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hemos diagnosticado 11 pacientes con CCM &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Se trataba de 7 varones &#40;63&#37;&#41; y 4 mujeres &#40;36&#37;&#41;&#44; con una edad media al diagn&#243;stico de 77&#44;6 a&#241;os y una mediana de 81 a&#241;os &#40;rango&#58; 60-92&#41;&#46; El 45&#37; de los tumores se localizaron en cabeza y cuello &#40;5&#47;11&#41;&#44; otro 45&#37; en las extremidades &#40;5&#47;11&#41; y solo un caso en el tronco&#46; Todos los pacientes presentaban fototipo II-III de Fitzpatrick y ninguno inmunosupresi&#243;n&#46; Cl&#237;nicamente las lesiones demostraron un gran polimorfismo&#46; Preferentemente se presentaron como n&#243;dulos subcut&#225;neos &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1A</a>&#41; o tumores exof&#237;ticos eritematosos de superficie lisa &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>B&#41;&#44; asintom&#225;ticos y de r&#225;pido crecimiento&#46; Tres casos se presentaron como tumores exof&#237;ticos de superficie erosionada &#40;<a class="elsevierStyleCrossRef" href="#fig0005">figs&#46; 1</a>C y D&#41;&#44; y en un caso como placa eritematosa descamativa de bordes mal delimitados&#46; En 7&#47;11 pacientes &#40;63&#37;&#41; el di&#225;metro mayor del tumor primario al diagn&#243;stico fue &#62;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm &#40;cT2&#41;&#46; Cuatro pacientes presentaron afectaci&#243;n linf&#225;tica regional en la exploraci&#243;n f&#237;sica en el momento del diagn&#243;stico que fue confirmada histol&#243;gicamente tras punci&#243;n-aspiraci&#243;n con aguja fina &#40;PAAF&#41;&#46; Adem&#225;s&#44; otro paciente present&#243; satelitosis en el postoperatorio inmediato tras la cirug&#237;a del tumor primario &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2A</a>&#41;&#59; por lo que el 45&#37; &#40;5&#47;11&#41; presentaban un estadio IIIB &#40;pTNM&#41; al diagn&#243;stico&#46; Solo un paciente comenz&#243; con met&#225;stasis hep&#225;ticas&#44; pulmonares y &#243;seas&#44; confirmadas histol&#243;gicamente mediante autopsia tras el fallecimiento &#40;estadio IV&#41;&#46; En 2 pacientes realizamos biopsia selectiva de ganglio centinela &#40;BSGC&#41; resultando negativa en un caso y positiva en el otro&#46; Un tercer paciente fue programado para realizar BSGC&#44; pero su realizaci&#243;n se desestim&#243; por migraci&#243;n del radiotrazador a 4 territorios ganglionares en la linfoescintigraf&#237;a previa a la cirug&#237;a&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Todos los pacientes menos uno &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>D&#41;&#44; fueron subsidiarios de cirug&#237;a radical local&#44; con m&#225;rgenes cl&#237;nicos de entre 1 y 3<span class="elsevierStyleHsp" style=""></span>cm seg&#250;n la localizaci&#243;n anat&#243;mica&#46; El estudio histopatol&#243;gico mostr&#243; en todos los casos tumoraciones de c&#233;lulas redondas&#44; discohesivas&#44; de escaso citoplasma bas&#243;filo y n&#250;cleos con cromatina granular&#44; con varios nucl&#233;olos y abundantes mitosis y apoptosis&#44; que se dispon&#237;an preferentemente en nidos s&#243;lidos &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; La inmunohistoqu&#237;mica mostr&#243; positividad para CK20 en gota paranuclear y cromogranina en todos los casos &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>F&#41;&#46; CK7 y TTF1 fueron negativos&#46; El &#237;ndice de proliferaci&#243;n &#40;Ki-67&#41; result&#243; elevado en la mayor&#237;a de los pacientes&#46; Siete de los 9 pacientes operados &#40;uno inoperable&#44; una p&#233;rdida de seguimiento tras biopsia confirmatoria&#41;&#44; presentaron invasi&#243;n linfovascular &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>E&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El &#250;nico paciente no candidato a cirug&#237;a recibi&#243; radioterapia &#40;RT&#41; local y regional neoadyuvante&#46; Tras la cirug&#237;a&#44; otros 5 pacientes recibieron RT adyuvante &#40;2 RT local y 3 RT local y ganglionar&#41; y 3 pacientes recibieron quimioterapia &#40;QT&#41; adyuvante&#59; platinos y etop&#243;sido como primera l&#237;nea &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2B</a>&#41;&#46; Sin embargo&#44; 6&#47;11 pacientes &#40;54&#37;&#41; fallecieron a causa del tumor con un tiempo medio de supervivencia de 14&#44;5 meses y una mediana de tiempo de supervivencia de 9 meses &#40;rango&#58; 3-45 meses&#41;&#46; Otros 2 pacientes fallecieron por otras causas &#40;infecci&#243;n respiratoria e insuficiencia hep&#225;tica&#41; tras m&#225;s de 6 a&#241;os de seguimiento&#44; mientras que 2 pacientes presentaron p&#233;rdida de seguimiento&#46; Hasta el momento solo un paciente permanece vivo y libre de enfermedad tras 23 meses de seguimiento&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Discusi&#243;n y conclusiones</span><p id="par0035" class="elsevierStylePara elsevierViewall">El CCM es una neoplasia maligna infrecuente de curso evolutivo muy agresivo descrita por Toker en 1972<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a>&#46; Su incidencia est&#225; aumentando&#44; siendo Australia el pa&#237;s con mayor tasa con 1&#44;6 casos&#47;100&#46;000 habitantes&#47;a&#241;o<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; En EE&#46; UU&#46; y Europa la incidencia se sit&#250;a en 0&#44;18-0&#44;41 casos&#47;100&#46;000 habitantes&#47;a&#241;o y se esperan 2&#46;500 nuevos casos al a&#241;o en la Uni&#243;n Europea&#44; de los cuales se estima que 1&#46;000 de esos pacientes mueran por el tumor<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">4&#8211;6</span></a>&#46; La incidencia calculada en nuestra serie es de 0&#44;29-0&#44;32 casos&#47;100&#46;000 habitantes&#47;a&#241;o&#44; dato que coincide con la literatura europea&#46; Solo hemos encontrado un estudio espa&#241;ol que recoge la tasa de incidencia de CCM en Espa&#241;a en una serie de 19 casos en Gerona entre 1995-2005 &#40;1&#44;3 casos&#47;100&#46;000 habitantes&#47;a&#241;o&#41;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">7</span></a>&#46; El hecho de que la incidencia de nuestra serie sea menor a la descrita en la serie de Gerona puede ser debido a que nuestro estudio incluye &#250;nicamente los casos de un solo centro hospitalario mientras que la serie catalana recoge todos los casos de la poblaci&#243;n de la provincia&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El CCM es un tumor con una alta agresividad&#44; y con frecuencia el diagn&#243;stico se realiza en estadios avanzados&#46; Hasta un 27-32&#37; de los pacientes seg&#250;n las distintas series publicadas en la literatura presenta diseminaci&#243;n linf&#225;tica al diagn&#243;stico<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">8&#44;9</span></a>&#46; De hecho&#44; el conocimiento del estado ganglionar es el factor pron&#243;stico m&#225;s importante&#44; con tasas de supervivencia a los 5 a&#241;os del diagn&#243;stico de un 51&#37; en tumores localizados y &#60;<span class="elsevierStyleHsp" style=""></span>14&#37; en caso de enfermedad a distancia<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">10&#44;11</span></a>&#46; En nuestra serie&#44; el 36&#44;3&#37; de los pacientes &#40;4&#47;11&#41; presentaron ganglios patol&#243;gicos en la exploraci&#243;n f&#237;sica realizada en el momento del diagn&#243;stico&#44; confirm&#225;ndose en todos los casos la afectaci&#243;n ganglionar mediante PAAF&#46; Aproximadamente un