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1&#41; Describir las caracter&#237;sticas epidemiol&#243;gicas&#44; cl&#237;nicas y anatomopatol&#243;gicas del CBC en el &#193;rea Sur de Salud de la provincia de Santa Cruz de Tenerife &#40;ASSTF&#41;&#59; 2&#41; analizar la afectaci&#243;n de los bordes quir&#250;rgicos de los CBC intervenidos por el servicio de Dermatolog&#237;a del Hospital Universitario Nuestra Se&#241;ora de Candelaria &#40;HUNSC&#41;&#44; y 3&#41; identificar factores de riesgo asociados a una resecci&#243;n quir&#250;rgica incompleta&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todo</span><p id="par0015" class="elsevierStylePara elsevierViewall">Se dise&#241;&#243; un estudio observacional retrospectivo en el &#225;rea de salud del HUNSC&#44; hospital de tercer nivel de 960 camas que atiende a una poblaci&#243;n de aproximadamente 500&#46;000 habitantes&#46; Se incluyeron todos los pacientes diagnosticados de CBC&#44; desde el 1 de enero de 2014 al 31 de diciembre de 2014&#46; Se identificaron mediante el programa PAT-Win&#174; introduciendo los t&#233;rminos&#58; carcinoma&#44; piel&#44; biopsia&#46; La actualizaci&#243;n de datos se finaliz&#243; el 14 de marzo de 2022&#46; El proyecto fue aprobado por el Comit&#233; de &#201;tica &#40;c&#243;digo CHUNSC&#95;2023&#95;29&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Para el estudio se recogieron variables cl&#237;nicas&#44; epidemiol&#243;gicas e histol&#243;gicas&#46; Las variables cl&#237;nicas y epidemiol&#243;gicas registradas fueron&#58; g&#233;nero &#40;var&#243;n&#47;mujer&#41;&#44; edad al diagn&#243;stico &#40;a&#241;os&#41;&#44; servicio que realiz&#243; el tratamiento quir&#250;rgico &#40;Dermatolog&#237;a&#44; Cirug&#237;a Pl&#225;stica&#44; Cirug&#237;a Maxilofacial&#44; Oftalmolog&#237;a&#44; Cirug&#237;a General&#44; Otorrinolaringolog&#237;a&#44; desconocido&#41;&#44; n&#250;mero de CBC diagnosticados en cada paciente&#44; localizaci&#243;n del CBC &#40;nariz&#44; pabell&#243;n auricular&#44; cara excluyendo nariz y pabell&#243;n auricular&#44; cuero cabelludo&#44; cuello&#44; tronco&#44; extremidad superior&#44; extremidad inferior&#41; y di&#225;metro del tumor&#46; El subtipo histol&#243;gico se agrup&#243; en&#58; nodular&#47;s&#243;lido&#44; infiltrante&#44; superficial&#47;multic&#233;ntrico&#44; morfeiforme&#47;esclerodermiforme&#44; otros&#46; El patr&#243;n de riesgo se agrup&#243; en<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a>&#58; bajo riesgo &#40;nodular&#44; superficial&#44; pigmentado&#44; infundibuloqu&#237;stico y fibroepitelial&#41; y alto riesgo &#40;basoescamoso&#44; morfeiforme&#47;esclerodermiforme&#44; infiltrante&#44; CBC con diferenciaci&#243;n sarcomatoide y micronodular&#41;&#46; Analizamos el estado de los m&#225;rgenes quir&#250;rgicos &#40;laterales y profundos&#41; de las piezas extirpadas por el servicio de Dermatolog&#237;a&#46; El resultado de la b&#250;squeda se almacen&#243; en una hoja de c&#225;lculo MS Excel &#40;2019&#41; que se export&#243; con posterioridad al programa SPSS IBM 19&#46;0 IBM Co&#8482;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">An&#225;lisis estad&#237;stico</span><p id="par0025" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas de las muestras recopiladas se describen resumiendo las variables nominales con la frecuencia de sus categor&#237;as componentes&#59; las de escala num&#233;rica con mediana y rango intercuart&#237;lico &#40;IQR&#41;&#44; verificando su no seguimiento de distribuci&#243;n normal mediante la exploraci&#243;n de sus histogramas y resultados de la prueba