subject (MEDLINE search, June 2011), though we found no reports in the Spanish-language literature.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case Description</span><p id="par0020" class="elsevierStylePara elsevierViewall">The patient was a 76-year-old woman referred to dermatology outpatients for a lesion that had been present for 7 years on the left lower eyelid, adjacent to the malar region. The lesion had shown slow and progressive growth that had accelerated in the previous 6 months. There were no systemic symptoms. Physical examination revealed a mobile, well-defined, translucent bluish-gray nodule of 1.2<span class="elsevierStyleHsp" style=""></span>cm diameter with no changes in the overlying epidermis. Apocrine hidrocystoma was diagnosed and the lesion was excised. Histology revealed a nodular lesion that reached the reticular dermis. The cytological and immunohistochemical characteristics were consistent with melanoma metastasis with a Breslow thickness of 9<span class="elsevierStyleHsp" style=""></span>mm. Histology of multiple serial sections showed no signs of ulceration or regression and no junctional component (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Complete physical examination, including examination of the eyes and mucosas, revealed no lesions suggestive of malignancy, no palpable lymph nodes or organomegaly, and no areas of leukoderma. The patient said that she had not had any previous pigmented lesions that had been excised or that had undergone spontaneous regression.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The results of a full range of laboratory tests, including lactate dehydrogenase, were completely normal, and positron emission tomography showed no areas of pathological uptake.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">In approximately 2% to 5% of melanoma metastases there is no known primary tumor; two thirds of these metastases are lymphatic and a third affect the skin and/or subcutaneous cellular tissue or other organs.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> These latter forms are classified as stage IV (M1a in the case of skin metastases) by the American Joint Committee on Cancer (AJCC) for melanoma, and they are associated with an estimated 5-year survival of 5% to 17.9%.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The incidence of solitary melanoma lesions confined to the dermis and/or subcutaneous cellular tissue is less than 1% in all series.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3–8</span></a> However, survival rates of 71% to 100% have been reported after follow-up periods of 4 to 8 years, except in the series published by Katz et al.,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> in which the estimated 5-year survival was 25% (though those authors did not specify whether all their patients had solitary dermal lesions) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Bowen et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> described 11 patients with solitary melanomas confined to the dermis and/or subcutaneous cellular tissue (patients with a past history of melanoma or with surgical excision or regression of cutaneous or ocular lesions suggestive of melanoma were excluded). Histologically the tumors were well-defined nodules composed of atypical melanocytes, with no junctional component or signs of regression. In that case series the estimated survival at 8 years was 83%, considerably higher than expected, but similar to previous studies.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a> Those authors finally concluded that the foci of melanoma in their patients were primary tumors that arose in the dermis or subcutaneous cellular tissue from nonepidermal remnants or aberrations of embryologic melanocyte migration or melanocytes included in deep adnexal structures.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Later, Swetter et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> used the term PDM to refer to patients with solitary melanoma in the dermis and/or subcutaneous cellular tissue and proposed a new subtype of melanoma with an excellent prognosis, perhaps even less aggressive than primary melanomas of similar thickness, with a mean Breslow thickness of 6 to 7<span class="elsevierStyleHsp" style=""></span>mm.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Lee et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> reported the largest series, including 12 817 patients with melanoma. More than 900 of their patients had melanoma without a known primary, and 101 of these tumors presented as dermal melanomas: 85 as localized disease, 7 with regional involvement, and 9 with metastatic disease at the time of diagnosis. The majority of patients with SDM in that study were less than 60 years of age, most were men, and the tumors arose mainly on the limbs; our patient did not fall into any of these categories. Patients with SDM in that study also had a better prognosis, with an estimated 5-year survival of 73%, similar to the survival in thick (Breslow thickness, 6–7<span class="elsevierStyleHsp" style=""></span>mm) or intermediate-thickness (Breslow thickness, 1–2<span class="elsevierStyleHsp" style=""></span>mm) primary melanomas. It is particularly noticeable that 23% of patients with SDM can present lymph-node involvement at the time of diagnosis or later. These patients would therefore benefit from sentinel lymph node biopsy, followed by lymphadenectomy when applicable, with management similar to that used in regional disease without distant spread. Patients with SDM and lymph-node involvement have an estimated 5-year survival of 67%, similar to or better than the survival in primary melanomas with lymph-node metastases (classified as stage III in the AJCC melanoma staging system), which is between 13% and 50%.