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1-4<span class="elsevierStyleHsp" style=""></span>mm&#41; and states that it may be recommended for T4 melanomas &#40;Breslow thickness&#44; &#62;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; again after weighing up the risks and benefits with the patient&#46; If the biopsy is positive&#44; patients can be treated with complete lymph node dissection &#40;CLND&#41; or careful observation depending on the risk of micrometastatic disease&#44; determined by an evaluation of clinical and pathologic factors&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The European Society of Medical Oncology &#40;ESMO&#41; clinical practice guidelines recommend SLN biopsy for melanomas with a Breslow thickness of over 1<span class="elsevierStyleHsp" style=""></span>mm or of over 0&#46;75<span class="elsevierStyleHsp" style=""></span>mm if there are additional risk factors&#44; such as ulceration and a mitotic rate of 1 mitosis&#47;mm<span class="elsevierStyleSup">2</span> &#40;pT1b&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">2</span></a> In this case&#44; the guidelines state that CLND must be considered if the biopsy is positive&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The above recommendation is made despite a lack of evidence showing the therapeutic value of SLN biopsy&#44; followed or not by CLND&#44; as the procedure has not been found to improve overall survival in patients with melanoma&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a> Its usefulness therefore lies in its ability to provide prognostic information&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Although SLN biopsy causes less morbidity than CLND&#44; its complication rates are still considerable&#46; In addition&#44; patients with a positive result were until very recently offered CLND and hence exposed to the risk of further complications&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Several studies in recent years have evaluated the therapeutic and prognostic value of SLN biopsy and its associated complications&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">4&#8211;13</span></a> Their results highlight variations in study design and complication rates ranging from 4&#46;6&#37;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a> to 33&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a> There is thus no clear evidence on the true incidence of complications and sequelae associated with this technique&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The aim of this study was to describe the incidence of complications and sequelae in patients with melanoma who underwent SLN biopsy&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study Design and Scope</span><p id="par0040" class="elsevierStylePara elsevierViewall">Retrospective cohort study of all patients with melanoma in the healthcare district of Vigo &#40;northwest Spain&#41; who underwent SLN biopsy between January 1&#44; 2011 and June 5&#44; 2017&#46; The patients were identified from the pathology laboratory database at our hospital&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">We also analyzed the subgroup of patients who underwent CLND after a positive SLN biopsy&#44; as we consider that complications caused by CLND are indirectly linked to the indication of SLN biopsy&#44; as none of the patients would have undergone CLND if the biopsy had not been performed&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">We recorded the following information for all patients&#58; demographic variables&#44; tumor characteristics&#44; SLN biopsy characteristics&#44; including assessment of whether the biopsy was performed as indicated by current guidelines &#40;using the ASCO&#47;SSO guideline<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a> as a reference&#41;&#44; biopsy results&#44; performance of CLND in a second procedure&#44; and complications and sequelae reported in the patient&#39;s medical record&#46; Sequelae were defined as adverse effects lasting over 1 year&#46; The definitions of complications and sequelae are described in the supplementary material &#40;<a class="elsevierStyleCrossRef" href="#sec0055">see Appendix B supplementary material</a>&#41;&#46; Severity was graded using the classification system described by Dindo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a> in 2004&#44; which is based on the type of intervention needed to treat the complication and the associated risk to the patient&#39;s life &#40;<a class="elsevierStyleCrossRef" href="#sec0055">see Appendix B supplementary material</a>&#41;&#46; Lymphedema severity was assessed using the International Society of Lymphology classification system&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Data were obtained from electronic medical records and recorded anonymously using EpiData&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The statistical analyses were performed in Stata 14&#46; 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Their characteristics are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">SLN biopsy was performed according to the indications in the ASCO-SSO clinical practice guideline in 111 &#40;89&#46;5&#37;&#41; of the patients&#46; In the remaining 13 cases &#40;10&#46;4&#37;&#41;&#44; the indication was unclear&#46; Local excision with wide margins was performed at the same time as the biopsy in 95&#46;1&#37; of cases &#40;118&#47;124&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In total&#44; 24&#46;1&#37; of patients in the overall group &#40;30&#47;124&#41; and 81&#37; of those with a positive SLN biopsy &#40;30&#47;37&#41; underwent CLND&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Complications</span><p id="par0085" class="elsevierStylePara elsevierViewall">Complications were reported for 37&#46;9&#37; of patients &#40;47&#47;124&#41; &#40;95&#37; CI&#44; 29&#46;7&#37;-46&#46;9&#37;&#41;&#44; and several patients had more than 1 complication&#46; The type and severity are summarized in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">No life-threatening &#40;grade <span class="elsevierStyleSmallCaps">iv</span>&#41; or fatal &#40;grade <span class="elsevierStyleSmallCaps">v</span>&#41; complications were observed&#46; Most of the complications were grade <span class="elsevierStyleSmallCaps">i</span> or <span class="elsevierStyleSmallCaps">ii</span> and there was 1 grade <span class="elsevierStyleSmallCaps">iii</span> complication&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In the multivariate logistic regression analysis&#44; no differences were observed for occurrence of complications according to age&#44; sex&#44; obesity&#44; SLN biopsy indication according to the ASCO&#47;SSO guideline&#44; or melanoma site &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Smoking&#44; however&#44; was associated with an increased odds of experiencing a complication &#40;odds ratio &#91;OR&#93;&#44; 5&#46;4&#59; 95&#37; CI&#44; 1&#46;4-20&#46;8&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;015&#41;&#59; 33&#46;0&#37; &#40;95&#37; CI&#44; 24&#46;8&#37;-42&#46;5&#37;&#41; of nonsmokers &#40;36&#47;109&#41; developed complications compared with 73&#46;3&#37; &#40;95&#37; CI&#44; 45&#46;4&#37;-90&#46;1&#37;&#41; of smokers &#40;11&#47;15&#41; &#40;Fisher exact text&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;004&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the incidence of complications according to whether patients underwent SLN biopsy only or SLN biopsy followed by CLND&#46; The rate was 30&#46;9&#37; &#40;95&#37; CI&#44; 22&#46;2&#37;-41&#37;&#41; in patients who underwent SLN biopsy only &#40;29&#47;94&#41; compared with 60&#37; &#40;95&#37; CI&#44; 41&#46;5&#37;-76&#46;1&#37;&#41; in those who underwent SLN biopsy and CLND &#40;18&#47;30&#41; &#40;Fisher exact test&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;005&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">No differences were observed between patients in whom SLN biopsy was performed according to guideline indications &#40;38&#46;5&#37; &#91;5&#47;13&#93;&#59; 95&#37; CI&#44; 16&#46;2&#37;-66&#46;9&#37;&#41; and patients for whom the indication was not clear &#40;37&#46;8&#37; &#91;42&#47;111&#93;&#59; 95&#37; CI&#44; 29&#46;2&#37;-47&#46;3&#37;&#41; &#40;Fisher exact test&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">There were also no significant difference between patients with a negative and a positive result &#40;32&#46;2&#37; &#91;28&#47;87&#93;&#59; 95&#37; CI&#44; 23&#46;1&#37;-42&#46;8&#37; vs&#46; 51&#46;4&#37; &#91;19&#47;37&#93;&#59; 95&#37; CI&#44; 35&#46;3&#37;-67&#46;1&#37;&#41; &#40;Fisher exact test&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;068&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The SLN was identified in all cases&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Sequelae</span><p id="par0120" class="elsevierStylePara elsevierViewall">Sequelae were recorded for 15&#46;3&#37; of patients &#40;16&#47;124&#41;&#44; and the most common sequela was lymphedema &#40;8&#46;9&#37;&#41;&#46; Two patients had 2 sequelae&#58; lymphedema and scarring in one case and altered sensitivity and scarring in the other&#46; The incidence of the different types of sequelae is shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Lymphedema affected the upper arm in 7 patients &#40;63&#46;6&#37;&#41; and the lower arm in 4 &#40;36&#46;4&#37;&#41;&#46; Two cases &#40;18&#46;2&#37;&#41; were graded as stage 0&#44; mild severity&#59; 5 &#40;45&#46;4&#37;&#41; as stage <span class="elsevierStyleSmallCaps">I&#44;</span> mild severity&#59; 2 as stage <span class="elsevierStyleSmallCaps">I&#44;</span> moderate severity&#59; and 2 as stage <span class="elsevierStyleSmallCaps">II&#44;</span> moderate severity&#46; Three of the 11 patients who developed