de normalidad de Kolmogorov-Smirnov&#46; Las variables continuas se compararon mediante el estad&#237;stico U de Mann-Whitney y las variables nominales&#44; mediante los estad&#237;sticos Chi2 o test de Fisher&#46; Para el an&#225;lisis multivariante se aplic&#243; la regresi&#243;n log&#237;stica utilizando un proceso de selecci&#243;n por pasos hacia atr&#225;s&#46; Todas las pruebas estad&#237;sticas empleadas en el tratamiento de los datos han sido bivariadas a un nivel de significaci&#243;n p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;05 y los c&#225;lculos correspondientes se han realizado con ayuda del paquete de procesamiento estad&#237;stico SPSS 19&#46;0 IBM Co&#8482;&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se identificaron un total de 966 muestras con un diagn&#243;stico de CBC correspondientes a 776 pacientes&#46; En 33 muestras no se especific&#243; la intenci&#243;n de la cirug&#237;a&#46; De las 933 restantes&#44; 83 &#40;9&#37;&#41; fueron biopsias&#44; 827 &#40;89&#37;&#41; ex&#233;resis y 23 &#40;2&#37;&#41; obedecieron a otras t&#233;cnicas con intenci&#243;n curativa &#40;afeitado&#44; afeitado y electrocoagulaci&#243;n&#41;&#46; Ning&#250;n paciente fue tratado mediante cirug&#237;a de Mohs&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Los 850 tumores abordados con intenci&#243;n curativa correspondieron a 701 pacientes&#46; De ellos&#44; 362 &#40;51&#44;6&#37;&#41; fueron varones y 339 mujeres &#40;48&#44;4&#37;&#41;&#46; La mediana de edad al diagn&#243;stico fue 71 a&#241;os &#40;IQR 25-75&#58; 60-73&#41;&#44; sin observar diferencias significativas en la edad al diagn&#243;stico entre sexos&#46; El 17&#44;5&#37; de los pacientes &#40;149 pacientes&#41; desarrollaron m&#225;s de un CBC durante el mismo a&#241;o y este hecho fue significativamente m&#225;s frecuente en varones&#46; El 20&#44;8&#37; &#40;95 pacientes&#41; de los varones desarrollaron m&#225;s de un CBC&#44; mientras que esto se observ&#243; en el 14&#37; &#40;54 pacientes&#41; de las mujeres &#40;Chi2&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#46; La mayor&#237;a de los CBC fueron extirpados por el servicio de Dermatolog&#237;a &#40;71&#44;5&#37;&#41;&#46; La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> muestra los servicios responsables de las intervenciones&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se describen las caracter&#237;sticas de los CBC analizados&#46; La mayor&#237;a de los tumores se localizaron en la cara &#40;excluyendo la nariz y el pabell&#243;n auricular&#41; &#40;267 tumores&#59; 33&#44;8&#37;&#41;&#46; El patr&#243;n histol&#243;gico m&#225;s frecuente fue el nodular &#40;523 casos&#44; &#91;64&#44;6&#37;&#93;&#41;&#44; 211 tumores &#40;25&#44;5&#37;&#41; fueron de alto riesgo y 616 &#40;74&#44;5&#37;&#41; de bajo riesgo&#46; Proporcionalmente&#44; el pabell&#243;n auricular fue la localizaci&#243;n donde se diagnosticaron mayor n&#250;mero de CBC de alto riesgo histol&#243;gico &#40;50&#37; de los casos&#41; y el tronco donde menos &#40;17&#44;3&#37;&#41;&#59; en la nariz el 31&#44;9&#37; fueron de alto riesgo&#46; La <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> resume estos resultados&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">De los 540 tumores sometidos a tratamiento con intenci&#243;n curativa por el servicio de Dermatolog&#237;a&#44; 517 fueron ex&#233;resis&#46; Se dispon&#237;a del estado de los m&#225;rgenes quir&#250;rgicos en 506 tumores&#46; El margen lateral estaba afecto en 73 casos &#40;14&#44;4&#37;&#41;&#44; el margen profundo en 40 casos &#40;7&#44;9&#37;&#41;&#44; y