tercio de los pacientes con ganglios cl&#237;nicamente negativos tienen enfermedad ganglionar microsc&#243;pica&#44; por esto&#44; la BSGC constituye una herramienta de estadificaci&#243;n m&#237;nimamente invasiva&#46; En nuestra serie solo pudimos plantear la realizaci&#243;n de la BSGC a 3 pacientes debido al estadio cl&#237;nico avanzado de la mayor&#237;a de los pacientes&#46; La alta tasa de mortalidad descrita en nuestra serie creemos que est&#225; en relaci&#243;n con la edad avanzada &#40;edad media&#58; 77&#44;6 a&#241;os&#41; y con el estadio avanzado de la enfermedad &#40;63&#44;6&#37; con un estadio pIIIA o superior al diagn&#243;stico&#41; y&#44; por tanto&#44; con el alto n&#250;mero de pacientes con afectaci&#243;n ganglionar al diagn&#243;stico&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">En 2009 la American Joint Committee on Cancer &#40;AJCC&#41; desarroll&#243; el primer consenso de estadificaci&#243;n tras analizar 5&#46;823 casos del National Cancer Database &#40;NCDB&#41; que ha sido recientemente actualizado en 2017<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">8&#44;12</span></a>&#46; Actualmente&#44; la octava edici&#243;n de estadificaci&#243;n propuesta por la AJCC establece una diferencia entre estadio cl&#237;nico y patol&#243;gico en funci&#243;n de la confirmaci&#243;n histol&#243;gica de las met&#225;stasis ganglionares y&#47;o a distancia&#44; respectivamente &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">tablas 2 y 3</a>&#41;&#46; En nuestra serie llama la atenci&#243;n el avanzado estadio cl&#237;nico y&#47;o patol&#243;gico que presentaron los pacientes&#58; 7 pacientes presentaron un estadio pIIIA o superior al diagn&#243;stico &#40;un paciente estadio pIIIA&#44; 5 pacientes estadio pIIIB y un paciente estadio pIV&#41;&#46; Esto probablemente se deba al tama&#241;o de tumor primario &#40;5 pacientes con tumores &#8804;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cm&#41; y al elevado &#237;ndice de proliferaci&#243;n celular &#40;Ki-67&#41; evidenciado en el estudio histopatol&#243;gico&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">No existe consenso sobre las t&#233;cnicas de imagen m&#225;s adecuadas a realizar como estudio de extensi&#243;n en pacientes con CCM&#46; Tanto las &#250;ltimas gu&#237;as americanas como las gu&#237;as de pr&#225;ctica cl&#237;nica de la Academia Espa&#241;ola de Dermatolog&#237;a y Venereolog&#237;a &#40;AEDV&#41; hablan de la PET&#47;TC de cuerpo completo como la prueba de imagen a elegir para valorar la extensi&#243;n tumoral<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">13</span></a>&#46; En nuestro caso el estudio de extensi&#243;n de todos los pacientes lo llevamos a cabo con TC debido a la falta de disponibilidad de PET&#47;TC en nuestro centro&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Si es posible&#44; el tratamiento del CCM debe incluir una extirpaci&#243;n quir&#250;rgica con m&#225;rgenes de 1-2<span class="elsevierStyleHsp" style=""></span>cm&#46; A pesar de la ausencia de estudios prospectivos&#44; la CMM no ha demostrado diferencias significativas ni en la presencia de tumor residual o en los m&#225;rgenes quir&#250;rgicos afectos ni en la supervivencia global<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">14</span></a>&#46; Si la exploraci&#243;n f&#237;sica no evidencia afectaci&#243;n ganglionar&#44; la extirpaci&#243;n quir&#250;rgica debe acompa&#241;arse de una BSGC&#46; Adem&#225;s&#44; si existen factores de alto riesgo &#40;tumor &#62;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>cm&#44; m&#225;rgenes quir&#250;rgicos afectos o insuficientes&#44; afectaci&#243;n linfovascular o localizaci&#243;n en cabeza y cuello&#41;&#44; las gu&#237;as actuales recomiendan aplicar RT 50-66<span class="elsevierStyleHsp" style=""></span>Gy sobre el lecho tumoral<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">15</span></a>&#46; En estadios avanzados y en funci&#243;n de la presencia de diseminaci&#243;n linf&#225;tica y&#47;o met&#225;stasis a distancia&#44; la RT del territorio ganglionar y la quimioterapia pueden ser necesarias&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Avelumab es un anticuerpo monoclonal contra el PD-L1 aprobado en marzo de 2017 por la Food and Drug Administration &#40;FDA&#41; y en septiembre de 2017 por la European Medicines Agency &#40;EMA&#41; para el CCM metast&#225;sico<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">16</span></a>&#46; Nosotros no hemos podido probar este f&#225;rmaco&#44; ya que nuestro &#250;ltimo paciente fue diagnosticado en febrero 2017&#44; cuando este f&#225;rmaco no ten&#237;a aprobaci&#243;n&#46; Pembrolizumab y nivolumab est&#225;n actualmente siendo evaluados en ensayos cl&#237;nicos con resultados prometedores<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">17&#44;18</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; el CCM es una neoplasia maligna muy agresiva&#46; Con frecuencia el diagn&#243;stico es tard&#237;o&#46; Actualmente la aprobaci&#243;n de nuevos f&#225;rmacos de inmunoterapia ha supuesto una esperanza para pacientes con CCM metast&#225;sico&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflicto de intereses</span><p id="par0070" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El carcinoma de c&#233;lulas de Merkel &#40;CCM&#41; es una neoplasia neuroendocrina maligna&#46; Con frecuencia existe diseminaci&#243;n ganglionar o met&#225;stasis al diagn&#243;stico&#46; Realizamos un estudio descriptivo retrospectivo de los pacientes con CMM del Hospital Universitario Fundaci&#243;n Alcorc&#243;n entre enero&#47;1998 y diciembre&#47;2018&#46; En 21 a&#241;os diagnosticamos 11 pacientes con CCM&#58; 7 varones &#40;63&#37;&#41; y 4 mujeres &#40;36&#37;&#41;&#44; con una edad media de 77&#44;6 a&#241;os&#46; El 45&#37; de los pacientes presentaron un estadio IIIB &#40;pTNM&#41; al diagn&#243;stico&#46; Todos los pacientes menos uno&#44; fueron subsidiarios de cirug&#237;a local&#44; identific&#225;ndose en 7 casos invasi&#243;n linfovascular&#46; Tras la cirug&#237;a&#44; 5 pacientes recibieron radioterapia adyuvante y 3 quimioterapia adyuvante&#46; El 54&#37; fallecieron por el tumor &#40;tiempo medio supervivencia&#58; 14&#44;5 meses&#41;&#46; El CCM es una neoplasia maligna infrecuente cuya incidencia se sit&#250;a en 0&#44;18-0&#44;41 casos&#47;100&#46;000 habitantes&#47;a&#241;o&#44; similar a los 0&#44;29-0&#44;32 casos&#47;100&#46;000 habitantes&#47;a&#241;o registrados en nuestra serie&#46; Recientemente ha sido aprobado avelumab para casos metast&#225;sicos con esperanzas prometedoras&#46;</p></span>"
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        "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Merkel cell carcinoma &#40;MCC&#41; is a malignant neuroendocrine tumor&#46; Metastasis or lymph node spread is often detected at diagnosis&#46; We performed a descriptive&#44; retrospective study of patients diagnosed with MMC at Hospital Universitario Fundaci&#243;n Alcorc&#243;n in the Community of Madrid&#44; Spain between January 1998 and December 2018&#46; Eleven patients &#40;7 men &#91;63&#37;&#93; and 4 women &#91;36&#37;&#93;&#59; mean age&#44; 77&#46;6 years&#41; were diagnosed with MCC during this 21-year period&#59; 45&#37; of patients had stage IIIB disease &#40;pTNM&#41; at diagnosis&#46; All patients but one underwent local surgery&#44; and lymphovascular invasion was detected in 7 cases&#46; Eight patients received adjuvant therapy after surgery &#40;radiation therapy in 5 cases and chemotherapy in 3&#41;&#46; Six patients &#40;54&#37;&#41; died of MCC &#40;mean survival&#44; 14&#46;5 months&#41;&#46; MCC is an uncommon malignant tumor with an annual incidence of around 0&#46;18 to 0&#46;41 cases per 100&#160;000 inhabitants&#59; this is similar to the rate of 0&#46;29 to 0&#46;32 cases per 100&#160;000 inhabitants a year detected in our series&#46; Results with avelumab&#44; a drug recently approved for the treatment of metastatic MCC&#59; have been promising&#46;</p></span>"