lymphedema had not undergone CLND&#46; The association between persistent lymphedema and CLND was not significant &#40;OR&#44; 2&#46;7&#59; 95&#37; CI&#44; 0&#46;7-10&#46;1&#41;&#44; although the lack of association could be due to the small number of cases&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">One patient developed altered sensitivity in the form of paraesthesia affecting the outer ear and left neck region&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In the subgroup of patients with scar-related complications&#44; 2 patients developed keloid scars that persisted despite treatment and another developed chronic scar tissue pain in the armpit area&#59; 3 patients had persistent limited mobility of the upper arm&#44; 2 had chronic upper arm pain&#44; and 1 had neck rigidity&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Sequelae were less common in patients who did not undergo CLND &#40;7&#46;4&#37; &#91;7&#47;94&#93;&#59; 95&#37; CI 3&#46;6&#37;-15&#37;&#41; than in those who did &#40;30&#37; &#91;9&#47;30&#93;&#44; 95&#37; CI&#44; 16&#46;1&#37;-48&#46;9&#37;&#41; &#40;Fisher exact test&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;003&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">No significant differences were observed for the incidence of sequelae in patients who underwent SLN biopsy according to guideline recommendations &#40;15&#46;4&#37; &#91;2&#47;13&#93;&#59; 95&#37; CI&#44; 3&#46;6&#37;-47&#37;&#41; and those who did not &#40;12&#46;6&#37; &#91;14&#47;111&#93;&#59; 95&#37; CI&#44; 7&#46;6&#37;-20&#46;3&#37;&#41; &#40;Fisher exact test&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;675&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Sequelae were more common in patients with a positive SLN biopsy &#40;24&#46;3&#37; &#91;9&#47;37&#93;&#59; 95&#37; CI&#44; 13&#37;-40&#46;9&#37; vs 8&#37; &#91;7&#47;87&#93;&#59; 95&#37; CI&#44; 3&#46;8&#37;-16&#46;1&#37; for those with a negative biopsy&#41; &#40;Fisher exact test&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;019&#41;&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0155" class="elsevierStylePara elsevierViewall">Our study shows that complications and sequelae are common in patients who undergo SLN biopsy&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Comparisons with other studies that have analyzed complications associated with SLN biopsy are difficult due to large differences&#46; Most studies do not provide clear definitions of the complications analyzed&#44; while others describe short-term or long-term complications or complications that require repeat surgery&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">This heterogeneity was demonstrated in a meta-analysis of 21 studies by Moody et al&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">16</span></a> who reported an overall complication rate of 11&#46;3&#37; &#40;95&#37; CI&#44; 8&#46;1&#37;-15&#46;0&#37;&#41;&#46; The specific rates were 2&#46;9&#37; &#40;95&#37; CI&#44; 1&#46;5&#37;-4&#46;6&#37;&#41; for infections&#44; 5&#46;1&#37; &#40;95&#37; CI&#44; 2&#46;5&#37;-8&#46;6&#37;&#41; for seroma&#44; 0&#46;5&#37; &#40;95&#37; CI&#44; 0&#46;3&#37;-0&#46;9&#37;&#41; for hematoma&#44; 1&#46;3&#37; &#40;95&#37; CI&#44; 0&#46;5&#37;-2&#46;6&#37;&#41; for lymphedema&#44; and 0&#46;3&#37; &#40;95&#37; CI&#44; 0&#46;1&#37;-0&#46;6&#37;&#41; for nerve damage&#46; No significant differences according to SLN biopsy site or geographic location &#40;continent&#41; were observed&#46; The overall complication rate in our series was higher&#44; at 37&#46;9&#37;&#44; but this is partly because we included patients who underwent CLND after SLN biopsy&#46; We believe that this design is important for studying overall SLN biopsy complications&#44; as patients referred for SLN biopsy are likely to undergo CLND if the biopsy result is positive&#46; Findings that CLND does not improve survival in micrometastatic SLN disease suggest that this procedure should no longer be indicated in this setting&#44; but these findings emerged after our study started&#46; Indeed a high proportion of patients with a positive SLN biopsy in our series did not undergo CLND&#46; To enable comparison with future studies we have separated our findings for complications and sequelae according to patients who underwent SLN biopsy only and those who underwent SLN biopsy plus CLND &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">In the Multicenter Selective Lymphadenectomy Trial 1 &#40;MSLT-1&#41;&#44; Morton et al&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a> described a complication rate of 10&#46;1&#37; for patients who underwent SLN biopsy only and 37&#46;1&#37; for those who underwent SLN biopsy followed by CLND&#46; These lower rates could be due to the fact that only regional complications that occurred within 30 days of the procedure were considered&#46; The complication rate associated with SLN biopsy rose to 12&#46;6&#37; when systemic complications &#40;leg edema&#44; thrombophlebitis&#44; and urinary&#44; pulmonary and other complications&#41; were also considered&#46; The article does not describe complications or sequelae that occurred after this initial period of 30 days&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">In MSLT-2&#44; Faries et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a> only reported lymphedema rates&#44; which were 6&#46;3&#37; in patients who underwent SLN biopsy and 24&#46;1&#37; in those who underwent SLN biopsy and CLND&#46; In this case&#44; the follow-up time was 3 years and the rates are similar to those observed in our study&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">The authors of the DeCOG-SLT trial &#40;CLND versus no dissection in patients with sentinel lymph biopsy&#8211;positive melanoma&#41; only reported adverse events for patients who underwent CLND&#46; These events were analyzed immediately after surgery and at 3 and 6 months&#46; Follow-up was longer for moderate and severe complications&#46; The complication rate was 24&#37; &#40;58&#47;240&#41;&#59; 6&#37; &#40;15&#47;240&#41; of the complications were moderate&#44; while 8&#37; &#40;19&#47;240&#41; were severe&#46; Moderate and severe complications included lymphedema&#44; lymph fistula&#44; seroma&#44; infection&#44; and delayed wound healing&#46; Lymphedema occurred in 20 patients and persisted in 13 of these &#40;5&#46;4&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a> Rates for both lymphedema and persistent lymphedema in our series were more common&#44; possibly because of the longer follow-up period&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">It is difficult to compare complication rates for patients who underwent SLN biopsy only &#40;30&#46;9&#37; in our series&#41; with other studies&#44; as most do not consider scarring complications&#44; such as keloid or fibrous scars&#44; or only report on complications in the immediate postoperative period&#46; In one study that did include scarring&#44; Hettiaratchy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a> reported a complication rate of 33&#37;&#44; which is similar to ours&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">The only factor significantly associated with an increased likelihood of complications in our series was smoking&#44; as 73&#46;3&#37; of smokers developed complications&#44; compared with just 33&#46;0&#37; of nonsmokers&#46; This result coincides with reports by Ascha et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">12</span></a> who in their study of risk factors for lymphatic surgeries for melanoma found smoking to be the only significant predictor of complications associated with SLN biopsy&#44; regardless of biopsy site &#40;odds ratio&#44; 1&#46;8&#59; 95&#37; CI&#44; 1&#46;0-2&#46;9&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;038&#41;&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Our study has some limitations&#44; including the risk of information bias that might have affected the accuracy of our results&#46; Patients&#44; for example&#44; may have been treated for complications at another center &#40;although the medical records analyzed cover primary care&#41; or may not have sought care&#46; Likewise&#44; complications may not have been accurately recorded&#46; However&#44; if this bias did exist&#44; the true complication and sequela rates would be even higher&#46; In our opinion&#44; information bias is unlikely as similar rates have been reported in studies with a similar design&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">Another potential limitation is that diagnoses were based on data from medical records&#44; which are less reliable than prospectively collected data based on pre-established definitions&#46; Nevertheless&#44; we do not believe that our retrospective design resulted in an overestimation of complications or sequelae&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Another consideration is that our results are from a single hospital and may not be representative&#46; We did&#44; however&#44; analyze data for all consecutive patients in the database&#46; At our hospital&#44; SLN biopsy is performed by surgeons with extensive experience and we believe that the identification of the SLN in all cases attests to adequate performance of the procedure&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">We used the ASCO&#47;SSO clinical practice guideline to determine whether or not the SLN biopsies in our series were performed according to current indications&#44; and while the indication rates may have varied slightly had we used another guideline&#44; we do not believe that this would have altered our results&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">The morbidity rates associated with SLN biopsy in our cohort and in previous studies have important implications for the routine