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The origin of PDM is controversial. The following possibilities have been proposed: <span class="elsevierStyleItalic">a)</span> a distant or in-transit skin metastasis from a primary melanoma that has regressed completely, <span class="elsevierStyleItalic">b)</span> a primary nodular melanoma or a melanoma whose junctional component has regressed, and <span class="elsevierStyleItalic">c)</span> a true primary dermal melanoma. Based on the findings of survival studies, these tumors are unlikely to be melanoma metastases, as survival is closer to the estimates for thick or intermediate-thickness primary melanomas.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Cassarino et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> suggested that immunohistochemical characterization of PDM shows lower levels of expression of p53, Ki-67, cyclin D1, and D2-40 than found in cutaneous melanoma metastases or primary nodular melanoma, and they considered that these differences would explain the less aggressive biological behavior of PDM.</p><p id="par0065" class="elsevierStylePara elsevierViewall">PDM is difficult to recognize clinically. It can present as a cystic lesion, a violaceous papule, a bluish or grayish subcutaneous nodule, or a poorly defined subcutaneous mass. In the differential diagnosis we should consider basal cell carcinoma, squamous cell carcinoma, dermatofibroma, neurofibroma, hemangioma, amelanotic melanoma, and adnexal tumors,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> including apocrine hidrocystoma, as suspected in the case we present.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The histology findings show a well-defined nodular or multinodular dermal lesion with cellular atypia, numerous mitoses, and areas of necrosis, with no evidence of an in situ or junctional component, no follicular involvement or neural invasion, no ulceration, regression, or vascular or lymphatic invasion, and no history of a previous melanocytic nevus. The Breslow thickness varies between 2.5 and 11.7<span class="elsevierStyleHsp" style=""></span>mm, with a mean of 7<span class="elsevierStyleHsp" style=""></span>mm.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The present case fitted all these descriptions.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The histopathological differential diagnosis includes metastatic melanoma, nodular melanoma, malignant blue nevus, clear cell sarcoma of tendons and aponeuroses (also known as malignant melanoma of soft parts), and malignant peripheral nerve sheath tumor. Malignant blue nevus is a lesion that clearly arises from a pre-existing blue nevus and it has a very poor prognosis. In other tumors, immunohistochemistry can help to confirm or exclude the diagnosis.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Clear cell sarcoma is characterized by the reciprocal translocation t(12;22)(q13;q12), which gives rise to the EWS-AFT1 fusion protein, present in 70% to 90% of cases.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a> Malignant peripheral nerve sheath tumor is more common in patients with neurofibromatosis and affects large peripheral nerves. This tumor can be partially encapsulated and shows areas of neural differentiation associated with other areas of myxoid stroma.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The diagnosis of PDM must be based on a correct correlation of the clinical and pathological findings. Workup must therefore include a detailed history to detect possible skin lesions that have regressed or have been excised, a meticulous physical examination (including all mucosas and ophthalmic and gynecological examination), screening for tumor spread (including biochemistry with lactate dehydrogenase, positron emission tomography and/or computed tomography, and cranial magnetic resonance imaging),<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and sentinel lymph node study for correct staging.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> These patients will benefit from wide local excision combined, when indicated, with lymphadenectomy.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In our case, limited excision of the lesion was performed without extending the surgical margins and without sentinel lymph node biopsy because of the location of the lesion on the face and following the wishes of the patient. After a year of follow-up, 8 years since the lesion first appeared, the patient remains asymptomatic, with no signs of disease recurrence or progression. The diagnosis of PDM was based on clinical and histological findings and on the clinical course. We would like to draw attention to the fact that, as the growth of the lesion was very slow, late metastases are possible, as the growth rate of metastases appears to be related to the growth rate of the primary tumor.