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          "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A&#41; Ejemplo de presentaci&#243;n cl&#237;nica de 4 pacientes con carcinoma de c&#233;lulas de Merkel en forma de lesiones nodulares subcut&#225;neas&#59; B&#41; tumoraci&#243;n eritematosa aislada&#59; C y D&#41; dos lesiones ulceradas o de superficie friable&#46;</p>"
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                  \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">Edad&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">Localizaci&#243;n&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">Al diagn&#243;stico&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">PPCC&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">Estadio&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">Tratamiento&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&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">1&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">V&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">84&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">Brazo&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&#44;3<span class="elsevierStyleHsp" style=""></span>cm&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">Adenopat&#237;as&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">PAAF &#43;&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">pIIIB&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">Cx<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>RT&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">2&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">V&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">81&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">Concha auricular&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&#44;5<span class="elsevierStyleHsp" style=""></span>cm&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">Adenopat&#237;as&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">PAAF &#43;&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">pIIIB&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">RT&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">3&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">M&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">82&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">Rodilla&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<span class="elsevierStyleHsp" style=""></span>cm&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">Adenopat&#237;as&#44; met&#225;stasis&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">PAAF &#43;&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">pIV&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">Cx<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>QT&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">4&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">V&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">60&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">Frente&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<span class="elsevierStyleHsp" style=""></span>cm&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">Satelitosis&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="" 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">pIIIB&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">Cx<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>RT&#47;QT&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">5&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">V&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">78&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">Muslo&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">0&#44;7<span class="elsevierStyleHsp" style=""></span>cm&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="" 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">BSGC &#8722;&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">pI&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">Cx&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">6&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">M&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">92&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">Frente&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 cm&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">Adenopat&#237;as&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">PAAF &#43;&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">pIIIB&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">Cx<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>RT&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">7&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">V&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">75&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">Cuero cabelludo&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<span class="elsevierStyleHsp" style=""></span>cm&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="" 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">P&#233;rdida de seguimiento&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="" 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="" 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">8&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">M&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">79&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">Mano&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&#44;5<span class="elsevierStyleHsp" style=""></span>cm&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">Adenopat&#237;as&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">PAAF &#43;&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">pIIIB&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">Cx&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">9&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">M&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">81&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">Cuero cabelludo&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<span class="elsevierStyleHsp" style=""></span>cm&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="" 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">P&#233;rdida seguimiento&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">Cx&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="" 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">10&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">V&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">81&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">Pierna&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&#44;1<span class="elsevierStyleHsp" style=""></span>cm&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="" 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">BSGC &#43;&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">pIIIA&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">Cx<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>RT&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">11&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">M&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">61&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">Flanco&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<span class="elsevierStyleHsp" style=""></span>cm&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="" valign="\n
