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Animals : an open access journal from MDPI2025; 15(13); 1853; doi: 10.3390/ani15131853

Equine Veterinarian Perspectives on Mucocutaneous Tumors in Horses: A Survey-Based Study in Portugal.

Abstract: This study explores equine veterinarians' clinical practices regarding mucocutaneous tumors, based on a survey conducted among members of the Portuguese Association of Equine Veterinarians, and examines their perceptions of owner and buyer concerns regarding these tumors. Veterinarians expressed significantly greater concern about squamous cell carcinoma (SCC) during routine examinations ( < 0.001) compared to sarcoids and melanomas. Concern over sarcoids was significantly greater during pre-purchase evaluations compared to routine clinical exams ( = 0.03). For melanomas, a trend toward increased concern in pre-purchase evaluations compared to routine examinations was observed ( = 0.07). There was a statistically significant association between the use of histopathology and the type of tumor ( < 0.001). Histopathology was performed less frequently in cases of melanoma compared to other tumor types. The cost was the main reason for not performing histopathology. During pre-purchase exams, buyers appeared to show greater concern regarding the presence of sarcoids ( = 0.001) and melanomas ( = 0.002) than regular owners. This study highlights the need to bolster training and education in equine oncology for veterinarians and owners to promote better diagnostic and therapeutic practices.
Publication Date: 2025-06-23 PubMed ID: 40646752PubMed Central: PMC12248879DOI: 10.3390/ani15131853Google Scholar: Lookup
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  • Journal Article

Summary

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The research article explores how horse veterinarians in Portugal approach and perceive mucocutaneous tumors, specifically focusing on the types of tumors that cause the most concern during both routine examinations and pre-purchase evaluations. The study also looks into the relationship between tumor type and the use of histopathology.

Survey Results and Veterinarian Opinions

  • The survey was conducted among members of the Portuguese Association of Equine Veterinarians with the goal of understanding their clinical practices and perceptions regarding mucocutaneous tumors in horses.
  • The data showed that there was a significant concern about squamous cell carcinoma (SCC) during routine examinations compared to other kinds of tumors like sarcoids and melanomas.
  • Interestingly, the level of concern over sarcoids was greater during pre-purchase evaluations compared to routine clinical exams.
  • Moreover, there seemed to be a trend of increasing concern for melanomas during pre-purchase examinations, although the difference was not statistically significant.

Usage of Histopathology

  • One of the key findings in the report was a significant association between the kind of tumor and the use of histopathology — a lab test that studies tissues under a microscope to identify disease.
  • Among the different types of tumors, histopathology was used less frequently in cases of melanoma.
  • Financial factors seemed to be an important reason behind not using histopathology, suggesting that cost may be a barrier in the diagnostic process for some veterinarians.

Owners and Buyers’ Concerns

  • According to the veterinarians in the study, potential buyers appeared to be more concerned about the presence of sarcoids and melanomas than regular owners during pre-purchase exams.
  • This distinction implies that the perceived health risk of the horse might be affecting buyer decisions.

Key Implications and Recommendations

  • The study suggests the need for further training and education in equine oncology for veterinarians to improve their diagnostic and therapeutic practices.
  • Greater knowledge can aid in early detection and treatment, and can also better inform and reassure horse owners and potential buyers about these types of tumors.

Cite This Article

APA
Pimenta J, Cotovio M. (2025). Equine Veterinarian Perspectives on Mucocutaneous Tumors in Horses: A Survey-Based Study in Portugal. Animals (Basel), 15(13), 1853. https://doi.org/10.3390/ani15131853

Publication

ISSN: 2076-2615
NlmUniqueID: 101635614
Country: Switzerland
Language: English
Volume: 15
Issue: 13
PII: 1853

Researcher Affiliations

Pimenta, José
  • CIVG-Vasco da Gama Research Center, EUVG-Vasco da Gama University School, 3020-210 Coimbra, Portugal.
  • CECAV-Veterinary and Animals Research Center, University of Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal.
  • Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 5000-801 Vila Real, Portugal.
Cotovio, Mário
  • CECAV-Veterinary and Animals Research Center, University of Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal.
  • Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 5000-801 Vila Real, Portugal.
  • Faculty of Veterinary Medicine, Lusófona University, Campo Grande 376, 1749-024 Lisbon, Portugal.