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">In conclusion, we have presented a case that supports the diagnosis of PDM as a variant of melanoma. PDM carries a better prognosis than might be expected on the basis of its histological characteristics and Breslow thickness. This diagnosis should be considered in any patient with a solitary melanoma confined to the dermis or subcutaneous cellular tissue, with no evidence of a primary origin or of distant spread after adequate screening. We believe it is necessary to be aware of this type of melanoma in order to provide optimal management and correct prognostic information for these patients.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of Interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1777515" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1560681" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1777514" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1560682" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case Description" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of Interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1560681" "palabras" => array:3 [ 0 => "Primary dermal melanoma" 1 => "Metastatic melanoma" 2 => "Prognosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1560682" "palabras" => array:3 [ 0 => "Melanoma dérmico primario" 1 => "Melanoma metastásico" 2 => "Pronóstico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patients with cutaneous metastatic melanoma of unknown primary origin (stage IV M1a disease according to the American Joint Committee on Cancer melanoma staging system) have an estimated 5-year survival rate of between 5% and 17.9% and a median survival of 6 months. However, certain patients with stage IV M1a disease have much higher survival rates. The existence of this subpopulation has given rise to the term <span class="elsevierStyleItalic">primary dermal melanoma</span> to describe such cases.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We report a case of melanoma with characteristics consistent with primary dermal melanoma and review the relevant literature. A diagnosis of primary dermal melanoma requires careful clinical and pathologic correlation and should be considered in all patients with a solitary melanoma confined to the dermis and subcutaneous tissue when there is no evidence of a primary tumor or disease at other sites following appropriate staging studies. We believe that familiarity with this subtype of melanoma is essential in order to provide patients with optimal care and better prognostic information.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La supervivencia de pacientes con metástasis cutánea de melanoma de origen primario desconocido, clasificados como estadio IV (M1a) por el <span class="elsevierStyleItalic">American Joint Comittee on Cancer</span> para melanoma, se estima en un 5–17,9% a los 5 años, con una mediana de 6 meses. Es conocida la existencia de pacientes así clasificados que presentan una supervivencia mucho mayor, lo que ha llevado a utilizar el término de «melanoma dérmico primario» (MDP).</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Presentamos un caso compatible con MDP, así como una revisión de los principales artículos publicados. El diagnóstico está sujeto a una correcta correlación clínico-patológica y debe ser considerado en todos los pacientes con melanoma solitario confinado en la dermis y en el tejido celular subcutáneo, en los que no se encuentre un origen primario ni evidencia de enfermedad tras un adecuado estudio de extensión. Creemos necesario el conocimiento de esta posibilidad para un correcto manejo e información pronóstica de los pacientes.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Please cite this article as: González-de Arriba M, et al. Melanoma dérmico primario: presentación de un caso y revisión de la literatura. Actas Dermosifiliogr. 2013;104:518–22.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1113 "Ancho" => 1500 "Tamanyo" => 577383 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A, Clearly defined nodular lesion in the dermis, separated from the epidermis by a Grenz zone. The nodule is composed of atypical melanocytes and shows no signs of regression, ulceration, or any epidermal component (hematoxylin-eosin, original magnification ×200). B, Detail showing atypical cells and mitotic figures (mitotic index, 2/mm<span class="elsevierStyleSup">2</span>) (hematoxylin-eosin, original magnification ×400). C, HMB45 stain.