use of this procedure as a staging tool&#46; The use of any invasive technique should only be contemplated when the benefits for the patient outweigh the risks&#46; Clinical trials to date have not demonstrated an overall survival benefit for SLN biopsy alone or for biopsy followed by CLND&#46; Therefore&#44; as this procedure provides purely prognostic information&#44; the risk of complications and sequelae may be unacceptable&#46; Techniques and methods with a lower risk&#44; such as analysis of clinical data&#44; imaging studies&#44; and proteomic or genomic studies&#44; could offer similarly useful information&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">The indication for CLND in patients with micrometastatic disease was recently called into question&#46; A change in practice in this regard would lead to a reduction in associated morbidity&#44; but according to our findings&#44; SLN biopsy is still associated with complication and sequela rates of 30&#46;9&#37; and 7&#46;5&#37; and rates this high may not be justifiable for a procedure that provides prognostic information only&#44; even if the complications are of moderate severity&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">The increased risk of complications in smokers is also noteworthy and suggests that the indications for SLN biopsy in this subgroup of patients should be even more restrictive&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of Interest</span><p id="par0230" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Sentinel lymph node &#40;SLN&#41; biopsy is a staging&#44; not a therapeutic&#44; procedure&#46; The benefits of SLN biopsy have been more modest than expected and could be outweighed by the risks&#44; which remain unclear&#46; The aim of this study was to describe complications and sequelae observed in patients with melanoma who underwent routine SLN biopsy at our hospital&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">In this retrospective cohort study&#44; we performed a chart review of all patients with melanoma who underwent SLN biopsy at our hospital in Vigo&#44; Spain&#44; between January 2011 and July 2017&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In the period analyzed&#44; 124 SLN biopsies were performed&#46; Over a mean follow-up of 52&#46;7 months &#40;range&#44; 10&#46;8-88&#46;7 months&#41;&#46; A percentage of 37&#46;9 of the patients experienced complications&#46; The complication rate after excluding patients who underwent lymph node dissection was 30&#46;9&#37;&#46; In the full cohort group&#44; there were 14 scar-related complications &#40;11&#46;3&#37;&#41;&#44; 13 surgical wound infections &#40;10&#46;5&#37;&#41;&#44; 12 lymphedemas &#40;9&#46;7&#37;&#41;&#44; 11 seromas &#40;8&#46;9&#37;&#41;&#44; 4 hematomas &#40;3&#46;2&#37;&#41;&#44; 4 wound dehiscences &#40;3&#46;2&#37;&#41;&#44; 2 cases of lymphorrhagia &#40;1&#46;6&#37;&#41;&#44; 2 cases of sensitivity alteration &#40;1&#46;6&#37;&#41;&#44; and 1 urinary tract infection &#40;0&#46;8&#37;&#41;&#46; The most common sequela was lymphedema&#46; Sequelae were on record for 15&#46;3&#37; of patients in the full cohort &#40;7&#46;5&#37; of the patients who did not undergo lymphadenectomy&#41;&#46; Smoking was associated with a 33&#37; to 73&#37; increased risk of complications&#46; The main limitation of this study is the risk of information bias due to incomplete follow-up&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">SLN biopsy is a melanoma staging procedure that causes complications and sequelae&#46; Recommendations for its use in clinical practice guidelines should be revised and the risks and benefits carefully evaluated in each case&#46; Smokers&#44; in particular&#44; seem to have a high risk of complications&#46; Patients with melanoma could benefit greatly from the development of less invasive staging tools&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La biopsia selectiva de ganglio centinela &#40;BSGC&#41; no tiene utilidad terap&#233;utica y solo se utiliza por su valor pron&#243;stico&#46; Su beneficio ha sido menor del esperado&#44; por lo que los riesgos cobran m&#225;s valor y no est&#225;n claramente definidos&#46; Nos hemos propuesto describir las complicaciones y secuelas sufridas por pacientes con melanoma expuestos a la t&#233;cnica de BSGC en la pr&#225;ctica cl&#237;nica habitual&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">En este estudio de cohortes retrospectivo unic&#233;ntrico hemos recogido los datos de todos los pacientes diagnosticados de melanoma y sometidos a la BSGC en nuestro centro &#40;Vigo&#41; entre enero de 2011 y julio de 2017&#44; revisando sus historias cl&#237;nicas&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se realizaron 124 BSGC&#46; El tiempo de seguimiento medio fue de 52&#44;7 meses &#40;rango 10&#44;8-88&#44;7 meses&#41;&#46; El 37&#44;9&#37; de los pacientes presentaron complicaciones&#46; Excluyendo a aquellos en los que se realiz&#243; linfadenectom&#237;a&#44; el porcentaje de complicaciones fue del 30&#44;9&#37;&#46; De las complicaciones totales&#44; 14 &#40;11&#44;3&#37;&#41; fueron alteraciones en la cicatrizaci&#243;n&#44; 13 &#40;10&#44;5&#37;&#41; infecciones de la herida quir&#250;rgica&#44; 12 &#40;9&#44;7&#37;&#41; linfedemas&#44; 11 &#40;8&#44;9&#37;&#41; seromas&#44; 4 &#40;3&#44;2&#37;&#41; hematomas&#44; 4 &#40;3&#44;2&#37;&#41; heridas dehiscentes&#44; 2 &#40;1&#44;6&#37;&#41; linforragias&#44; 2 &#40;1&#44;6&#37;&#41; alteraciones sensitivas y una &#40;0&#44;8&#37;&#41; infecci&#243;n del tracto urinario&#46; El 15&#44;3&#37; de los pacientes presentaron secuelas&#44; siendo el linfedema la m&#225;s frecuente&#46; Entre los pacientes sin linfadenectom&#237;a completa presentaron secuelas el 7&#44;5&#37;&#46; El tabaquismo se asoci&#243; con un aumento en el porcentaje de complicaciones de un 33 a un 73&#37;&#46; La principal limitaci&#243;n de este estudio es que pueda haber un sesgo de informaci&#243;n que infravalore los resultados por un seguimiento incompleto de los pacientes&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La BSGC es una t&#233;cnica de estadificaci&#243;n del melanoma no exenta de complicaciones y secuelas&#46; La recomendaci&#243;n de su uso rutinario en las gu&#237;as de pr&#225;ctica cl&#237;nica deber&#237;a revisarse&#44; sopesando los riesgos y los beneficios en cada caso&#46; En especial tienen un alto riesgo de presentar complicaciones los pacientes fumadores&#46; El desarrollo de otras herramientas de estadificaci&#243;n menos invasivas puede ser de gran utilidad para los pacientes con melanoma&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Antecedentes y objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Pacientes y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Espinosa-Pereiro CE&#44; Zulaica G&#225;rate A&#44; Garc&#237;a-Doval I&#46; Complicaciones y secuelas de la t&#233;cnica de biopsia selectiva del ganglio centinela para el melanoma en una cohorte retrospectiva&#46; Actas Dermosifiliogr&#46; 2019&#59;110&#58;482&#8211;489&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0245" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0055"
          ]
        ]
      ]
    ]
    "multimedia" => array:5 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; ALM&#44; acral lentiginous melanoma&#59; BMI&#44; body mass index&#59; LLM&#44; lentigo maligna melanoma&#59; NM&#44; nodular melanoma&#59; SSM&#44; superficial spreading melanoma&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristic&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients&#44; No&#46; &#40;&#37;&#41;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>124&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Male&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">52 &#40;41&#46;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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Smokers&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">15 &#40;12&#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="elsevierStyleItalic">Obesity &#40;BMI</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#62;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">30&#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">38 &#40;30&#46;6&#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
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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-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">Age&#44; y&#44; mean &#40;SD&#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">56 &#40;1&#46;5&#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="elsevierStyleItalic">Follow-up&#44; mo&#44; mean &#40;SD&#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">52&#46;6 &#40;2&#46;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
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                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Primary melanoma</span></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Location&#44; No&#46; &#40;&#37;&#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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Head and neck&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">11 &#40;8&#46;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><span class="elsevierStyleHsp" style=""></span>Trunk&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">42 &#40;33&#46;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><span class="elsevierStyleHsp" style=""></span>Upper limb&nbsp;\t\t\t\t\t\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">33 &#40;26&#46;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><span class="elsevierStyleHsp" style=""></span>Lower limb&nbsp;\t\t\t\t\t\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;30&#46;6&#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