Grant Funding

  • 00772/2020 / Fundau00e7u00e3o para a Ciu00eancia e Tecnologia

Conflict of Interest Statement

The authors declare no conflicts of interest.

References

This article includes 73 references
  1. Pinto C, Aluai-Cunha C, Santos A. The Human and Animals’ Malignant Melanoma: Comparative Tumor Models and the Role of Microbiome in Dogs and Humans.. Melanoma Res. 2023;33:87–103.
    doi: 10.1097/CMR.0000000000000880pubmed: 36662668google scholar: lookup
  2. Deleon M. Cutaneous Melanoma: A Comparative Study Between Gray Horses, Canines, and Humans.. Iowa State University (Digital Repository); Ames, IA, USA: 2021.
  3. Smith S.H., Goldschmidt M.H., Mcmanus P.M.. A Comparative Review of Melanocytic Neoplasms.. Vet. Pathol. 2002;39:651–678.
    doi: 10.1354/vp.39-6-651pubmed: 12450197google scholar: lookup
  4. Sultan F, Ganaie B.A. Comparative Oncology: Integrating Human and Veterinary Medicine.. Open Vet. J. 2018;8:25–34.
    doi: 10.4314/ovj.v8i1.5pmc: PMC5806664pubmed: 29445618google scholar: lookup
  5. Seltenhammer M.H., Heere-Ress E., Brandt S., Druml T., Jansen B., Pehamberger H., Niebauer G.W.. Comparative Histopathology of Grey-Horse-Melanoma and Human Malignant Melanoma.. Pigment Cell Res. 2004;17:674–681.
  6. Rieder S., Stricker C., Joerg H., Dummer R., Stranzinger G.. A Comparative Genetic Approach for the Investigation of Ageing Grey Horse Melanoma.. J. Anim. Breed. Genet. 2000;117:73–82.
  7. Hollis A. Equine Oncology: Why Does It Matter Anyway?. In: Hollis A., Toribio R., editors. Equine Oncology, An Issue of Veterinary Clinics of North America. Elsevier; Philadelphia, PA, USA: 2024. p. 13.
    pubmed: 39294012
  8. Knottenbelt D.C., Patterson-Kane J.C., Snalune K.L.. Clinical Equine Oncology.. Elsevier; Amsterdam, The Netherlands: 2015. The Challenges and Problems of Equine Oncological Practice; pp. 7–10.
  9. Braeuer R.R., Watson I.R., Wu C.J., Mobley A.K., Kamiya T., Shoshan E., Bar-Eli M. Why Is Melanoma so Metastatic?. Pigment Cell Melanoma Res. 2014;27:19–36.
    doi: 10.1111/pcmr.12172pubmed: 24106873google scholar: lookup
  10. Mair T. Equine Veterinary Education Virtual Issue on Oncology.. Equine Vet. Educ. 2014;26:115.
    doi: 10.1111/eve.12151google scholar: lookup
  11. Nishiya A.T., Massoco C.O., Felizzola C.R., Perlmann E., Batschinski K., Tedardi M.V., Garcia J.S., Mendonça P.P., Teixeira T.F., Dagli M.L.Z.. Comparative Aspects of Canine Melanoma.. Vet. Sci. 2016;3:7.
    doi: 10.3390/vetsci3010007pmc: PMC5644618pubmed: 29056717google scholar: lookup
  12. Smedley R.C., Spangler W.L., Esplin D.G., Kitchell B.E., Bergman P.J., Ho H.Y., Bergin I.L., Kiupel M. Prognostic Markers for Canine Melanocytic Neoplasms: A Comparative Review of the Literature and Goals for Future Investigation.. Vet. Pathol. 2011;48:54–72.
    doi: 10.1177/0300985810390717pubmed: 21266721google scholar: lookup
  13. MacKay R.J.. Treatment Options for Melanoma of Gray Horses.. Vet. Clin. North Am.—Equine Pract. 2019;35:311–325.
    doi: 10.1016/j.cveq.2019.04.003pubmed: 31279435google scholar: lookup
  14. Knottenbelt D.C., Patterson-Kane J.C., Snalune K.L.. Clinical Equine Oncology.. Elsevier; Amsterdam, The Netherlands: 2015. Principles of Diagnosis; pp. 85–107.