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><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">Reference \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">No. of Cases \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">Site \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">Age, y (Range) \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">Treatment \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">Total No. of Melanomas \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">Incidence \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">Survival \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Giuliano et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\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">_ \t\t\t\t\t\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">43.0<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> (20–70) \t\t\t\t\t\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">Variable (resection, chemotherapy, radiotherapy or immunotherapy) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">980 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.92% \t\t\t\t\t\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% (5 y) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Schlagenhauff et al.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\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">Limbs (woman)Head and neck (both)Trunk (man) \t\t\t\t\t\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 (15–85) \t\t\t\t\t\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">Excision with 1–2<span class="elsevierStyleHsp" style=""></span>cm margin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3258 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.92% \t\t\t\t\t\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">83% (5 y) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anbari et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\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">Trunk (2)Thigh (1) \t\t\t\t\t\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">49.5 (29–74) \t\t\t\t\t\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">Surgical excision \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\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% (4 y) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bowen et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Back (3)Limbs (5)Head (2)Neck (1) \t\t\t\t\t\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">55.7 (28–90) \t\t\t\t\t\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">Excision with a 1–2<span class="elsevierStyleHsp" style=""></span>cm margin (11)Interferon alfa (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1800 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.61% \t\t\t\t\t\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">83% (8 y) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Swetter et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\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">Head (4)Limbs (3) \t\t\t\t\t\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">67.4 (22–85) \t\t\t\t\t\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">Wide local excision (7)Interferon alfa (2)Sentinel lymph node biopsy: 6 negative, 1 lost \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1800 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.39% \t\t\t\t\t\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% (5 y) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Katz et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\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">- \t\t\t\t\t\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"> \t\t\t\t\t\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">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2485 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.48% \t\t\t\t\t\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">25% (5 y) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cassarino et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (6<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>7<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>) \t\t\t\t\t\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">Head (7)Limbs (5)Back (1) \t\t\t\t\t\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">70 (21–85) \t\t\t\t\t\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">Excision with a 2<span class="elsevierStyleHsp" style=""></span>cm margin (9)Sentinel lymph node biopsy in 11: 10 negative, 1 lost \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\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">92% (44 mo) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lee et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(85<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a>) 71<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">e</span></a> \t\t\t\t\t\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">Head and neck (13)Trunk (27)Limbs (31) \t\t\t\t\t\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"><<span class="elsevierStyleHsp" style=""></span>60 (50)><span class="elsevierStyleHsp" style=""></span>60 (21) \t\t\t\t\t\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">Wide local excisionSentinel lymph node biopsy in 20: 3 positiveElective lymphadenectomy in 17: 4 positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 817 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><1% \t\t\t\t\t\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% (5 y) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">González de Arriba et al. