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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tb0005"></elsevierMultimedia></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0025" class="elsevierStylePara elsevierViewall">The incidence and mortality of cutaneous melanoma have increased in recent decades in numerous countries&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Melanoma affects individuals of all races and ethnic groups&#44; although its incidence is closely linked to the color composition of the skin and varies according to the geographical area of residence&#46; This cancer is responsible for more than 90&#37; of deaths due to skin cancer&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The most important prognostic factor in these patients is still tumor thickness&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The public campaigns aimed at encouraging the early diagnosis of melanoma appear to have led to an increase in the incidence of melanoma at the expense of a larger number of diagnoses of thin melanomas&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> However&#44; the proportion of patients with thick melanomas&#44; which are associated with a poorer prognosis&#44; has not declined&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">There is debate as to whether the increase in the incidence of melanoma is real or is due to the bias introduced by the greater number of melanomas diagnosed in early stages&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#8211;16</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">There are several studies on the epidemiology of cutaneous melanoma in Spain&#44; but very few analyze the epidemiological&#44; clinical and histological characteristics of these patients and whether there are variations in the epidemiological profiles of patients with melanoma compared with previous decades&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#8211;22</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">We have conducted a descriptive epidemiological analysis of patients histologically diagnosed with cutaneous melanoma in healthcare area number 1 of the Autonomous Community of Madrid&#44; 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but the patients were nevertheless treated at HGUGM for this reason&#46; These data were obtained primarily in the melanoma area of the Department of Dermatology at HGUGM and through a review of the medical records of all patients diagnosed with melanoma according to the ICD 9 in the general archive of medical records in this hospital&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Melanomas of any thickness were included&#44; even intraepidermal melanomas&#46; Primary melanomas in soft tissue and in the visual apparatus were excluded&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In the descriptive study&#44; the following variables were considered&#58; age at the time of diagnosis&#44; gender&#44; phototype according to the Fitzpatrick classification in terms of response to sun exposure &#40;type I&#58; always burns&#44; never tans&#59; type II&#58; burns frequently&#44; barely tans&#59; type III&#58; tans frequently&#44; barely burns&#59; type IV&#58; always tans&#44; never burns&#41; determined using case histories and physical examinations of the patients&#44; number of melanocytic nevi observed in the physical examination &#40;&#62;25&#59; 25&#8211;50&#59; 50&#8211;100&#59; &#62;100&#41;&#44; history of melanoma&#44; family history of melanoma&#44; anatomical location of the melanoma &#40;head and neck&#44; torso&#44; extremities&#41;&#44; histological type of the melanoma&#44; tumor thickness in millimeters &#40;Breslow index&#41;&#44; tumor thickness based on stage T according to the AJCC classification of 2001&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Clark level and the presence of melanocytic nevi associated with melanoma&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The statistical analysis consisted of a descriptive and analytical study of the variables obtained using the statistical program SPSS<span class="elsevierStyleSup">&#174;</span> version 14 &#40;SPSS<span class="elsevierStyleSup">&#174;</span> Inc&#46;&#44; 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1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The melanomas located in the torso increased significantly in females &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; increasing from 32 cases of melanoma &#40;22&#46;7&#37;&#41; in the first period to 57 cases during the last period &#40;40&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The most common histological type during the 3 study periods was the superficial spreading melanoma&#46; In the last period&#44; a significant increase was observed in the lentigo maligna type of melanoma along with a slight reduction in nodular melanomas&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The mean tumor thickness based on the Breslow index showed a significant reduction&#44; decreasing from 1&#46;84<span class="elsevierStyleHsp" style=""></span>mm &#40;SD&#58; &#177;2&#46;68&#41; in the first period to 1&#46;39<span class="elsevierStyleHsp" style=""></span>mm &#40;SD&#58; &#177;2&#46;93&#41; in the third period &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;015&#41;&#46; These variations in the tumor thickness were also significant in terms of stage T&#44; with a marked increase in intraepidermal melanomas &#40;Tis&#41;&#46; However&#44; the proportion of these thick melanomas &#40;&#62;2<span class="elsevierStyleHsp" style=""></span>mm&#41; remained above 20&#37; over the 3 study periods&#44; presenting more frequently in males and those over 65 years of age&#46; The distribution of the melanomas according to their thickness &#40;stage T&#41; and based on age at diagnosis is shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46; We can see that the height of the columns is greater in stages T0 and T1 than in stages T2&#44; T3 and T4&#44; such that overall&#44; the melanomas were diagnosed with lesser rather than greater thickness&#46; Melanomas of more than 4<span class="elsevierStyleHsp" style=""></span>mm of thickness &#40;T4&#41; represented 51&#37; of the total in patients over 65 years of age&#44; compared with 11&#37; in those under 40 years of age&#46; The distribution of the melanomas according to their thickness &#40;stage T&#41; and based on the gender is shown in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#46; Melanomas of more than 4<span class="elsevierStyleHsp" style=""></span>mm of thickness were more common in males &#40;59&#46;5&#37;&#41; than in females &#40;40&#46;5&#37;&#41;&#44; while <span class="elsevierStyleItalic">in situ</span> melanomas and those with thicknesses less than 2<span class="elsevierStyleHsp" style=""></span>mm were more common in females&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">The results obtained in our study in terms of the epidemiological variations observed in the patients with melanoma agree with those of other studies conducted on patients in Spain&#44;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#8211;22</span></a>&#44; Italy&#44;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#8211;25</span></a> Germany&#44;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26&#44;27</span></a> and the United States&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> In general&#44; we can see an increase in the annual incidence of melanoma in all of these studies&#44; especially at the expense of facially located lentigo maligna melanomas in elderly individuals&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;26</span></a> We also see an increase in the age at diagnosis and a reduction in the mean tumor thickness&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Our study analyzed a significant sample of patients with melanoma treated at a single hospital center over a period of 15 years&#46; The results confirm that the epidemiological characteristics of patients with melanoma are changing over time&#44; probably due to various factors such as sun exposure and clothing habits&#44; prevention campaigns and early diagnosis&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">This study is the largest and most recent epidemiological study on melanoma conducted in the Autonomous Community of Madrid&#44; given that the study performed by Arranz-S&#225;nchez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> included only 526 patients with melanoma diagnosed between 1990 and 2004&#46; The results of our series agree with those of these authors in terms of the trend toward the reduction in mean tumor thickness&#44; which was even lower in our series &#40;mean thickness of 1&#46;61<span class="elsevierStyleHsp" style=""></span>mm&#41; than in the Arranz-S&#225;nchez et al&#46; series &#40;mean thickness of 2&#46;63<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> We also agree with Arranz-S&#225;nchez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> in terms of the greater tumor thickness in males and those over 60 years of age&#44; although in our series we also observed an increase in <span class="elsevierStyleItalic">in situ</span> lentigo maligna melanomas in the head and neck in the elderly population&#46; With regard to the location of the melanoma&#44; the torso was the most common location in both series&#46; When analyzing this variable in terms of gender&#44; we observed in our study that&#44; for females&#44; there was a progressive increase in melanomas located in the torso and a decrease in those located in the extremities&#44; a fact not reflected in any of the series conducted in Spain on epidemiological changes&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Marcoval et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> analyzed 1026 patients diagnosed with melanoma in the Catalan community between 1988 and 2006&#44; comparing the data of the first half with the second half of the period analyzed&#46; The number of <span class="elsevierStyleItalic">in situ</span> melanomas changed from 36&#47;302 cases &#40;11&#46;92&#37;&#41; in the first half of the period to 224&#47;724 &#40;30&#46;94&#37;&#41; in the second&#46; The melanomas greater than 4<span class="elsevierStyleHsp" style=""></span>mm changed from 29&#47;302 cases &#40;9&#46;60&#37;&#41; to 62&#47;724 &#40;8&#46;56&#37;&#41;&#46; The mean tumor thickness was 1&#46;91<span class="elsevierStyleHsp" style=""></span>mm and remained stable throughout the period&#46; Our series analyzed a similar number of patients during a shorter period of time and included epidemiological variables with significant changes that were not assessed by these authors&#44; such as the location of the primary tumor and the histological type of the melanoma&#46; Both studies agree in terms of the increase in the number of <span class="elsevierStyleItalic">in situ</span> melanomas and a stabilization of the proportion of thick melanomas over the course of the study periods&#46; However&#44; in our series&#44; the mean tumor thickness decreased significantly during the last 2 study periods&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Nagore et al&#46; analyzed the factors related to tumor thickness in 1571 patients in the community of Valencia &#40;1983&#8211;2001&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Older age&#44; male gender&#44; the presence of bleeding and a location on the palms and soles were factors associated with a greater tumor thickness&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">These same authors attempted to establish the clinical and epidemiological profiles of patients with cutaneous melanoma according to the degree of sun