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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
                  \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Diagnosis&#44; No&#46; &#40;&#37;&#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><span class="elsevierStyleHsp" style=""></span>SSM&nbsp;\t\t\t\t\t\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">68 &#40;54&#46;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><span class="elsevierStyleHsp" style=""></span>ALM&nbsp;\t\t\t\t\t\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 &#40;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><span class="elsevierStyleHsp" style=""></span>LMM&nbsp;\t\t\t\t\t\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">7 &#40;5&#46;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><span class="elsevierStyleHsp" style=""></span>NM&nbsp;\t\t\t\t\t\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">24 &#40;19&#46;3&#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>Other&nbsp;\t\t\t\t\t\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;16&#46;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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Clark level</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="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">I</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">2 &#40;1&#46;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><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">II</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">9 &#40;7&#46;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><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">III</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">39 &#40;31&#46;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><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">IV</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">68 &#40;54&#46;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><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">V</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">4 &#40;3&#46;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><span class="elsevierStyleHsp" style=""></span>Not available&nbsp;\t\t\t\t\t\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 &#40;1&#46;6&#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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ulceration&#44; No&#46; &#40;&#37;&#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><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\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">35 &#40;28&#46;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><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">87 &#40;70&#46;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>Not available&nbsp;\t\t\t\t\t\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 &#40;1&#46;6&#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="elsevierStyleHsp" style=""></span>Breslow thickness&#44; mm</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>Mean &#40;SD&#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">2&#46;5 &#40;1&#46;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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mitotic figures&#44; No&#46;</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>Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;2 &#40;3&#46;3&#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"><span class="elsevierStyleBold">Sentinel lymph node biopsy</span></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">Mean sentinel lymph nodes removed per patient&#44; No&#46; &#40;SD&#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">2&#46;1 &#40;1&#46;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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Indication</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></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>Yes&nbsp;\t\t\t\t\t\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">111 &#40;88&#46;5&#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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Location&#44; No&#46; &#40;&#37;&#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><span class="elsevierStyleHsp" style=""></span>Groin&nbsp;\t\t\t\t\t\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">42 &#40;33&#46;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><span class="elsevierStyleHsp" style=""></span>Armpit&nbsp;\t\t\t\t\t\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">63 &#40;50&#46;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><span class="elsevierStyleHsp" style=""></span>Neck&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;14&#46;5&#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>In-transit<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#46;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><span class="elsevierStyleItalic">Positive result</span>&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">37 &#40;29&#46;8&#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\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">Complications and sequelae &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>124&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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">Grade I<span class="elsevierStyleSmallCaps">&#44;</span> No&#46; &#40;&#37;&#41;&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" style="border-bottom: 2px solid black">Grade II<span class="elsevierStyleSmallCaps">&#44;</span> No&#46; &#40;&#37;&#41;&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">Grade III<span class="elsevierStyleSmallCaps">&#44;</span> No&#46; &#40;&#37;&#41;&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">Scarring&nbsp;\t\t\t\t\t\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">13 &#40;92&#46;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">1 &#40;7&#46;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">-&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">Wound infection&nbsp;\t\t\t\t\t\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 &#40;7&#46;7&#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">12 &#40;92&#46;3&#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">-&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">Lymphedema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;100&#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">-&nbsp;\t\t\t\t\t\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">-&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
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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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">Hematoma&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">4 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Wound dehiscence&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">3 &#40;75&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;25&#41;&nbsp;\t\t\t\t\t\t\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">Lymphorrhagia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;100&#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  " 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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Altered sensitivity&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;100&#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  " align="left" valign="\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
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                  \t\t\t\t">Urinary tract infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;100&#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">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;30&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;07-1&#46;33&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;28-5&#46;51&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">SLN biopsy indication<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;12-1&#46;85&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;28&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">4 &#40;4&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;26&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;4&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;6&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Altered sensitivity&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">1 &#40;1&#46;1&#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  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;1&#46;1&#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  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#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  " align="left" valign="\n
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                  \t\t\t\t">7 &#40;7&#46;5&#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  " align="left" valign="\n
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                  \t\t\t\t">9 &#40;30&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;4&#46;3&#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">2 &#40;6&#46;7&#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>Lymphedema&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;26&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                        "tituloSerie" => "Australas J Dermatol"
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Original Article
Complications and Sequelae After Sentinel Lymph Node Biopsy in Melanoma: A Retrospective Cohort Study
Complicaciones y secuelas de la técnica de biopsia selectiva del ganglio centinela para el melanoma en una cohorte retrospectiva
C.E. Espinosa-Pereiroa, A. Zulaica Gárateb, I. García-Dovalb,
Autor para correspondencia
Ignacio.garcia.doval@sergas.es

Corresponding author.