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\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">Head \t\t\t\t\t\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">76 \t\t\t\t\t\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">Limited excision \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\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">8 y \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] "notaPie" => array:5 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Patients with metastatic melanoma with an unknown primary: the age range included patients with cutaneous or subcutaneous, lymph node, and visceral lesions.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Extension of a previous study.</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Not specified whether all patients presented solitary lesions.</p>" ] 3 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "d" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Cases of solitary dermal melanoma prior to lymph-node recurrence.</p>" ] 4 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "e" "nota" => "<p 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| 2024 Octubre | 67 | 39 | 106 |
| 2024 Septiembre | 106 | 40 | 146 |
| 2024 Agosto | 124 | 54 | 178 |
| 2024 Julio | 119 | 49 | 168 |
| 2024 Junio | 110 | 48 | 158 |
| 2024 Mayo | 79 | 40 | 119 |
| 2024 Abril | 76 | 33 | 109 |
| 2024 Marzo | 73 | 24 | 97 |
| 2024 Febrero | 67 | 34 | 101 |
| 2024 Enero | 72 | 28 | 100 |
| 2023 Diciembre | 61 | 25 | 86 |
| 2023 Noviembre | 66 | 23 | 89 |
| 2023 Octubre | 70 | 26 | 96 |
| 2023 Septiembre | 63 | 25 | 88 |
| 2023 Agosto | 64 | 16 | 80 |
| 2023 Julio | 92 | 30 | 122 |
| 2023 Junio | 62 | 23 | 85 |
| 2023 Mayo | 103 | 31 | 134 |
| 2023 Abril | 69 | 20 | 89 |
| 2023 Marzo | 91 | 30 | 121 |
| 2023 Febrero | 76 | 25 | 101 |
| 2023 Enero | 73 | 31 | 104 |
| 2022 Diciembre | 79 | 55 | 134 |
| 2022 Noviembre | 46 | 24 | 70 |
| 2022 Octubre | 43 | 23 | 66 |
| 2022 Septiembre | 48 | 33 | 81 |
| 2022 Agosto | 41 | 30 | 71 |
| 2022 Julio | 44 | 32 | 76 |
| 2022 Junio | 67 | 46 | 113 |
| 2022 Mayo | 103 | 42 | 145 |
| 2022 Abril | 128 | 45 | 173 |
| 2022 Marzo | 134 | 52 | 186 |
| 2022 Febrero | 124 | 47 | 171 |
| 2022 Enero | 128 | 43 | 171 |
| 2021 Diciembre | 62 | 51 | 113 |
| 2021 Noviembre | 66 | 43 | 109 |
| 2021 Octubre | 76 | 51 | 127 |
| 2021 Septiembre | 59 | 43 | 102 |
| 2021 Agosto | 77 | 33 | 110 |
| 2021 Julio | 49 | 38 | 87 |
| 2021 Junio | 62 | 30 | 92 |
| 2021 Mayo | 70 | 59 | 129 |
| 2021 Abril | 139 | 75 | 214 |
| 2021 Marzo | 89 | 41 | 130 |
| 2021 Febrero | 96 | 33 | 129 |
| 2021 Enero | 70 | 35 | 105 |
| 2020 Diciembre | 66 | 24 | 90 |
| 2020 Noviembre | 47 | 26 | 73 |
| 2020 Octubre | 60 | 22 | 82 |
| 2020 Septiembre | 52 | 23 | 75 |
| 2020 Agosto | 48 | 27 | 75 |
| 2020 Julio | 55 | 25 | 80 |
| 2020 Junio | 49 | 29 | 78 |
| 2020 Mayo | 93 | 24 | 117 |
| 2020 Abril | 44 | 26 | 70 |
| 2020 Marzo | 46 | 30 | 76 |
| 2020 Febrero | 4 | 7 | 11 |
| 2020 Enero | 4 | 4 | 8 |
| 2019 Diciembre | 8 | 4 | 12 |
| 2019 Noviembre | 4 | 2 | 6 |
| 2019 Septiembre | 8 | 2 | 10 |
| 2019 Agosto | 4 | 7 | 11 |
| 2019 Julio | 4 | 8 | 12 |
| 2019 Junio | 6 | 18 | 24 |
| 2019 Mayo | 4 | 51 | 55 |
| 2019 Abril | 3 | 31 | 34 |
| 2019 Marzo | 2 | 9 | 11 |
| 2019 Febrero | 3 | 3 | 6 |
| 2019 Enero | 2 | 2 | 4 |
| 2018 Diciembre | 1 | 8 | 9 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 3 | 3 | 6 |
| 2018 Agosto | 0 | 6 | 6 |
| 2018 Julio | 0 | 7 | 7 |
| 2018 Junio | 0 | 4 | 4 |
| 2018 Mayo | 0 | 9 | 9 |
| 2018 Abril | 0 | 4 | 4 |
| 2018 Marzo | 3 | 10 | 13 |
| 2018 Febrero | 53 | 13 | 66 |
| 2018 Enero | 58 | 16 | 74 |
| 2017 Diciembre | 60 | 11 | 71 |
| 2017 Noviembre | 52 | 16 | 68 |
| 2017 Octubre | 50 | 12 | 62 |
| 2017 Septiembre | 63 | 7 | 70 |
| 2017 Agosto | 57 | 16 | 73 |
| 2017 Julio | 77 | 13 | 90 |
| 2017 Junio | 67 | 18 | 85 |
| 2017 Mayo | 63 | 22 | 85 |
| 2017 Abril | 64 | 10 | 74 |
| 2017 Marzo | 59 | 14 | 73 |
| 2017 Febrero | 53 | 19 | 72 |
| 2017 Enero | 37 | 14 | 51 |
| 2016 Diciembre | 67 | 16 | 83 |
| 2016 Noviembre | 65 | 23 | 88 |
| 2016 Octubre | 79 | 18 | 97 |
| 2016 Septiembre | 87 | 18 | 105 |
| 2016 Agosto | 58 | 15 | 73 |
| 2016 Julio | 38 | 6 | 44 |
| 2016 Junio | 11 | 9 | 20 |
| 2016 Mayo | 4 | 12 | 16 |
| 2016 Abril | 6 | 15 | 21 |
| 2016 Marzo | 1 | 2 | 3 |
| 2016 Febrero | 5 | 15 | 20 |
| 2016 Enero | 12 | 1 | 13 |
| 2015 Diciembre | 8 | 4 | 12 |
| 2015 Noviembre | 11 | 1 | 12 |
| 2015 Octubre | 23 | 2 | 25 |
| 2015 Septiembre | 9 | 5 | 14 |
| 2015 Agosto | 13 | 1 | 14 |
| 2015 Julio | 73 | 1 | 74 |
| 2015 Junio | 47 | 10 | 57 |
| 2015 Mayo | 59 | 8 | 67 |
| 2015 Abril | 31 | 6 | 37 |
| 2015 Marzo | 40 | 8 | 48 |
| 2015 Febrero | 40 | 5 | 45 |
| 2015 Enero | 30 | 15 | 45 |
| 2014 Diciembre | 28 | 12 | 40 |
| 2014 Noviembre | 44 | 7 | 51 |
| 2014 Octubre | 43 | 13 | 56 |
| 2014 Septiembre | 42 | 8 | 50 |
| 2014 Agosto | 30 | 8 | 38 |
| 2014 Julio | 46 | 7 | 53 |
| 2014 Junio | 54 | 6 | 60 |
| 2014 Mayo | 47 | 12 | 59 |
| 2014 Abril | 25 | 4 | 29 |
| 2014 Marzo | 46 | 12 | 58 |
| 2014 Febrero | 29 | 19 | 48 |
| 2014 Enero | 31 | 12 | 43 |
| 2013 Diciembre | 17 | 4 | 21 |
| 2013 Noviembre | 10 | 2 | 12 |
| 2013 Octubre | 9 | 9 | 18 |
| 2013 Septiembre | 1 | 3 | 4 |
| 2013 Agosto | 2 | 2 | 4 |
| 2013 Julio | 9 | 5 | 14 |
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