exposure on the location of the melanoma&#44; based on the epidemiological and phenotypic characteristics and the personal and family history of cancer of 789 patients&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> The results of this study agree with those of our series&#44; which suggests several epidemiological patterns and profiles in patients with melanoma&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The majority of patients diagnosed with melanoma are 40&#8211;50-year-old patients with melanoma in locations that are intermittently exposed to the sun&#46; The second epidemiological group by number consists of elderly patients with melanomas in areas that are chronically exposed to the sun &#40;forehead&#44; nose and cheeks&#41;&#44; the majority of which are <span class="elsevierStyleItalic">in situ</span> lentigo maligna type&#44; whose number continues to increase due to longer life expectancy&#44; greater or lesser access to healthcare facilities and improved training of primary care physicians&#46; Finally&#44; the third group consists of melanomas from areas of the skin that are not exposed to the sun&#44; such as the soles of the feet&#46; This group includes elderly patients&#44; as does the previous group&#59; however&#44; these are diagnosed with a greater tumor thickness and in advanced stages of the disease &#40;stages <span class="elsevierStyleSmallCaps">III</span> and <span class="elsevierStyleSmallCaps">IV</span>&#41;&#46; The proportion of these thick melanomas&#44; mainly nodular and acral lentiginous melanomas&#44; remain stable both in our series and in those by other authors&#44; which shows the ineffectiveness of rules such as the ABCD &#40;asymmetry&#44; irregular edges&#44; multiple colors&#44; diameter &#62;6<span class="elsevierStyleHsp" style=""></span>mm&#41; for the early diagnosis of these subtypes of melanoma&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">The data included in this study belong to a single hospital center&#46; Although the majority of the included patients belonged to the healthcare zone assigned to this hospital and because this center is a regional reference hospital&#44; approximately 15&#37; of the patients belonged to other healthcare zones&#46; In addition&#44; during the 3 last years of the study&#44; 2 other hospitals began operations in the same healthcare zone&#44; a factor that was responsible for the apparent stabilization in the incidence of cases treated in our center during the final years of the study&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In conclusion&#44; the results confirm a series of epidemiological changes in patients with melanoma&#46; These changes include an increase in the mean age at diagnosis&#44; an increase in melanomas located on the face and torso and a reduction in those located on the extremities in females&#46; Superficial spreading melanoma remains the most common histological type of melanoma&#44; followed by lentigo maligna melanoma&#46; We also observed a reduction in the mean tumor thickness at the time of diagnosis and an increase in the proportion of <span class="elsevierStyleItalic">in situ</span> melanomas&#46; Approximately 20&#37; of the patients still have melanomas that are thicker than 2<span class="elsevierStyleHsp" style=""></span>mm&#44; especially males and those over 65 years of age&#44; which confers a poorer prognosis&#46; We should therefore enhance the surveillance and early diagnosis in this population subgroup&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "identificador" => "xres61013"
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            0 => "Abstract"
            1 => "Background"
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            3 => "Results"
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            0 => "Resumen"
            1 => "Introducci&#243;n"
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          "titulo" => "Introduction"
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          "titulo" => "Material and methods"
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        6 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Results"
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        7 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Discussion"
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        8 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Conflicts of interest"
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        9 => array:1 [
          "titulo" => "References"
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    "fechaRecibido" => "2012-03-15"
    "fechaAceptado" => "2012-06-11"
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          "palabras" => array:5 [
            0 => "Melanoma"
            1 => "Epidemiology"
            2 => "Tumor thickness"
            3 => "Age"
            4 => "Spain"
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          "palabras" => array:5 [
            0 => "Melanoma"
            1 => "Epidemiolog&#237;a"
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            3 => "Edad"