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                  \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"><span class="elsevierStyleItalic">Escintig</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">cIIA&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">Cx<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>RT&#47;QT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab2474372.png"
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          "es" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Datos de los pacientes</p>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">AJCC&#58; American Joint Committe on Cancer&#59; cN0&#58; sin afectaci&#243;n ganglionar en la exploraci&#243;n f&#237;sica o mediante pruebas de imagen&#59; cN1&#58; afectaci&#243;n ganglionar cl&#237;nica&#59; cN2&#58; met&#225;stasis en tr&#225;nsito sin afectaci&#243;n ganglionar&#59; cN3&#58; met&#225;stasis en tr&#225;nsito y afectaci&#243;n ganglionar cl&#237;nica&#59; M0&#58; sin met&#225;stasis a distancia&#59; M1a&#58; met&#225;stasis a distancia cut&#225;neas&#44; subcut&#225;neas o met&#225;stasis ganglionares distantes&#59; M1b&#58; met&#225;stasis pulmonares&#59; M1c&#58; otras met&#225;stasis a distancia&#59; Tis&#58; tumor primario <span class="elsevierStyleItalic">in situ&#59;</span> T0&#58; sin tumor primario&#59; T1&#58; tumor primario &#8804;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm&#59; T2&#58; tumor primario &#62;<span class="elsevierStyleHsp" style=""></span>2 y &#8804;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cm&#59; T3&#58; tumor primario &#62;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cm&#59; T4&#58; tumor primario que invade fascia&#44; m&#250;sculo&#44; cart&#237;lago o hueso&#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"><th class="td" title="\n
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                  \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">Estadios cl&#237;nicos &#40;cTNM&#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">T&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">N&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">M&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">0&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">Tis&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">N0&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">M0&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">I&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">T1&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">N0&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">M0&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">IIA&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">T2-3&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">N0&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">M0&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">IIB&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">T4&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">N0&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">M0&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">III&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">T0-4&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">N1-3&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">M0&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">IV&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">T0-4&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">Cualquier N&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">M1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        ]
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estadios patol&#243;gicos &#40;pTNM&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">N0&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">I&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">T1&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">T2-3&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">N0&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">IIB&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">N0&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">M0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">IIIA&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">N1a &#40;sn&#41; o N1aN1b&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                            3 => "R&#46;W&#46; Joseph"
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                            2 => "F&#46;A&#46; Castro"
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                            4 => "A&#46; Eberle"
                            5 => "A&#46; Nennecke"
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                        "paginaInicial" => "778"
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Comunicación Breve
Carcinoma de células de Merkel: estudio descriptivo de 11 casos
Merkel Cell Carcinoma: A Description of 11 Cases
E. García-Zamoraa,
Corresponding author
garciazamoraelena@gmail.com

Autor para correspondencia.
, M. Vela Ganuzaa, J. Martín-Alcaldea, R. Miñano Medranoa, F. Pinedo Moraledab, J.L. López-Estebaranza
a Dermatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
b Anatomía Patológica, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introducci&#243;n y objetivos</span><p id="par0005" class="elsevierStylePara elsevierViewall">El carcinoma de c&#233;lulas de Merkel &#40;CCM&#41; es una neoplasia neuroendocrina maligna infrecuente&#44; que a menudo se presenta en estadios avanzados&#46; Se localiza en zonas fotoexpuestas de pacientes de edad avanzada&#44; y con frecuencia existe diseminaci&#243;n ganglionar o met&#225;stasis al diagn&#243;stico&#46; En las &#250;ltimas d&#233;cadas su incidencia est&#225; increment&#225;ndose debido al envejecimiento de la poblaci&#243;n&#44; al aumento de la esperanza de vida y a una mejora en las t&#233;cnicas diagn&#243;sticas &#40;t&#233;cnicas inmunohistoqu&#237;micas&#41;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Existe poca informaci&#243;n acerca de la incidencia del carcinoma de Merkel en Espa&#241;a&#46; Es por esto que el objetivo primario del estudio fue realizar un an&#225;lisis descriptivo de los datos demogr&#225;ficos&#44; cl&#237;nicos e histopatol&#243;gicos&#44; describiendo la tasa de incidencia de CCM de nuestra serie&#46; Como objetivo secundario nos planteamos describir la mediana de tiempo de supervivencia de nuestros pacientes&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Material y m&#233;todos</span><p id="par0015" class="elsevierStylePara elsevierViewall">Realizamos un estudio descriptivo retrospectivo de todos los pacientes diagnosticados de CMM en el Hospital Universitario Fundaci&#243;n Alcorc&#243;n &#40;HUFA&#41; entre enero&#47;1998 y diciembre&#47;2018&#46; Hasta 2011 la poblaci&#243;n de referencia de nuestro hospital era de 273&#46;703 habitantes&#44; cifra reducida a 103&#46;000 habitantes desde 2012&#46; A trav&#233;s de la historia cl&#237;nica electr&#243;nica