a Facultad de Medicina, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, España
b Servicio de Dermatología, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Sentinel lymph node &#40;SLN&#41; biopsy is a minimally invasive procedure&#44; but there is disagreement about its potential complications&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The American Society of Clinical Oncology &#40;ASCO&#41; and Society of Surgical Oncology &#40;SSO&#41; clinical practice guideline on the use of SLN biopsy in melanoma states that this technique may be considered for T1b melanomas &#40;Breslow thickness&#44; 0&#46;8-1<span class="elsevierStyleHsp" style=""></span>mm or &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;8<span class="elsevierStyleHsp" style=""></span>mm with ulceration&#41; after thorough discussion of risks and benefits with the patient&#46; The guideline recommends the procedure for T2 and T3 melanomas &#40;Breslow thickness&#44; 1-4<span class="elsevierStyleHsp" style=""></span>mm&#41; and states that it may be recommended for T4 melanomas &#40;Breslow thickness&#44; &#62;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; again after weighing up the risks and benefits with the patient&#46; If the biopsy is positive&#44; patients can be treated with complete lymph node dissection &#40;CLND&#41; or careful observation depending on the risk of micrometastatic disease&#44; determined by an evaluation of clinical and pathologic factors&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The European Society of Medical Oncology &#40;ESMO&#41; clinical practice guidelines recommend SLN biopsy for melanomas with a Breslow thickness of over 1<span class="elsevierStyleHsp" style=""></span>mm or of over 0&#46;75<span class="elsevierStyleHsp" style=""></span>mm if there are additional risk factors&#44; such as ulceration and a mitotic rate of 1 mitosis&#47;mm<span class="elsevierStyleSup">2</span> &#40;pT1b&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">2</span></a> In this case&#44; the guidelines state that CLND must be considered if the biopsy is positive&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The above recommendation is made despite a lack of evidence showing the therapeutic value of SLN biopsy&#44; followed or not by CLND&#44; as the procedure has not been found to improve overall survival in patients with melanoma&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a> Its usefulness therefore lies in its ability to provide prognostic information&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Although SLN biopsy causes less morbidity than CLND&#44; its complication rates are still considerable&#46; In addition&#44; patients with a positive result were until very recently offered CLND and hence exposed to the risk of further complications&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Several studies in recent years have evaluated the therapeutic and prognostic value of SLN biopsy and its associated complications&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">4&#8211;13</span></a> Their results highlight variations in study design and complication rates ranging from 4&#46;6&#37;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a> to 33&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a> There is thus no clear evidence on the true incidence of complications and sequelae associated with this technique&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The aim of this study was to describe the incidence of complications and sequelae in patients with melanoma who underwent SLN biopsy&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study Design and Scope</span><p id="par0040" class="elsevierStylePara elsevierViewall">Retrospective cohort study of all patients with melanoma in the healthcare district of Vigo &#40;northwest Spain&#41; who underwent SLN biopsy between January 1&#44; 2011 and June 5&#44; 2017&#46; The patients were identified from the pathology laboratory database at our hospital&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">We also analyzed the subgroup of patients who underwent CLND after a positive SLN biopsy&#44; as we consider that complications caused by CLND are indirectly linked to the indication of SLN biopsy&#44; as none of the patients would have undergone CLND if the biopsy had not been performed&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">We recorded the following information for all patients&#58; demographic variables&#44; tumor characteristics&#44; SLN biopsy characteristics&#44; including assessment of whether the biopsy was performed as indicated by current guidelines &#40;using the ASCO&#47;SSO guideline<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a> as a reference&#41;&#44; biopsy results&#44; performance of CLND in a second procedure&#44; and complications and sequelae reported in the patient&#39;s medical record&#46; Sequelae were defined as adverse effects lasting over 1 year&#46; The definitions of complications and sequelae are described in the supplementary material &#40;<a class="elsevierStyleCrossRef" href="#sec0055">see Appendix B supplementary material</a>&#41;&#46; Severity was graded using the classification system described by Dindo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a> in 2004&#44; which is based on the type of intervention needed to treat the complication and the associated risk to the patient&#39;s life &#40;<a class="elsevierStyleCrossRef" href="#sec0055">see Appendix B supplementary material</a>&#41;&#46; Lymphedema severity was assessed using the International Society of Lymphology classification system&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Data were obtained from electronic medical records and recorded anonymously using EpiData&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The statistical analyses were performed in Stata 14&#46; We analyzed the risk of different complications and sequelae associated with SLN biopsy&#46; Descriptive statistics for the population are presented as mean &#40;SD&#41; in the case of quantitative variables and percentages in the case of qualitative variables&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Qualitative variables were compared using the Fisher exact test&#46; Logistic regression was used to explore significant associations &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; between variables and the occurrence of complications&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Population and Follow-up</span><p id="par0070" class="elsevierStylePara elsevierViewall">We identified 124 patients who underwent SLN biopsy during the study period&#46; Their characteristics are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">SLN biopsy was performed according to the indications in the ASCO-SSO clinical practice guideline in 111 &#40;89&#46;5&#37;&#41; of the patients&#46; In the remaining 13 cases &#40;10&#46;4&#37;&#41;&#44; the indication was unclear&#46; Local excision with wide margins was performed at the same time as the biopsy in 95&#46;1&#37; of cases &#40;118&#47;124&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In total&#44; 24&#46;1&#37; of patients in the overall group &#40;30&#47;124&#41; and 81&#37; of those with a positive SLN biopsy &#40;30&#47;37&#41; underwent CLND&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Complications</span><p id="par0085" class="elsevierStylePara elsevierViewall">Complications were reported for 37&#46;9&#37; of patients &#40;47&#47;124&#41; &#40;95&#37; CI&#44; 29&#46;7&#37;-46&#46;9&#37;&#41;&#44; and several patients had more than 1 complication&#46; The type and severity are summarized in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">No life-threatening &#40;grade <span class="elsevierStyleSmallCaps">iv</span>&#41; or fatal &#40;grade <span class="elsevierStyleSmallCaps">v</span>&#41; complications were observed&#46; Most of the complications were grade <span class="elsevierStyleSmallCaps">i</span> or <span class="elsevierStyleSmallCaps">ii</span> and there was 1 grade <span class="elsevierStyleSmallCaps">iii</span> complication&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In the multivariate logistic regression analysis&#44; no differences were observed for occurrence of complications according to age&#44; sex&#44; obesity&#44; SLN biopsy indication according to the ASCO&#47;SSO guideline&#44; or melanoma site &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Smoking&#44; however&#44; was associated with an increased odds of experiencing a complication &#40;odds ratio &#91;OR&#93;&#44; 5&#46;4&#59; 95&#37; CI&#44; 1&#46;4-20&#46;8&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;015&#41;&#59; 33&#46;0&#37; &#40;95&#37; CI&#44; 24&#46;8&#37;-42&#46;5&#37;&#41; of nonsmokers &#40;36&#47;109&#41; developed complications compared with 73&#46;3&#37; &#40;95&#37; CI&#44; 45&#46;4&#37;-90&#46;1&#37;&#41; of smokers &#40;11&#47;15&#41; &#40;Fisher exact text&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;004&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the incidence of complications according to whether patients underwent SLN biopsy only or SLN biopsy followed by CLND&#46; The rate was 30&#46;9&#37; &#40;95&#37; CI&#44; 22&#46;2&#37;-41&#37;&#41; in patients who underwent SLN biopsy only &#40;29&#47;94&#41; compared with 60&#37; &#40;95&#37; CI&#44; 41&#46;5&#37;-76&#46;1&#37;&#41; in those who underwent SLN biopsy and CLND &#40;18&#47;30&#41; &#40;Fisher exact test&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;005&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">No differences were observed between patients in whom SLN biopsy was performed according to guideline indications &#40;38&#46;5&#37; &#91;5&#47;13&#93;&#59; 95&#37; CI&#44; 16&#46;2&#37;-66&#46;9&#37;&#41; and patients for whom the indication was not clear &#40;37&#46;8&#37; &#91;42&#47;111&#93;&#59; 95&#37; CI&#44; 29&#46;2&#37;-47&#46;3&#37;&#41; &#40;Fisher exact test&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">There were also no significant difference between patients with a negative and a positive result &#40;32&#46;2&#37; &#91;28&#47;87&#93;&#59; 95&#37; CI&#44; 23&#46;1&#37;-42&#46;8&#37; vs&#46; 51&#46;4&#37; &#91;19&#47;37&#93;&#59; 95&#37; CI&#44; 35&#46;3&#37;-67&#46;1&#37;&#41; &#40;Fisher exact test&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;068&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The SLN was identified in all cases&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Sequelae</span><p id="par0120" class="elsevierStylePara elsevierViewall">Sequelae were recorded for 15&#46;3&#37; of patients &#40;16&#47;124&#41;&#44; and the most common sequela was lymphedema &#40;8&#46;9&#37;&#41;&#46; Two patients had 2 sequelae&#58; lymphedema and scarring in one case and altered sensitivity and scarring in the other&#46; The incidence of the different types of sequelae is shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Lymphedema affected the upper arm in 7 patients &#40;63&#46;6&#37;&#41; and the lower