            4 => "Espa&#241;a"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The incidence of malignant melanoma has increased over recent decades all over the world&#59; however&#44; we are not aware if this also occurs in Madrid&#46; Our objective was to analyze epidemiological changes in cutaneous malignant melanomas diagnosed over a 15-year period&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective analysis of data of patients with primary cutaneous melanomas attended at Hospital Gregorio Mara&#241;&#243;n&#44; Madrid&#44; Spain&#44; between 1996 and 2010&#44; divided into three periods&#58; 1996&#8211;2000&#59; 2001&#8211;2005&#59; 2006&#8211;2010&#44; was obtained&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In total&#44; 969 melanomas were histologically diagnosed&#46; The mean age at the moment of diagnosis was 58&#46;5 years old&#46; The mean tumor thickness was 1&#46;61<span class="elsevierStyleHsp" style=""></span>mm&#46; The most common histological type was surface-spreading melanoma and the most common site was the trunk&#46; There were statistically significant differences &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; between the three periods of the study&#58; older age at diagnoses &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#59; larger number of head and neck melanomas &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#59; more melanomas on trunk in women &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#59; increase of lentigo maligna melanoma &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#59; thinner mean tumor thickness &#40;Breslow index&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#59; larger number of melanomas <span class="elsevierStyleItalic">in situ</span> &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; However&#44; thick melanomas &#40;tumor thickness over 2<span class="elsevierStyleHsp" style=""></span>mm&#41; ratio was still over 20&#37; in all periods&#44; especially in males and in those over 65 years old&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Diagnosis of cutaneous melanoma in Spain is made increasingly with a thinner mean tumor thickness&#44; although thick melanomas are still diagnosed in men and in individuals over 65 years&#46;</p>"
      ]
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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La incidencia del melanoma cut&#225;neo ha aumentando durante las &#250;ltimas d&#233;cadas en muchos pa&#237;ses&#44; pero desconocemos si esto tambi&#233;n ha sucedido en Madrid&#46; Hemos analizado los cambios epidemiol&#243;gicos ocurridos en el melanoma cut&#225;neo durante un per&#237;odo de 15 a&#241;os&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se obtuvieron de forma retrospectiva los datos referentes a todos los pacientes con melanoma cut&#225;neo atendidos en el Hospital Gregorio Mara&#241;&#243;n de Madrid entre los a&#241;os 1996-2010&#44; dividido en 3 periodos&#58; 1996-2000&#59; 2001-2005&#44; y 2006-2010&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se diagnosticaron histol&#243;gicamente un total de 969 melanomas&#46; La edad media en el momento del diagn&#243;stico fue de 58&#44;5 a&#241;os&#46; El espesor tumoral medio fue de 1&#44;61<span class="elsevierStyleHsp" style=""></span>mm&#46; El tipo histol&#243;gico m&#225;s frecuente fue el melanoma de extensi&#243;n superficial&#46; Las diferencias estad&#237;sticamente significativas &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; entre los 3 periodos del estudio fueron&#58; mayor edad media al diagn&#243;stico &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#59; mayor n&#250;mero de melanomas en cabeza y cuello &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#59; mayor n&#250;mero de melanomas en tronco en el sexo femenino &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#59; aumento del melanoma tipo lentigo maligno &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#59; disminuci&#243;n del espesor medio &#40;&#237;ndice de Breslow&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#59; mayor n&#250;mero de melanomas intraepid&#233;rmicos &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Sin embargo&#44; la proporci&#243;n de melanomas gruesos &#40;&#62;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mm de Breslow&#41; se mantuvo por encima del 20&#37;&#44; siendo m&#225;s frecuente este subtipo de melanomas en varones y en mayores de 65 a&#241;os&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El melanoma cut&#225;neo en Espa&#241;a se diagnostica con un espesor tumoral medio cada vez m&#225;s fino&#44; aunque se siguen diagnosticando melanomas de gran espesor especialmente en varones y pacientes de m&#225;s de 65 a&#241;os&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Avil&#233;s-Izquierdo JA&#44; et al&#46; Cambios epidemiol&#243;gicos en el melanoma cut&#225;neo&#58; estudio retrospectivo de 969 casos &#40;1996&#8211;2010&#41;&#46; Rev Clin Esp&#46; 2013&#58;213&#58;81&#8211;7&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of melanoma according to its location in females and males&#46;</p>"
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        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Distribution of melanoma according to its tumor thickness &#40;stage T&#41; and gender&#46;</p>"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Percentages in parentheses&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Total patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Period 1 &#40;1996&#8211;2000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Period 2 &#40;2001&#8211;2005&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Period 3 &#40;2006&#8211;2010&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Statistical significance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Family history of melanoma</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">History of other primary melanoma</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Age at diagnosis &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;059&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;40&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>40&#8211;65&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">58&#46;55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;55&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">56&#46;66<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;68&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Median&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Range&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Interquartile