y de la base de datos del servicio de anatom&#237;a patol&#243;gica&#44; recogimos todas las variables demogr&#225;ficas &#40;sexo&#44; edad al diagn&#243;stico&#41;&#44; cl&#237;nicas &#40;tipo de lesi&#243;n&#44; tama&#241;o tumoral m&#225;ximo&#44; presencia de ulceraci&#243;n&#41;&#44; histopatol&#243;gicas &#40;celularidad tumoral&#44; t&#233;cnicas de inmunohistoqu&#237;mica&#44; &#237;ndice de proliferaci&#243;n celular&#41;&#44; tratamiento &#40;tipo de cirug&#237;a&#44; radioterapia&#44; quimioterapia&#41;&#44; evoluci&#243;n y tiempo de supervivencia&#46; Los datos obtenidos fueron introducidos en una base de datos anonimizada y analizados con el paquete estad&#237;stico SPSS&#174; &#40;version 20&#46;0&#59; SPSS Inc&#44; Chicago IL&#44; EE&#46; UU&#46;&#41;&#46; Las variables cualitativas fueron expresadas en porcentaje mientras que las cuantitativas se expresaron con mediana y rango&#46; El estudio cuenta con la aprobaci&#243;n del Comit&#233; &#201;tico de Investigaci&#243;n con medicamentos del HUFA&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Resultados</span><p id="par0020" class="elsevierStylePara elsevierViewall">En 21 a&#241;os &#40;1998-2018&#41; hemos diagnosticado 11 pacientes con CCM &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Se trataba de 7 varones &#40;63&#37;&#41; y 4 mujeres &#40;36&#37;&#41;&#44; con una edad media al diagn&#243;stico de 77&#44;6 a&#241;os y una mediana de 81 a&#241;os &#40;rango&#58; 60-92&#41;&#46; El 45&#37; de los tumores se localizaron en cabeza y cuello &#40;5&#47;11&#41;&#44; otro 45&#37; en las extremidades &#40;5&#47;11&#41; y solo un caso en el tronco&#46; Todos los pacientes presentaban fototipo II-III de Fitzpatrick y ninguno inmunosupresi&#243;n&#46; Cl&#237;nicamente las lesiones demostraron un gran polimorfismo&#46; Preferentemente se presentaron como n&#243;dulos subcut&#225;neos &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1A</a>&#41; o tumores exof&#237;ticos eritematosos de superficie lisa &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>B&#41;&#44; asintom&#225;ticos y de r&#225;pido crecimiento&#46; Tres casos se presentaron como tumores exof&#237;ticos de superficie erosionada &#40;<a class="elsevierStyleCrossRef" href="#fig0005">figs&#46; 1</a>C y D&#41;&#44; y en un caso como placa eritematosa descamativa de bordes mal delimitados&#46; En 7&#47;11 pacientes &#40;63&#37;&#41; el di&#225;metro mayor del tumor primario al diagn&#243;stico fue &#62;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm &#40;cT2&#41;&#46; Cuatro pacientes presentaron afectaci&#243;n linf&#225;tica regional en la exploraci&#243;n f&#237;sica en el momento del diagn&#243;stico que fue confirmada histol&#243;gicamente tras punci&#243;n-aspiraci&#243;n con aguja fina &#40;PAAF&#41;&#46; Adem&#225;s&#44; otro paciente present&#243; satelitosis en el postoperatorio inmediato tras la cirug&#237;a del tumor primario &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2A</a>&#41;&#59; por lo que el 45&#37; &#40;5&#47;11&#41; presentaban un estadio IIIB &#40;pTNM&#41; al diagn&#243;stico&#46; Solo un paciente comenz&#243; con met&#225;stasis hep&#225;ticas&#44; pulmonares y &#243;seas&#44; confirmadas histol&#243;gicamente mediante autopsia tras el fallecimiento &#40;estadio IV&#41;&#46; En 2 pacientes realizamos biopsia selectiva de ganglio centinela &#40;BSGC&#41; resultando negativa en un caso y positiva en el otro&#46; Un tercer paciente fue programado para realizar BSGC&#44; pero su realizaci&#243;n se desestim&#243; por migraci&#243;n del radiotrazador a 4 territorios ganglionares en la linfoescintigraf&#237;a previa a la cirug&#237;a&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Todos los pacientes menos uno &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>D&#41;&#44; fueron subsidiarios de cirug&#237;a radical local&#44; con m&#225;rgenes cl&#237;nicos de entre 1 y 3<span class="elsevierStyleHsp" style=""></span>cm seg&#250;n la localizaci&#243;n anat&#243;mica&#46; El estudio histopatol&#243;gico mostr&#243; en todos los casos tumoraciones de c&#233;lulas redondas&#44; discohesivas&#44; de escaso citoplasma bas&#243;filo y n&#250;cleos con cromatina granular&#44; con varios nucl&#233;olos y abundantes mitosis y apoptosis&#44; que se dispon&#237;an preferentemente en nidos s&#243;lidos &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; La inmunohistoqu&#237;mica mostr&#243; positividad para CK20 en gota paranuclear y cromogranina en todos los casos &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>F&#41;&#46; CK7 y TTF1 fueron negativos&#46; El &#237;ndice de proliferaci&#243;n &#40;Ki-67&#41; result&#243; elevado en la mayor&#237;a de los pacientes&#46; Siete de los 9 pacientes operados &#40;uno inoperable&#44; una p&#233;rdida de seguimiento tras biopsia confirmatoria&#41;&#44; presentaron invasi&#243;n linfovascular &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>E&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El &#250;nico paciente no candidato a cirug&#237;a recibi&#243; radioterapia &#40;RT&#41; local y regional neoadyuvante&#46; Tras la cirug&#237;a&#44; otros 5 pacientes recibieron RT adyuvante &#40;2 RT local y 3 RT local y ganglionar&#41; y 3 pacientes recibieron quimioterapia &#40;QT&#41; adyuvante&#59; platinos y etop&#243;sido como primera l&#237;nea &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2B</a>&#41;&#46; Sin embargo&#44; 6&#47;11 pacientes &#40;54&#37;&#41; fallecieron a causa del tumor con un tiempo medio de supervivencia de 14&#44;5 meses y una mediana de tiempo de supervivencia de 9 meses &#40;rango&#58; 3-45 meses&#41;&#46; Otros 2 pacientes fallecieron por otras causas &#40;infecci&#243;n respiratoria e insuficiencia hep&#225;tica&#41; tras m&#225;s de 6 a&#241;os de seguimiento&#44; mientras que 2 pacientes presentaron p&#233;rdida de seguimiento&#46; Hasta el momento solo un paciente permanece vivo y libre de enfermedad tras 23 meses de seguimiento&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Discusi&#243;n y conclusiones</span><p id="par0035" class="elsevierStylePara elsevierViewall">El CCM es una neoplasia maligna infrecuente de curso evolutivo muy agresivo descrita por Toker en 1972<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a>&#46; Su incidencia est&#225; aumentando&#44; siendo Australia el pa&#237;s con mayor tasa con 1&#44;6 casos&#47;100&#46;000 habitantes&#47;a&#241;o<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; En EE&#46; UU&#46; y Europa la incidencia se sit&#250;a en 0&#44;18-0&#44;41 casos&#47;100&#46;000 habitantes&#47;a&#241;o y se esperan 2&#46;500 nuevos casos al a&#241;o en la Uni&#243;n Europea&#44; de los cuales se estima que 1&#46;000 de esos pacientes mueran por el tumor<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">4&#8211;6</span></a>&#46; La incidencia calculada en nuestra serie es de 0&#44;29-0&#44;32 casos&#47;100&#46;000 habitantes&#47;a&#241;o&#44; dato que coincide con la literatura europea&#46; Solo hemos encontrado un estudio espa&#241;ol que recoge la tasa de incidencia de CCM en Espa&#241;a en una serie de 19 casos en Gerona entre 1995-2005 &#40;1&#44;3 casos&#47;100&#46;000 habitantes&#47;a&#241;o&#41;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">7</span></a>&#46; El hecho de que la incidencia de nuestra serie sea menor a la descrita en la serie de Gerona puede ser debido a que nuestro estudio incluye &#250;nicamente los casos de un solo centro hospitalario mientras que la serie catalana recoge todos los casos de