  15. Knottenbelt D.C., Patterson-Kane J.C., Snalune K.L.. Clinical Equine Oncology.. Elsevier; Amsterdam, The Netherlands: 2015. Tumours of the Skin; pp. 544–584.
  16. Knottenbelt D.C., Patterson-Kane J.C., Snalune K.L.. Clinical Equine Oncology.. Elsevier; Amsterdam, The Netherlands: 2015. Pathological Methods in Equine Oncology; pp. 108–117.
  17. Tamzali Y., Kemp-Symonds J. Clinical Equine Oncology.. Elsevier; Amsterdam, The Netherlands: 2015. Principles of Oncological Therapy; pp. 118–197.
  18. Funiciello B., Roccabianca P. Equine Science.. IntechOpen; London, UK: 2020. Equine Sarcoid.
  19. Knottenbelt D., Croft J. The Equine Melanoma.. Equine Health. 2018;18:30–32.
    doi: 10.12968/eqhe.2018.39.30google scholar: lookup
  20. Taylor S., Haldorson G. A Review of Equine Mucocutaneous Squamous Cell Carcinoma.. Equine Vet. Educ. 2012;25:374–378.
  21. Taylor S., Haldorson G. A Review of Equine Sarcoid.. Equine Vet. Educ. 2012;25:210–216.
  22. Ogłuszka M., Starzyński R.R., Pierzchała M., Otrocka-Domagała I., Raś A. Equine Sarcoids—Causes, Molecular Changes, and Clinicopathologic Features: A Review.. Vet. Pathol. 2021;58:472–482.
    doi: 10.1177/0300985820985114pubmed: 33461443google scholar: lookup
  23. Hollis A. Squamous Cell Carcinomas in Horses: An Update of the Aetiopathogenesis and Treatment Options.. In: Hollis A., Ramiro T., editors. Equine Oncology: An Issue of Veterinary Clinics of North America. Elsevier; Philadelphia, PA, USA: 2024. pp. 421–430.
    pubmed: 39168748
  24. Burden K. Melanomas and Their Effect on the Grey Horse.. Young Sci. J. 2011;4:75.
    doi: 10.4103/0974-6102.92207google scholar: lookup
  25. Hollis A. Equine Melanoma Updates.. In: Hollis A., Ramiro T., editors. Equine Oncology: An Issue of Veterinary Clinics of North America. Elsevier; Philadelphia, PA, USA: 2024. pp. 431–439.
    pubmed: 39266414
  26. Hollis A. What Is the Evidence Behind Sarcoid Treatment?. In: Hollis A., Ramiro T., editors. Equine Oncology: An Issue of Veterinary Clinics of North America. Elsevier; Philadelphia, PA, USA: 2024. pp. 409–419.
    pubmed: 39183073
  27. Imogen J., Jill B. Diagnosis and Staging of Equine Neoplasia.. In: Hollis A., Ramiro T., editors. Equine Oncology, An Issue of Veterinary Clinics of North America. Elsevier; Philadelphia, PA, USA: 2024. pp. 351–369.
    pubmed: 39266415
  28. Jackson A. Surgical Management of Equine Neoplasia.. In: Hollis A., Ramiro T., editors. Equine Oncology: An Issue of Veterinary Clinics of North America. Elsevier; Philadelphia, PA, USA: 2024. pp. 371–385.
    pubmed: 39266416
  29. Surjan Y., Donaldson D., Ostwald P., Milross C., Warren-Forward H. A Review of Current Treatment Options in the Treatment of Ocular and/or Periocular Squamous Cell Carcinoma in Horses: Is There a Definitive “Best” Practice?. J. Equine Vet. Sci. 2014;34:1037–1050.
  30. Yi Z., Gao Y., Yu F., Zhu Y., Liu H., Li J., Murua Escobar H. Interventions for Treatment of Cutaneous Melanoma in Horses: A Structured Literature Review.. Vet. Res. Commun. 2023;47:347–360.
    doi: 10.1007/s11259-022-10023-8pubmed: 36329228google scholar: lookup