arm in 4 &#40;36&#46;4&#37;&#41;&#46; Two cases &#40;18&#46;2&#37;&#41; were graded as stage 0&#44; mild severity&#59; 5 &#40;45&#46;4&#37;&#41; as stage <span class="elsevierStyleSmallCaps">I&#44;</span> mild severity&#59; 2 as stage <span class="elsevierStyleSmallCaps">I&#44;</span> moderate severity&#59; and 2 as stage <span class="elsevierStyleSmallCaps">II&#44;</span> moderate severity&#46; Three of the 11 patients who developed lymphedema had not undergone CLND&#46; The association between persistent lymphedema and CLND was not significant &#40;OR&#44; 2&#46;7&#59; 95&#37; CI&#44; 0&#46;7-10&#46;1&#41;&#44; although the lack of association could be due to the small number of cases&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">One patient developed altered sensitivity in the form of paraesthesia affecting the outer ear and left neck region&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In the subgroup of patients with scar-related complications&#44; 2 patients developed keloid scars that persisted despite treatment and another developed chronic scar tissue pain in the armpit area&#59; 3 patients had persistent limited mobility of the upper arm&#44; 2 had chronic upper arm pain&#44; and 1 had neck rigidity&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Sequelae were less common in patients who did not undergo CLND &#40;7&#46;4&#37; &#91;7&#47;94&#93;&#59; 95&#37; CI 3&#46;6&#37;-15&#37;&#41; than in those who did &#40;30&#37; &#91;9&#47;30&#93;&#44; 95&#37; CI&#44; 16&#46;1&#37;-48&#46;9&#37;&#41; &#40;Fisher exact test&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;003&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">No significant differences were observed for the incidence of sequelae in patients who underwent SLN biopsy according to guideline recommendations &#40;15&#46;4&#37; &#91;2&#47;13&#93;&#59; 95&#37; CI&#44; 3&#46;6&#37;-47&#37;&#41; and those who did not &#40;12&#46;6&#37; &#91;14&#47;111&#93;&#59; 95&#37; CI&#44; 7&#46;6&#37;-20&#46;3&#37;&#41; &#40;Fisher exact test&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;675&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Sequelae were more common in patients with a positive SLN biopsy &#40;24&#46;3&#37; &#91;9&#47;37&#93;&#59; 95&#37; CI&#44; 13&#37;-40&#46;9&#37; vs 8&#37; &#91;7&#47;87&#93;&#59; 95&#37; CI&#44; 3&#46;8&#37;-16&#46;1&#37; for those with a negative biopsy&#41; &#40;Fisher exact test&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;019&#41;&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0155" class="elsevierStylePara elsevierViewall">Our study shows that complications and sequelae are common in patients who undergo SLN biopsy&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Comparisons with other studies that have analyzed complications associated with SLN biopsy are difficult due to large differences&#46; Most studies do not provide clear definitions of the complications analyzed&#44; while others describe short-term or long-term complications or complications that require repeat surgery&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">This heterogeneity was demonstrated in a meta-analysis of 21 studies by Moody et al&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">16</span></a> who reported an overall complication rate of 11&#46;3&#37; &#40;95&#37; CI&#44; 8&#46;1&#37;-15&#46;0&#37;&#41;&#46; The specific rates were 2&#46;9&#37; &#40;95&#37; CI&#44; 1&#46;5&#37;-4&#46;6&#37;&#41; for infections&#44; 5&#46;1&#37; &#40;95&#37; CI&#44; 2&#46;5&#37;-8&#46;6&#37;&#41; for seroma&#44; 0&#46;5&#37; &#40;95&#37; CI&#44; 0&#46;3&#37;-0&#46;9&#37;&#41; for hematoma&#44; 1&#46;3&#37; &#40;95&#37; CI&#44; 0&#46;5&#37;-2&#46;6&#37;&#41; for lymphedema&#44; and 0&#46;3&#37; &#40;95&#37; CI&#44; 0&#46;1&#37;-0&#46;6&#37;&#41; for nerve damage&#46; No significant differences according to SLN biopsy site or geographic location &#40;continent&#41; were observed&#46; The overall complication rate in our series was higher&#44; at 37&#46;9&#37;&#44; but this is partly because we included patients who underwent CLND after SLN biopsy&#46; We believe that this design is important for studying overall SLN biopsy complications&#44; as patients referred for SLN biopsy are likely to undergo CLND if the biopsy result is positive&#46; Findings that CLND does not improve survival in micrometastatic SLN disease suggest that this procedure should no longer be indicated in this setting&#44; but these findings emerged after our study started&#46; Indeed a high proportion of patients with a positive SLN biopsy in our series did not undergo CLND&#46; To enable comparison with future studies we have separated our findings for complications and sequelae according to patients who underwent SLN biopsy only and those who underwent SLN biopsy plus CLND &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">In the Multicenter Selective Lymphadenectomy Trial 1 &#40;MSLT-1&#41;&#44; Morton et al&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a> described a complication rate of 10&#46;1&#37; for patients who underwent SLN biopsy only and 37&#46;1&#37; for those who underwent SLN biopsy followed by CLND&#46; These lower rates could be due to the fact that only regional complications that occurred within 30 days of the procedure were considered&#46; The complication rate associated with SLN biopsy rose to 12&#46;6&#37; when systemic complications &#40;leg edema&#44; thrombophlebitis&#44; and urinary&#44; pulmonary and other complications&#41; were also considered&#46; The article does not describe complications or sequelae that occurred after this initial period of 30 days&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">In MSLT-2&#44; Faries et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a> only reported lymphedema rates&#44; which were 6&#46;3&#37; in patients who underwent SLN biopsy and 24&#46;1&#37; in those who underwent SLN biopsy and CLND&#46; In this case&#44; the follow-up time was 3 years and the rates are similar to those observed in our study&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">The authors of the DeCOG-SLT trial &#40;CLND versus no dissection in patients with sentinel lymph biopsy&#8211;positive melanoma&#41; only reported adverse events for patients who underwent CLND&#46; These events were analyzed immediately after surgery and at 3 and 6 months&#46; Follow-up was longer for moderate and severe complications&#46; The complication rate was 24&#37; &#40;58&#47;240&#41;&#59; 6&#37; &#40;15&#47;240&#41; of the complications were moderate&#44; while 8&#37; &#40;19&#47;240&#41; were severe&#46; Moderate and severe complications included lymphedema&#44; lymph fistula&#44; seroma&#44; infection&#44; and delayed wound healing&#46; Lymphedema occurred in 20 patients and persisted in 13 of these &#40;5&#46;4&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a> Rates for both lymphedema and persistent lymphedema in our series were more common&#44; possibly because of the longer follow-up period&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">It is difficult to compare complication rates for patients who underwent SLN biopsy only &#40;30&#46;9&#37; in our series&#41; with other studies&#44; as most do not consider scarring complications&#44; such as keloid or fibrous scars&#44; or only report on complications in the immediate postoperative period&#46; In one study that did include scarring&#44; Hettiaratchy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a> reported a complication rate of 33&#37;&#44; which is similar to ours&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">The only factor significantly associated with an increased likelihood of complications in our series was smoking&#44; as 73&#46;3&#37; of smokers developed complications&#44; compared with just 33&#46;0&#37; of nonsmokers&#46; This result coincides with reports by Ascha et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">12</span></a> who in their study of risk factors for lymphatic surgeries for melanoma found smoking to be the only significant predictor of complications associated with SLN biopsy&#44; regardless of biopsy site &#40;odds ratio&#44; 1&#46;8&#59; 95&#37; CI&#44; 1&#46;0-2&#46;9&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;038&#41;&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Our study has some limitations&#44; including the risk of information bias that might have affected the accuracy of our results&#46; Patients&#44; for example&#44; may have been treated for complications at another center &#40;although the medical records analyzed cover primary care&#41; or may not have sought care&#46; Likewise&#44; complications may not have been accurately recorded&#46; However&#44; if this bias did exist&#44; the true complication and sequela rates would be even higher&#46; In our opinion&#44; information bias is unlikely as similar rates have been reported in studies with a similar design&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">Another potential limitation is that diagnoses were based on data from medical records&#44; which are less reliable than prospectively collected data based on pre-established definitions&#46; Nevertheless&#44; we do not believe that our retrospective design resulted in an overestimation of complications or sequelae&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Another consideration is that our results are from a single hospital and may not be representative&#46; We did&#44; however&#44; analyze data for all consecutive patients in the database&#46; At our hospital&#44; SLN biopsy is performed by surgeons with extensive experience and we believe that the identification of the SLN in all cases attests to adequate performance of the procedure&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">We used the ASCO&#47;SSO clinical practice guideline to determine whether or not the SLN biopsies in our series were performed according to current indications&#44; and while the indication rates may have varied slightly had we used another guideline&#44; we do not believe that this would have altered our results&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">The morbidity rates associated with SLN biopsy in our cohort and in previous studies have important implications for the routine use of this procedure as a staging tool&#46; The use of any invasive technique should only be contemplated when the benefits for the patient outweigh the risks&#46; Clinical trials to date have not demonstrated an overall survival benefit for SLN biopsy alone or for biopsy followed by CLND&#46; Therefore&#44; as this procedure provides purely prognostic information&#44; the risk of complications and sequelae may be unacceptable&#46; Techniques and methods with a lower risk&#44; such as analysis of clinical data&#44; imaging studies&#44; and proteomic or genomic studies&#44; could offer similarly useful information&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">The indication for CLND in patients with micrometastatic disease was recently called into question&#46; A change in practice in this regard would lead to a reduction in associated morbidity&#44; but according to our findings&#44; SLN biopsy is still associated with complication and sequela rates of 30&#46;9&#37; and 7&#46;5&#37; and rates this high may not be justifiable for a procedure that provides prognostic information only&#44; even if the complications are of moderate severity&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">The increased risk of complications in smokers is also noteworthy and suggests that the indications for SLN biopsy in this subgroup of patients should be even more restrictive&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of Interest</span><p id="par0230" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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            0 => "Sentinel lymph node biopsy"