la poblaci&#243;n de la provincia&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El CCM es un tumor con una alta agresividad&#44; y con frecuencia el diagn&#243;stico se realiza en estadios avanzados&#46; Hasta un 27-32&#37; de los pacientes seg&#250;n las distintas series publicadas en la literatura presenta diseminaci&#243;n linf&#225;tica al diagn&#243;stico<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">8&#44;9</span></a>&#46; De hecho&#44; el conocimiento del estado ganglionar es el factor pron&#243;stico m&#225;s importante&#44; con tasas de supervivencia a los 5 a&#241;os del diagn&#243;stico de un 51&#37; en tumores localizados y &#60;<span class="elsevierStyleHsp" style=""></span>14&#37; en caso de enfermedad a distancia<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">10&#44;11</span></a>&#46; En nuestra serie&#44; el 36&#44;3&#37; de los pacientes &#40;4&#47;11&#41; presentaron ganglios patol&#243;gicos en la exploraci&#243;n f&#237;sica realizada en el momento del diagn&#243;stico&#44; confirm&#225;ndose en todos los casos la afectaci&#243;n ganglionar mediante PAAF&#46; Aproximadamente un tercio de los pacientes con ganglios cl&#237;nicamente negativos tienen enfermedad ganglionar microsc&#243;pica&#44; por esto&#44; la BSGC constituye una herramienta de estadificaci&#243;n m&#237;nimamente invasiva&#46; En nuestra serie solo pudimos plantear la realizaci&#243;n de la BSGC a 3 pacientes debido al estadio cl&#237;nico avanzado de la mayor&#237;a de los pacientes&#46; La alta tasa de mortalidad descrita en nuestra serie creemos que est&#225; en relaci&#243;n con la edad avanzada &#40;edad media&#58; 77&#44;6 a&#241;os&#41; y con el estadio avanzado de la enfermedad &#40;63&#44;6&#37; con un estadio pIIIA o superior al diagn&#243;stico&#41; y&#44; por tanto&#44; con el alto n&#250;mero de pacientes con afectaci&#243;n ganglionar al diagn&#243;stico&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">En 2009 la American Joint Committee on Cancer &#40;AJCC&#41; desarroll&#243; el primer consenso de estadificaci&#243;n tras analizar 5&#46;823 casos del National Cancer Database &#40;NCDB&#41; que ha sido recientemente actualizado en 2017<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">8&#44;12</span></a>&#46; Actualmente&#44; la octava edici&#243;n de estadificaci&#243;n propuesta por la AJCC establece una diferencia entre estadio cl&#237;nico y patol&#243;gico en funci&#243;n de la confirmaci&#243;n histol&#243;gica de las met&#225;stasis ganglionares y&#47;o a distancia&#44; respectivamente &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">tablas 2 y 3</a>&#41;&#46; En nuestra serie llama la atenci&#243;n el avanzado estadio cl&#237;nico y&#47;o patol&#243;gico que presentaron los pacientes&#58; 7 pacientes presentaron un estadio pIIIA o superior al diagn&#243;stico &#40;un paciente estadio pIIIA&#44; 5 pacientes estadio pIIIB y un paciente estadio pIV&#41;&#46; Esto probablemente se deba al tama&#241;o de tumor primario &#40;5 pacientes con tumores &#8804;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cm&#41; y al elevado &#237;ndice de proliferaci&#243;n celular &#40;Ki-67&#41; evidenciado en el estudio histopatol&#243;gico&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">No existe consenso sobre las t&#233;cnicas de imagen m&#225;s adecuadas a realizar como estudio de extensi&#243;n en pacientes con CCM&#46; Tanto las &#250;ltimas gu&#237;as americanas como las gu&#237;as de pr&#225;ctica cl&#237;nica de la Academia Espa&#241;ola de Dermatolog&#237;a y Venereolog&#237;a &#40;AEDV&#41; hablan de la PET&#47;TC de cuerpo completo como la prueba de imagen a elegir para valorar la extensi&#243;n tumoral<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">13</span></a>&#46; En nuestro caso el estudio de extensi&#243;n de todos los pacientes lo llevamos a cabo con TC debido a la falta de disponibilidad de PET&#47;TC en nuestro centro&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Si es posible&#44; el tratamiento del CCM debe incluir una extirpaci&#243;n quir&#250;rgica con m&#225;rgenes de 1-2<span class="elsevierStyleHsp" style=""></span>cm&#46; A pesar de la ausencia de estudios prospectivos&#44; la CMM no ha demostrado diferencias significativas ni en la presencia de tumor residual o en los m&#225;rgenes quir&#250;rgicos afectos ni en la supervivencia global<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">14</span></a>&#46; Si la exploraci&#243;n f&#237;sica no evidencia afectaci&#243;n ganglionar&#44; la extirpaci&#243;n quir&#250;rgica debe acompa&#241;arse de una BSGC&#46; Adem&#225;s&#44; si existen factores de alto riesgo &#40;tumor &#62;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>cm&#44; m&#225;rgenes quir&#250;rgicos afectos o insuficientes&#44; afectaci&#243;n linfovascular o localizaci&#243;n en cabeza y cuello&#41;&#44; las gu&#237;as actuales recomiendan aplicar RT 50-66<span class="elsevierStyleHsp" style=""></span>Gy sobre el lecho tumoral<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">15</span></a>&#46; En estadios avanzados y en funci&#243;n de la presencia de diseminaci&#243;n linf&#225;tica y&#47;o met&#225;stasis a distancia&#44; la RT del territorio ganglionar y la quimioterapia pueden ser necesarias&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Avelumab es un anticuerpo monoclonal contra el PD-L1 aprobado en marzo de 2017 por la Food and Drug Administration &#40;FDA&#41; y en septiembre de 2017 por la European Medicines Agency &#40;EMA&#41; para el CCM metast&#225;sico<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">16</span></a>&#46; Nosotros no hemos podido probar este f&#225;rmaco&#44; ya que nuestro &#250;ltimo paciente fue diagnosticado en febrero 2017&#44; cuando este f&#225;rmaco no ten&#237;a aprobaci&#243;n&#46; Pembrolizumab y nivolumab est&#225;n actualmente siendo evaluados en ensayos cl&#237;nicos con resultados prometedores<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">17&#44;18</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; el CCM es una neoplasia maligna muy agresiva&#46; Con frecuencia el diagn&#243;stico es tard&#237;o&#46; Actualmente la aprobaci&#243;n de nuevos f&#225;rmacos de inmunoterapia ha supuesto una esperanza para pacientes con CCM metast&#225;sico&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflicto de intereses</span><p id="par0070" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El carcinoma de c&#233;lulas de Merkel &#40;CCM&#41; es una neoplasia neuroendocrina maligna&#46; Con frecuencia existe diseminaci&#243;n ganglionar o met&#225;stasis al diagn&#243;stico&#46; Realizamos un estudio descriptivo retrospectivo de los pacientes con CMM del Hospital Universitario Fundaci&#243;n Alcorc&#243;n entre enero&#47;1998 y diciembre&#47;2018&#46; En 21 a&#241;os diagnosticamos 11 pacientes con CCM&#58; 7 varones &#40;63&#37;&#41; y 4 mujeres &#40;36&#37;&#41;&#44; con una edad media de 77&#44;6 a&#241;os&#46; El 45&#37; de los pacientes presentaron un estadio IIIB &#40;pTNM&#41; al diagn&#243;stico&#46; Todos los pacientes menos uno&#44; fueron subsidiarios de cirug&#237;a local&#44; identific&#225;ndose en 7 casos invasi&#243;n linfovascular&#46; Tras la cirug&#237;a&#44; 5 pacientes recibieron radioterapia adyuvante y 3 quimioterapia adyuvante&#46; El 54&#37; fallecieron por el tumor &#40;tiempo medio supervivencia&#58; 14&#44;5 meses&#41;&#46; El CCM es una neoplasia maligna infrecuente cuya incidencia se sit&#250;a en 0&#44;18-0&#44;41 casos&#47;100&#46;000 habitantes&#47;a&#241;o&#44; similar a los 0&#44;29-0&#44;32 casos&#47;100&#46;000 habitantes&#47;a&#241;o registrados en nuestra serie&#46; Recientemente ha sido aprobado avelumab para casos metast&#225;sicos con esperanzas prometedoras&#46;</p></span>"