  31. Knottenbelt D. Approach to the Suspected or Confirmed Cancer Case.. In: Knottenbelt D., editor. Clinical Equine Oncology. Elsevier; Amsterdam, The Netherlands: 2015. pp. 415–428.
  32. Machtinger E.T., Smarsh D.N., Kenny L.B., Poh K.C., Orr-Gissinger E.L., Kirkland B.G., Springer H.R. An Assessment of Equine Veterinarian Knowledge and Perceptions of Ticks and Tick-Borne Diseases in the United States to Inform Continuing Education Needs.. Equine Vet. Educ. 2023;36:527–535.
    doi: 10.1111/eve.13931google scholar: lookup
  33. Marshall-Gibson M.E., Durham M.G., Seabaugh K.A., Moorman V.J., Ferris D.J.. Survey of Equine Veterinarians Regarding Primary Equine Back Pain in the United States.. Front. Vet. Sci. 2023;10:1224605.
    doi: 10.3389/fvets.2023.1224605pmc: PMC10411723pubmed: 37565081google scholar: lookup
  34. Hepworth-Warren K.L., Love K. Survey of the Approach to the Diagnosis and Management of Bacterial Pneumonia in Adult Horses by Equine Veterinarians.. Front. Vet. Sci. 2024;11:1484970.
    doi: 10.3389/fvets.2024.1484970pmc: PMC11700971pubmed: 39764370google scholar: lookup
  35. Nichols J., Robinson S., Hiney K., Terry R., Ramsey J. An Investigation into Equine Nutrition Knowledge and Educational Needs of Equine Veterinarians.. J. Vet. Med. Educ. 2022;50:183–191.
    doi: 10.3138/jvme-2021-0121pubmed: 35143362google scholar: lookup
  36. Golding E., Neavyn Neita A., Walshe N., Hanlon A., Mulcahy G., Duggan V. Survey of the Knowledge and Perceptions of Horse Owners in Ireland of Common Clinical Conditions and Their Impact.. Equine Vet. J. 2023;55:270–281.
    doi: 10.1111/evj.13589pmc: PMC10084215pubmed: 35575027google scholar: lookup
  37. Elte Y., Wolframm I., van Grevenhof I., Nielen M., van Weeren R. Survey-Based Investigation of Sports and Leisure Horse Owners’ Approaches to, and Expectations of, Equine Veterinary Care.. Vet. Rec. 2024;194:e4197.
    doi: 10.1002/vetr.4197pubmed: 38809578google scholar: lookup
  38. Janke N., Coe J.B., Bernardo T.M., Dewey C.E., Stone E.A. Pet Owners’ and Veterinarians’ Perceptions of Information Exchange and Clinical Decision-Making in Companion Animal Practice.. PLoS ONE. 2021;16:e0245632.
  39. Tabor G., Williams J. The Use of Outcome Measures in Equine Rehabilitation.. Vet. Nurse. 2018;9:497–500.
  40. Eysenbach G. Eysenbach Gunther Improving the Quality of Web Surveys: The Checklist for Reporting Results of Internet E-Surveys.. J. Med. Internet Res. 2004;6:34–35.
    doi: 10.2196/jmir.6.3.e34pmc: PMC1550605pubmed: 15471760google scholar: lookup
  41. Bowen A.G., Tabor G., Labens R., Randle H. Visually Assessing Equine Quality of Movement: A Survey to Identify Key Movements and Patient-Specific Measures.. Animals. 2023;13:2822.
    doi: 10.3390/ani13182822pmc: PMC10525514pubmed: 37760222google scholar: lookup
  42. Pimenta J., Prada J., Cotovio M. Equine Melanocytic Tumors: A Narrative Review.. Animals. 2023;13:247.
    doi: 10.3390/ani13020247pmc: PMC9855132pubmed: 36670786google scholar: lookup
  43. Knottenbelt D.C.. Integumentary Disorders Including Cutaneous Neoplasia in Older Horses.. Vet. Clin. North Am.—Equine Pract. 2016;32:263–281.
    doi: 10.1016/j.cveq.2016.04.005pubmed: 27329491google scholar: lookup