            1 => "Melanoma"
            2 => "Complications"
            3 => "Sequelae"
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            0 => "Biopsia selectiva de ganglio centinela"
            1 => "Melanoma"
            2 => "Complicaciones"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Sentinel lymph node &#40;SLN&#41; biopsy is a staging&#44; not a therapeutic&#44; procedure&#46; The benefits of SLN biopsy have been more modest than expected and could be outweighed by the risks&#44; which remain unclear&#46; The aim of this study was to describe complications and sequelae observed in patients with melanoma who underwent routine SLN biopsy at our hospital&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">In this retrospective cohort study&#44; we performed a chart review of all patients with melanoma who underwent SLN biopsy at our hospital in Vigo&#44; Spain&#44; between January 2011 and July 2017&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In the period analyzed&#44; 124 SLN biopsies were performed&#46; Over a mean follow-up of 52&#46;7 months &#40;range&#44; 10&#46;8-88&#46;7 months&#41;&#46; A percentage of 37&#46;9 of the patients experienced complications&#46; The complication rate after excluding patients who underwent lymph node dissection was 30&#46;9&#37;&#46; In the full cohort group&#44; there were 14 scar-related complications &#40;11&#46;3&#37;&#41;&#44; 13 surgical wound infections &#40;10&#46;5&#37;&#41;&#44; 12 lymphedemas &#40;9&#46;7&#37;&#41;&#44; 11 seromas &#40;8&#46;9&#37;&#41;&#44; 4 hematomas &#40;3&#46;2&#37;&#41;&#44; 4 wound dehiscences &#40;3&#46;2&#37;&#41;&#44; 2 cases of lymphorrhagia &#40;1&#46;6&#37;&#41;&#44; 2 cases of sensitivity alteration &#40;1&#46;6&#37;&#41;&#44; and 1 urinary tract infection &#40;0&#46;8&#37;&#41;&#46; The most common sequela was lymphedema&#46; Sequelae were on record for 15&#46;3&#37; of patients in the full cohort &#40;7&#46;5&#37; of the patients who did not undergo lymphadenectomy&#41;&#46; Smoking was associated with a 33&#37; to 73&#37; increased risk of complications&#46; The main limitation of this study is the risk of information bias due to incomplete follow-up&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">SLN biopsy is a melanoma staging procedure that causes complications and sequelae&#46; Recommendations for its use in clinical practice guidelines should be revised and the risks and benefits carefully evaluated in each case&#46; Smokers&#44; in particular&#44; seem to have a high risk of complications&#46; Patients with melanoma could benefit greatly from the development of less invasive staging tools&#46;</p></span>"
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          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background and objective"
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          1 => array:2 [
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            "titulo" => "Patients and methods"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La biopsia selectiva de ganglio centinela &#40;BSGC&#41; no tiene utilidad terap&#233;utica y solo se utiliza por su valor pron&#243;stico&#46; Su beneficio ha sido menor del esperado&#44; por lo que los riesgos cobran m&#225;s valor y no est&#225;n claramente definidos&#46; Nos hemos propuesto describir las complicaciones y secuelas sufridas por pacientes con melanoma expuestos a la t&#233;cnica de BSGC en la pr&#225;ctica cl&#237;nica habitual&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">En este estudio de cohortes retrospectivo unic&#233;ntrico hemos recogido los datos de todos los pacientes diagnosticados de melanoma y sometidos a la BSGC en nuestro centro &#40;Vigo&#41; entre enero de 2011 y julio de 2017&#44; revisando sus historias cl&#237;nicas&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se realizaron 124 BSGC&#46; El tiempo de seguimiento medio fue de 52&#44;7 meses &#40;rango 10&#44;8-88&#44;7 meses&#41;&#46; El 37&#44;9&#37; de los pacientes presentaron complicaciones&#46; Excluyendo a aquellos en los que se realiz&#243; linfadenectom&#237;a&#44; el porcentaje de complicaciones fue del 30&#44;9&#37;&#46; De las complicaciones totales&#44; 14 &#40;11&#44;3&#37;&#41; fueron alteraciones en la cicatrizaci&#243;n&#44; 13 &#40;10&#44;5&#37;&#41; infecciones de la herida quir&#250;rgica&#44; 12 &#40;9&#44;7&#37;&#41; linfedemas&#44; 11 &#40;8&#44;9&#37;&#41; seromas&#44; 4 &#40;3&#44;2&#37;&#41; hematomas&#44; 4 &#40;3&#44;2&#37;&#41; heridas dehiscentes&#44; 2 &#40;1&#44;6&#37;&#41; linforragias&#44; 2 &#40;1&#44;6&#37;&#41; alteraciones sensitivas y una &#40;0&#44;8&#37;&#41; infecci&#243;n del tracto urinario&#46; El 15&#44;3&#37; de los pacientes presentaron secuelas&#44; siendo el linfedema la m&#225;s frecuente&#46; Entre los pacientes sin linfadenectom&#237;a completa presentaron secuelas el 7&#44;5&#37;&#46; El tabaquismo se asoci&#243; con un aumento en el porcentaje de complicaciones de un 33 a un 73&#37;&#46; La principal limitaci&#243;n de este estudio es que pueda haber un sesgo de informaci&#243;n que infravalore los resultados por un seguimiento incompleto de los pacientes&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La BSGC es una t&#233;cnica de estadificaci&#243;n del melanoma no exenta de complicaciones y secuelas&#46; La recomendaci&#243;n de su uso rutinario en las gu&#237;as de pr&#225;ctica cl&#237;nica deber&#237;a revisarse&#44; sopesando los riesgos y los beneficios en cada caso&#46; En especial tienen un alto riesgo de presentar complicaciones los pacientes fumadores&#46; El desarrollo de otras herramientas de estadificaci&#243;n menos invasivas puede ser de gran utilidad para los pacientes con melanoma&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Espinosa-Pereiro CE&#44; Zulaica G&#225;rate A&#44; Garc&#237;a-Doval I&#46; Complicaciones y secuelas de la t&#233;cnica de biopsia selectiva del ganglio centinela para el melanoma en una cohorte retrospectiva&#46; Actas Dermosifiliogr&#46; 2019&#59;110&#58;482&#8211;489&#46;</p>"
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            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0055"
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    ]
    "multimedia" => array:5 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; ALM&#44; acral lentiginous melanoma&#59; BMI&#44; body mass index&#59; LLM&#44; lentigo maligna melanoma&#59; NM&#44; nodular melanoma&#59; SSM&#44; superficial spreading melanoma&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><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">Characteristic&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">Patients&#44; No&#46; &#40;&#37;&#41;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>124&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="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Patients</span></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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Sex</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="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\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">52 &#40;41&#46;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>Smokers&nbsp;\t\t\t\t\t\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 &#40;12&#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="elsevierStyleItalic">Obesity &#40;BMI</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#62;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">30&#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">38 &#40;30&#46;6&#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-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">Age&#44; y&#44; mean &#40;SD&#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">56 &#40;1&#46;5&#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="elsevierStyleItalic">Follow-up&#44; mo&#44; mean &#40;SD&#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">52&#46;6 &#40;2&#46;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"><span class="elsevierStyleBold">Primary melanoma</span></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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Location&#44; No&#46; &#40;&#37;&#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><span class="elsevierStyleHsp" style=""></span>Head and neck&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;8&#46;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><span class="elsevierStyleHsp" style=""></span>Trunk&nbsp;\t\t\t\t\t\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">42 &#40;33&#46;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><span class="elsevierStyleHsp" style=""></span>Upper limb&nbsp;\t\t\t\t\t\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">33 &#40;26&#46;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><span class="elsevierStyleHsp" style=""></span>Lower limb&nbsp;\t\t\t\t\t\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;30&#46;6&#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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Diagnosis&#44; No&#46; &#40;&#37;&#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><span class="elsevierStyleHsp" style=""></span>SSM&nbsp;\t\t\t\t\t\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 &#40;54&#46;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><span class="elsevierStyleHsp" style=""></span>ALM&nbsp;\t\t\t\t\t\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 &#40;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><span class="elsevierStyleHsp" style=""></span>LMM&nbsp;\t\t\t\t\t\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">7 &#40;5&#46;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><span class="elsevierStyleHsp" style=""></span>NM&nbsp;\t\t\t\t\t\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">24 &#40;19&#46;3&#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>Other&nbsp;\t\t\t\t\t\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;16&#46;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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Clark level</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="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">I</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">2 &#40;1&#46;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><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">II</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">9 &#40;7&#46;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><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">III</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">39 &#40;31&#46;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><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">IV</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">68 &#40;54&#46;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><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">V</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">4 &#40;3&#46;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><span class="elsevierStyleHsp" style=""></span>Not available&nbsp;\t\t\t\t\t\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 &#40;1&#46;6&#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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ulceration&#44; No&#46; &#40;&#37;&#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><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\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">35 &#40;28&#46;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><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">87 &#40;70&#46;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>Not available&nbsp;\t\t\t\t\t\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 &#40;1&#46;6&#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="elsevierStyleHsp" style=""></span>Breslow thickness&#44; mm</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>Mean &#40;SD&#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">2&#46;5 &#40;1&#46;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
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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>Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;2 &#40;3&#46;3&#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
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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><span class="elsevierStyleItalic">Mean sentinel lymph nodes removed per patient&#44; No&#46; &#40;SD&#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">2&#46;1 &#40;1&#46;2&#41;&nbsp;\t\t\t\t\t\t\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="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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Indication</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></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>Yes&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">111 &#40;88&#46;5&#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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Location&#44; No&#46; &#40;&#37;&#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><span class="elsevierStyleHsp" style=""></span>Groin&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">42 &#40;33&#46;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><span class="elsevierStyleHsp" style=""></span>Armpit&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">63 &#40;50&#46;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><span class="elsevierStyleHsp" style=""></span>Neck&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">18 &#40;14&#46;5&#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>In-transit<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&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 &#40;0&#46;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><span class="elsevierStyleItalic">Positive result</span>&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">37 &#40;29&#46;8&#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\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">Complications and sequelae &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>124&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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">Grade I<span class="elsevierStyleSmallCaps">&#44;</span> No&#46; &#40;&#37;&#41;&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">Grade II<span class="elsevierStyleSmallCaps">&#44;</span> No&#46; &#40;&#37;&#41;&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">Grade III<span class="elsevierStyleSmallCaps">&#44;</span> No&#46; &#40;&#37;&#41;&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">Scarring&nbsp;\t\t\t\t\t\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">13 &#40;92&#46;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">1 &#40;7&#46;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">-&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">Wound infection&nbsp;\t\t\t\t\t\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 &#40;7&#46;7&#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">12 &#40;92&#46;3&#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">-&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">Lymphedema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;100&#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">-&nbsp;\t\t\t\t\t\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">-&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">Seroma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;100&#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">-&nbsp;\t\t\t\t\t\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">-&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">Hematoma&nbsp;\t\t\t\t\t\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">4 &#40;100&#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">-&nbsp;\t\t\t\t\t\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">-&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">Wound dehiscence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;75&#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">-&nbsp;\t\t\t\t\t\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 &#40;25&#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">Lymphorrhagia&nbsp;\t\t\t\t\t\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 &#40;100&#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">-&nbsp;\t\t\t\t\t\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 ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Altered sensitivity&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \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">Urinary tract infection&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
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;30&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">0&#46;07-1&#46;33&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;25&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">0&#46;28-5&#46;51&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;96&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#46;21-4&#46;29&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td></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">SLN biopsy indication<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;47&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">0&#46;12-1&#46;85&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;28&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">1&#46;7&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">0&#46;71-4&#46;03&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;23&nbsp;\t\t\t\t\t\t\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"><span class="elsevierStyleItalic">Obesity &#40;BMI</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#62;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">30&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;82-4&#46;96&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&#46;38-20&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;01&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;10&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;13&#46;3&#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">9 &#40;9&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;13&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Seroma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;5&#46;3&#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\ttop\n
                  \t\t\t\t">6 &#40;20&#46;0&#41;&nbsp;\t\t\t\t\t\t\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"><span class="elsevierStyleHsp" style=""></span>Lymphedema&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;4&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;26&#46;7&#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>Wound dehiscence&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;4&#46;3&#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  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;2&#46;1&#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">2 &#40;6&#46;7&#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 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;3&#46;3&#41;&nbsp;\t\t\t\t\t\t\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
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                  \t\t\t\t">1 &#40;1&#46;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
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                  \t\t\t\t">1 &#40;3&#46;3&#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  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;1&#46;1&#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  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\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  " align="left" valign="\n
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                  \t\t\t\t">7 &#40;7&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9 &#40;30&#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">2 &#40;6&#46;7&#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">8 &#40;26&#46;7&#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  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                          "etal" => false
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                      "titulo" => "Les complications li&#233;es &#224; la technique du ganglion sentinelle dans le m&#233;lanome cutan&#233;&#46; &#201;tude r&#233;trospective &#224; partir de 127 cas"
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                            3 => "M&#46; Feinmesser"
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                            3 => "C&#46; Chao"
                            4 => "D&#46;S&#46; Reintgen"
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        "texto" => "<p id="par0235" class="elsevierStylePara elsevierViewall">We thank the pathology department for giving us access to its database&#44; which contains information on all SLN biopsies performed in the healthcare district of Vigo as well as melanoma pathology reports&#46;</p>"
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