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        "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Merkel cell carcinoma &#40;MCC&#41; is a malignant neuroendocrine tumor&#46; Metastasis or lymph node spread is often detected at diagnosis&#46; We performed a descriptive&#44; retrospective study of patients diagnosed with MMC at Hospital Universitario Fundaci&#243;n Alcorc&#243;n in the Community of Madrid&#44; Spain between January 1998 and December 2018&#46; Eleven patients &#40;7 men &#91;63&#37;&#93; and 4 women &#91;36&#37;&#93;&#59; mean age&#44; 77&#46;6 years&#41; were diagnosed with MCC during this 21-year period&#59; 45&#37; of patients had stage IIIB disease &#40;pTNM&#41; at diagnosis&#46; All patients but one underwent local surgery&#44; and lymphovascular invasion was detected in 7 cases&#46; Eight patients received adjuvant therapy after surgery &#40;radiation therapy in 5 cases and chemotherapy in 3&#41;&#46; Six patients &#40;54&#37;&#41; died of MCC &#40;mean survival&#44; 14&#46;5 months&#41;&#46; MCC is an uncommon malignant tumor with an annual incidence of around 0&#46;18 to 0&#46;41 cases per 100&#160;000 inhabitants&#59; this is similar to the rate of 0&#46;29 to 0&#46;32 cases per 100&#160;000 inhabitants a year detected in our series&#46; Results with avelumab&#44; a drug recently approved for the treatment of metastatic MCC&#59; have been promising&#46;</p></span>"
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          "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A&#41; Ejemplo de presentaci&#243;n cl&#237;nica de 4 pacientes con carcinoma de c&#233;lulas de Merkel en forma de lesiones nodulares subcut&#225;neas&#59; B&#41; tumoraci&#243;n eritematosa aislada&#59; C y D&#41; dos lesiones ulceradas o de superficie friable&#46;</p>"
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          "es" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A&#41; Satelitosis en un paciente con CCM en el postoperatorio inmediato tras la cirug&#237;a del tumor primario&#46; B&#41; Paciente con CCM avanzado localmente&#46; C-F&#41; Estudio histopatol&#243;gico de un CCM&#59; CK20 con marcaje en gota paranuclear&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&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">pIIIB&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&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">V&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">81&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">Concha auricular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;5<span class="elsevierStyleHsp" style=""></span>cm&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">PAAF &#43;&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">pIIIB&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">3&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">M&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">82&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">Rodilla&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<span class="elsevierStyleHsp" style=""></span>cm&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">Adenopat&#237;as&#44; met&#225;stasis&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">PAAF &#43;&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">pIV&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">Cx<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>QT&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">4&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">V&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">60&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">Frente&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<span class="elsevierStyleHsp" style=""></span>cm&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">Satelitosis&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="" 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">pIIIB&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">Cx<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>RT&#47;QT&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">5&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">V&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">78&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">Muslo&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">0&#44;7<span class="elsevierStyleHsp" style=""></span>cm&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="" 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">BSGC &#8722;&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">pI&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">Cx&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">6&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">M&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">92&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">Frente&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 cm&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">Adenopat&#237;as&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">PAAF &#43;&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">pIIIB&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">Cx<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>RT&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">7&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">V&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">75&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">Cuero cabelludo&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<span class="elsevierStyleHsp" style=""></span>cm&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="" 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">P&#233;rdida de seguimiento&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="" 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="" 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">8&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">M&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">79&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">Mano&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&#44;5<span class="elsevierStyleHsp" style=""></span>cm&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">Adenopat&#237;as&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">PAAF &#43;&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">pIIIB&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">Cx&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">9&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">M&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">81&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">Cuero cabelludo&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<span class="elsevierStyleHsp" style=""></span>cm&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="" 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">P&#233;rdida seguimiento&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">Cx&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="" 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">10&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">V&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">81&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">Pierna&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&#44;1<span class="elsevierStyleHsp" style=""></span>cm&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="" 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">BSGC &#43;&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">pIIIA&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">Cx<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>RT&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">11&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">M&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">61&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">Flanco&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<span class="elsevierStyleHsp" style=""></span>cm&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="" 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"><span class="elsevierStyleItalic">Escintig</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">cIIA&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">Cx<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>RT&#47;QT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2474372.png"