  44. Lazary S., Gerber H., Glatt P.A., Straub R. Equine Leucocyte Antigens in Sarcoid-affected Horses.. Equine Vet. J. 1985;17:283–286.
  45. Brostrom H., Fahlbrink E., Dubath M.-L., Lazary S. Association Between Equine Leucocyte Antigens (ELA) and Equine Sarcoid Tumors in the Population of Swedish Halfbreds and Some of Their Families.. Vet. Immunol. Immunopathol. 1988;19:215–223.
    doi: 10.1016/0165-2427(88)90109-2pubmed: 3252614google scholar: lookup
  46. Christen G., Gerber V., Dolf G., Burger D., Koch C. Inheritance of Equine Sarcoid Disease in Franches-Montagnes Horses.. Vet. J. 2014;199:68–71.
    doi: 10.1016/j.tvjl.2013.09.053pubmed: 24152383google scholar: lookup
  47. Barrett E., Arkins S. Abnormalities Detected at Pre-Purchase Examination of National Hunt Racehorses Presented at Sale.. Equine Vet. J. 2020;52:281–289.
    doi: 10.1111/evj.13164pubmed: 31418917google scholar: lookup
  48. Phillips J.C., Lembcke L.M.. Equine Melanocytic Tumors.. Vet. Clin. North Am. Equine Pract. 2013;29:673–687.
    doi: 10.1016/j.cveq.2013.08.008pubmed: 24267683google scholar: lookup
  49. Knottenbelt D.C., Patterson-Kane J.C., Snalune K.L.. Clinical Equine Oncology.. Elsevier; Amsterdam, The Netherlands: 2015. Melanocytic Neoplasms; pp. 237–246.
  50. Sullins K.E.. Melanocytic Tumours in Horses.. Equine Vet. Educ. 2020;32:624–630.
    doi: 10.1111/eve.13159google scholar: lookup
  51. Vicente A., Faria R.A.S., Ralão-Duarte J., Mateus M., Carolino N. Evolução Da Altura Ao Garrote, Pontuação Total e Pelagens Na Raça Lusitana.. Sociedade Portuguesa de Recursos Genéticos Animais—SPREGA; Vila Real, Portugal: 2024.
  52. Pimenta J., Prada J., Pires I., Cotovio M. The Impact of Excision Interval on Equine Melanoma Progression: Time Matters?. Animals. 2024;14:1244.
    doi: 10.3390/ani14081244pmc: PMC11047369pubmed: 38672392google scholar: lookup
  53. Knottenbelt D. Biology of Tumor Growth.. In: Knottenbelt D., editor. Clinical Equine Oncology. Elsevier; Amsterdam, The Netherlands: 2015. pp. 23–61.
  54. Knottenbelt D. Clinical Effects of Cancer in Horses.. In: Knottenbelt D., editor. Clinical Equine Oncology. Elsevier; Amsterdam, The Netherlands: 2015. pp. 70–84.
  55. Knottenbelt D. Tumour Nomenclature.. In: Knottenbelt D., editor. Clinical Equine Oncology. Elsevier; Amsterdam, The Netherlands: 2015. pp. 11–22.
  56. Knottenbelt D. Squamous Cell Carcinoma.. In: Knottenbelt D., editor. Clinical Equine Onocology. Elsevier; Amsterdam, The Netherlands: 2015. pp. 221–236.
  57. Knottenbelt D. Sarcoids.. In: Knottenbelt D., editor. Clinical Equine Oncology. Elsevier; Amsterdam, The Netherlands: 2015. pp. 204–219.
  58. Gysens L. Longitudinal Pilot Study Examining the Effect of Punch Biopsy on Equine Sarcoid Growth Dynamics.. Vet. Dermatol. 2024;35:148–155.
    doi: 10.1111/vde.13236pubmed: 38168049google scholar: lookup
  59. Moore J.S., Shaw C., Shaw E., Buechner-Maxwell V., Scarratt W.K., Crisman M., Furr M., Robertson J. Melanoma in Horses: Current Perspectives.. Equine Vet. Educ. 2013;25:144–151.
  60. Williams R. How the Cost of Veterinary Care Impacts the Wellbeing, Learning and Practice of Early Career Vets.. Vet. Rec. 2024;196:e4597.
    doi: 10.1002/vetr.4597pmc: PMC11740408pubmed: 39262051google scholar: lookup