interval &#40;Q3&#8211;Q1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Location of the melanoma</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Extremities&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Unknown&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Histological type of melanoma</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Superficial spreading&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nodular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lentigo maligna&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Acral lentiginous&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Others&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Unspecified&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Mean thickness in mm &#40;Breslow&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Median&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Range&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Interquartile interval &#40;Q3&#8211;Q1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Unknown&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tumor thickness according to stage T</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tis &#40;<span class="elsevierStyleItalic">in situ</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T1 &#40;0&#8211;1<span class="elsevierStyleHsp" style=""></span>mm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T2 &#40;1&#46;01&#8211;2<span class="elsevierStyleHsp" style=""></span>mm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T3 &#40;2&#46;01&#8211;4<span class="elsevierStyleHsp" style=""></span>mm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">137 &#40;14&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T4 &#40;&#62;4<span class="elsevierStyleHsp" style=""></span>mm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26 &#40;8&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Epidemiological&#44; clinical and histological characteristics of patients with melanoma by study period&#46;</p>"
        ]
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      4 => array:5 [
        "identificador" => "tb0005"
        "tipo" => "MULTIMEDIATEXTO"
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        "texto" => array:1 [
          "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">What we know</span><p id="par0010" class="elsevierStylePara elsevierViewall">The incidence of cutaneous melanoma is increasing&#44; but we do not know whether this is true for our community&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">What this article provides</span><p id="par0015" class="elsevierStylePara elsevierViewall">An analysis of 969 melanomas over three time periods &#40;1996&#8211;2000&#44; 2001&#8211;2005 and 2006&#8211;2010&#41; reveals four characteristics&#58; &#40;a&#41; melanomas are diagnosed at an ever increasing age&#59; &#40;b&#41; the majority of melanomas are located in the torso&#59; &#40;c&#41; the most common type of melanoma is the superficial spreading type&#44; while the prevalence of the lentigo maligna melanoma has increased the most&#59; and &#40;d&#41; in recent times&#44; melanomas have been diagnosed with an increasingly thinner average tumor thickness&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The Editors</p></span></span>"
        ]
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    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
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        0 => array:2 [
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            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;F&#46; Thompson"
                            1 => "R&#46;A&#46; Scolyer"
                            2 => "R&#46;F&#46; Kefford"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(05)17951-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2005"
                        "volumen" => "365"
                        "paginaInicial" => "687"
                        "paginaFinal" => "701"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15721476"
                            "web" => "Medline"
                          ]
                        ]
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              "identificador" => "bib0010"
              "etiqueta" => "2"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology and survival of cutaneous melanoma in Spain&#58; a report of 552 cases &#40;1994&#8211;2003&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;A&#46; Avil&#233;s"
                            1 => "P&#46; L&#225;zaro"
                            2 => "M&#46; Lecona"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "2006"
                        "volumen" => "206"
                        "paginaInicial" => "319"
                        "paginaFinal" => "325"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16831378"
                            "web" => "Medline"
                          ]
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                ]
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            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The epidemiology of skin cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T&#46;L&#46; Diepgen"
                            1 => "V&#46; Mahler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
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Vol. 213. Issue 2.
Pages 81-87 (March 2013)
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Vol. 213. Issue 2.
Pages 81-87 (March 2013)
Original article
Epidemiological changes in cutaneous melanoma: Retrospective study of 969 cases (1996–2010)
Cambios epidemiológicos en el melanoma cutáneo: estudio retrospectivo de 969 casos (1996–2010)
J.A. Avilés-Izquierdoa,
Corresponding author
jaavilesizquierdo@gmail.com