              ]
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          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Datos de los pacientes</p>"
        ]
      ]
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabla "
            "rol" => "short"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">AJCC&#58; American Joint Committe on Cancer&#59; cN0&#58; sin afectaci&#243;n ganglionar en la exploraci&#243;n f&#237;sica o mediante pruebas de imagen&#59; cN1&#58; afectaci&#243;n ganglionar cl&#237;nica&#59; cN2&#58; met&#225;stasis en tr&#225;nsito sin afectaci&#243;n ganglionar&#59; cN3&#58; met&#225;stasis en tr&#225;nsito y afectaci&#243;n ganglionar cl&#237;nica&#59; M0&#58; sin met&#225;stasis a distancia&#59; M1a&#58; met&#225;stasis a distancia cut&#225;neas&#44; subcut&#225;neas o met&#225;stasis ganglionares distantes&#59; M1b&#58; met&#225;stasis pulmonares&#59; M1c&#58; otras met&#225;stasis a distancia&#59; Tis&#58; tumor primario <span class="elsevierStyleItalic">in situ&#59;</span> T0&#58; sin tumor primario&#59; T1&#58; tumor primario &#8804;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm&#59; T2&#58; tumor primario &#62;<span class="elsevierStyleHsp" style=""></span>2 y &#8804;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cm&#59; T3&#58; tumor primario &#62;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cm&#59; T4&#58; tumor primario que invade fascia&#44; m&#250;sculo&#44; cart&#237;lago o hueso&#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">Estadios cl&#237;nicos &#40;cTNM&#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">T&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">N&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">M&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">0&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">Tis&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">N0&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">M0&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">I&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">T1&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">N0&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">M0&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">IIA&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">T2-3&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">N0&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">M0&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">IIB&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">T4&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">N0&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">M0&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">III&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">T0-4&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">N1-3&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">M0&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">IV&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">T0-4&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">Cualquier N&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">M1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Clasificaci&#243;n cl&#237;nica de la AJCC &#40;8&#46;&#170; edici&#243;n&#41;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabla 3"
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabla "
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">AJCC&#58; American Joint Committe on Cancer&#59; M0&#58; sin met&#225;stasis a distancia&#59; M1a&#58; met&#225;stasis a distancia cut&#225;neas&#44; subcut&#225;neas o met&#225;stasis ganglionares distantes&#59; M1b&#58; met&#225;stasis pulmonares&#59; M1c&#58; otras met&#225;stasis a distancia&#59; pN0&#58; sin afectaci&#243;n ganglionar en el estudio histol&#243;gico&#59; pN1a&#58; met&#225;stasis ganglionares ocultas identificadas en la resecci&#243;n linf&#225;tica&#59; pN1a &#40;sn&#41;&#58; met&#225;stasis ganglionares ocultas identificadas en el estudio de la BSGC&#59; pN1b&#58; met&#225;stasis ganglionares cl&#237;nicas o identificadas en pruebas de imagen y confirmadas histol&#243;gicamente&#59; pN2&#58; met&#225;stasis en tr&#225;nsito confirmadas histol&#243;gicamente sin afectaci&#243;n ganglionar&#59; pN3&#58; met&#225;stasis en tr&#225;nsito y ganglionares confirmadas histol&#243;gicamente&#59; Tis&#58; tumor primario <span class="elsevierStyleItalic">in situ&#59;</span> T0&#58; sin tumor primario&#59; T1&#58; tumor primario &#8804;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm&#59; T2&#58; tumor primario &#62;<span class="elsevierStyleHsp" style=""></span>2 y &#8804;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cm&#59; T3&#58; tumor primario &#62;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cm&#59; T4&#58; tumor primario que invade fascia&#44; m&#250;sculo&#44; cart&#237;lago o hueso&#46;</p>"
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              "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">Estadios patol&#243;gicos &#40;pTNM&#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">T&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">N&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">M&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">0&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">Tis&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">N0&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">M0&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">I&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">T1&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">N0&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">M0&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">IIA&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">T2-3&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">N0&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">M0&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">IIB&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">T4&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">N0&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">M0&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">IIIA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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Article information
ISSN: 00017310
Original language: Spanish
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