  61. Groom L.M., Sullins K.E.. Surgical Excision of Large Melanocytic Tumours in Grey Horses: 38 Cases (2001–2013). Equine Vet. Educ. 2018;30:438–443.
    doi: 10.1111/eve.12767google scholar: lookup
  62. Billi T., Karadima V., Tyrnenopoulou P., Apostolopoulou E.P., Brellou G.D., Diakakis N. Surgical Excision of a Malignant Metastatic Melanoma Located in a Skeletal Muscle of the Lateral Thorax of a Horse.. Vet. Med. Sci. 2021;7:297–302.
    doi: 10.1002/vms3.366pmc: PMC8025616pubmed: 32991055google scholar: lookup
  63. Rowe E.L., Sullins K.E.. Excision as Treatment of Dermal Melanomatosisin Horses: 11 Cases (1994–2000). JAVMA. 2004;225:94–96.
    doi: 10.2460/javma.2004.225.94pubmed: 15239480google scholar: lookup
  64. Lembcke Perez Prieto L.M.. Safety and Immunoreactivity of a Xenogeneic DNA Plasmid Vaccine Expressing Human Tyrosinase in Tumor-Bearing Horses.. Ph.D. Thesis. University of Tennessee; Knoxville, TN, USA: 2013.
  65. Lembcke L.M., Kania S.A., Blackford J.T., Trent D.J., Odoi A., Grosenbaugh D.A., Fraser D.G., Leard T., Phillips J.C.. Development of Immunologic Assays to Measure Response in Horses Vaccinated with Xenogeneic Plasmid DNA Encoding Human Tyrosinase.. J. Equine Vet. Sci. 2012;32:607–615.
  66. Echelmeyer J., Peckary R., Delarocque J., Patzl M., Feige K., Cavalleri J. Effect of Vaccination with Human Tyrosinase DNA in Horses with Melanoma in Comparison to Untreated Horses; Proceedings of the 12th Annual European College of Equine Internal Medicine Congress; Copenhagen, Denmark.. 14–16 November 2024; pp. 12–13.
  67. Pellin M.A.. The Use of Oncept Melanoma Vaccine in Veterinary Patients: A Review of the Literature.. Vet. Sci. 2022;9:597.
    doi: 10.3390/vetsci9110597pmc: PMC9693055pubmed: 36356074google scholar: lookup
  68. Laus F., Cerquetella M., Paggi E., Ippedico G., Argentieri M., Castellano G., Spaterna A., Tesei B. Evaluation of Cimetidine as a Therapy for Dermal Melanomatosis in Grey Horse.. Isr. J. Vet. Med. 2010;65:48–52.
  69. Helle N.M.. Effectiveness of Cimetidine on the Size of Melanomas of 40 Grey Horses.. University of Utrecht; Utrecht, The Netherlands: 2012.
  70. Cavalleri J.M.V., Mählmann K., Steinig P., Feige K. Aetiology, Clinical Presentation and Current Treatment Options of Equine Malignant Melanoma—A Review of the Literature.. Pferdeheilkunde. 2014;30:455–460.
    doi: 10.21836/PEM20140410google scholar: lookup
  71. Malalana F. Chemotherapeutics in Equine Practice.. In: Hollis A., Ramiro T., editors. Equine Oncology: An Issue of Veterinary Clinics of North America. Elsevier; Philadelphia, PA, USA: 2024. pp. 387–395.
    pubmed: 39155164
  72. Théon A.P., Wilson W.D., Magdesian K.G., Pusterla N., Snyder J.R.G.L.D.. Long-Term Outcome Associated with Intratumoral Chemotherapy with Cisplatin for Cutaneous Tumors in Equidae: 573 Cases (1995–2004). JAVMA. 2007;230:1506–1513.
    doi: 10.2460/javma.230.10.1506pubmed: 17504043google scholar: lookup
  73. Palmer S.E.. Treatment of Common Cutaneous Tumors Using the Carbon Dioxide Laser.. Clin. Tech. Equine Pract. 2002;1:43–50.
    doi: 10.1053/ctep.2002.33171google scholar: lookup

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