Corresponding author.
, P. Lázaro-Ochaitaa, R. Suárez-Fernándeza, I. Márquez-Rodasb, V. Parra-Blancoc, J.L. Escat-Cortésd
a Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
b Servicio de Oncología Médica, Hospital General Universitario Gregorio Marañón, Madrid, Spain
c Servicio de Anatomía Patológica, Hospital General Universitario Gregorio Marañón, Madrid, Spain
d Servicio de Cirugía General-I, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Table 1. Epidemiological, clinical and histological characteristics of patients with melanoma by study period.
Abstract
Background

The incidence of malignant melanoma has increased over recent decades all over the world; however, we are not aware if this also occurs in Madrid. Our objective was to analyze epidemiological changes in cutaneous malignant melanomas diagnosed over a 15-year period.

Patients and methods

Retrospective analysis of data of patients with primary cutaneous melanomas attended at Hospital Gregorio Marañón, Madrid, Spain, between 1996 and 2010, divided into three periods: 1996–2000; 2001–2005; 2006–2010, was obtained.

Results

In total, 969 melanomas were histologically diagnosed. The mean age at the moment of diagnosis was 58.5 years old. The mean tumor thickness was 1.61mm. The most common histological type was surface-spreading melanoma and the most common site was the trunk. There were statistically significant differences (P<.05) between the three periods of the study: older age at diagnoses (P<.001); larger number of head and neck melanomas (P<.001); more melanomas on trunk in women (P<.001); increase of lentigo maligna melanoma (P<.001); thinner mean tumor thickness (Breslow index) (P<.001); larger number of melanomas in situ (P<.001). However, thick melanomas (tumor thickness over 2mm) ratio was still over 20% in all periods, especially in males and in those over 65 years old.

Conclusions

Diagnosis of cutaneous melanoma in Spain is made increasingly with a thinner mean tumor thickness, although thick melanomas are still diagnosed in men and in individuals over 65 years.

Keywords:
Melanoma
Epidemiology
Tumor thickness
Age
Spain
Resumen
Introducción

La incidencia del melanoma cutáneo ha aumentando durante las últimas décadas en muchos países, pero desconocemos si esto también ha sucedido en Madrid. Hemos analizado los cambios epidemiológicos ocurridos en el melanoma cutáneo durante un período de 15 años.

Pacientes y métodos

Se obtuvieron de forma retrospectiva los datos referentes a todos los pacientes con melanoma cutáneo atendidos en el Hospital Gregorio Marañón de Madrid entre los años 1996-2010, dividido en 3 periodos: 1996-2000; 2001-2005, y 2006-2010.

Resultados

Se diagnosticaron histológicamente un total de 969 melanomas. La edad media en el momento del diagnóstico fue de 58,5 años. El espesor tumoral medio fue de 1,61mm. El tipo histológico más frecuente fue el melanoma de extensión superficial. Las diferencias estadísticamente significativas (p<0,05) entre los 3 periodos del estudio fueron: mayor edad media al diagnóstico (p<0,001); mayor número de melanomas en cabeza y cuello (p<0,001); mayor número de melanomas en tronco en el sexo femenino (p<0,001); aumento del melanoma tipo lentigo maligno (p<0,001); disminución del espesor medio (índice de Breslow) (p<0,001); mayor número de melanomas intraepidérmicos (p<0,001). Sin embargo, la proporción de melanomas gruesos (>2mm de Breslow) se mantuvo por encima del 20%, siendo más frecuente este subtipo de melanomas en varones y en mayores de 65 años.

Conclusiones

El melanoma cutáneo en España se diagnostica con un espesor tumoral medio cada vez más fino, aunque se siguen diagnosticando melanomas de gran espesor especialmente en varones y pacientes de más de 65 años.

Palabras clave:
Melanoma
Epidemiología
Espesor tumoral
Edad
España

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