el margen lateral o profundo mostr&#243; enfermedad en 86 casos &#40;17&#37;&#41;&#46; Cuando el margen lateral se encontr&#243; afecto&#44; tambi&#233;n lo estuvo el profundo en un 37&#37; de los casos&#46; En el 3&#37; de los casos encontramos afectaci&#243;n del margen profundo con los m&#225;rgenes laterales libres de enfermedad &#40;kappa 0&#44;418&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Al analizar la afectaci&#243;n de los m&#225;rgenes seg&#250;n el patr&#243;n histol&#243;gico observamos que estaba afectado en 26 &#40;25&#37;&#41; de los tumores con patr&#243;n de alto riesgo frente a 59 &#40;15&#44;1&#37;&#41; de los tumores con patr&#243;n de bajo riesgo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;017&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46; Los CBC de subtipo histol&#243;gico de alto riesgo localizados en la nariz y el pabell&#243;n auricular ten&#237;an m&#225;rgenes afectos en un mayor porcentaje&#44; 31&#44;9&#37; y 50&#37;&#44; respectivamente&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">En cuanto a la localizaci&#243;n&#44; el mayor porcentaje de m&#225;rgenes afectos se encontr&#243; en la cara &#40;21&#44;7&#37;&#59; 55 tumores&#41;&#59; sin embargo&#44; en localizaciones extrafaciales&#44; el porcentaje fue del 9&#44;8&#37; &#40;20 casos&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; Dentro de la cara&#44; la pir&#225;mide nasal es la localizaci&#243;n donde con m&#225;s frecuencia se observaron m&#225;rgenes afectos &#40;26&#44;8&#37;&#59; 22 tumores&#41;&#44; seguida del pabell&#243;n auricular &#40;20&#37;&#59; 2 tumores&#41;&#46; La <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> muestra la frecuencia de bordes afectos en otras regiones faciales y extrafaciales&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">El an&#225;lisis multivariante mediante regresi&#243;n log&#237;stica incluy&#243; los 447 casos en los que se dispuso de la informaci&#243;n correspondiente a las variables sexo&#44; localizaci&#243;n de riesgo del CBC y patr&#243;n histol&#243;gico de riesgo del CBC&#46; Este an&#225;lisis evidenci&#243; que las dos &#250;ltimas son factores de riesgo independientes para no alcanzar una extirpaci&#243;n completa del tumor&#46; El odds ratio &#40;OR&#41; de obtener m&#225;rgenes afectos en los tumores localizados en las zonas de riesgo &#40;cara&#44; cuello&#44; nariz o pabellones auriculares&#41; fue de 2&#44;51 &#40;IC95&#37;&#58; 1&#44;44-4&#44;36&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; El OR de identificar m&#225;rgenes afectos en tumores con patr&#243;n histol&#243;gico de alto riesgo fue de 1&#44;77 &#40;IC95&#37;&#58; 1&#44;01-3&#44;09&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;044&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discusi&#243;n</span><p id="par0065" class="elsevierStylePara elsevierViewall">Diferentes estudios retrospectivos analizan las caracter&#237;sticas de los CBC intervenidos y el porcentaje de m&#225;rgenes afectos seg&#250;n localizaci&#243;n y subtipo histol&#243;gico&#46; A pesar de que se han desarrollado en distintas latitudes con distintos &#237;ndices de radiaci&#243;n UV &#40;Australia&#44; EE&#46;UU&#46;&#44; UK&#44; Holanda&#44; Suiza&#44; Italia&#44; Turqu&#237;a&#44; B&#233;lgica&#44; Espa&#241;a&#41;&#44; los resultados son similares<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;6&#8211;22</span></a>&#46; Sin embargo&#44; hay diferencias entre estos estudios en el dise&#241;o y en el servicio que los publica siendo la mayor&#237;a realizados por Dermatolog&#237;a o Cirug&#237;a Pl&#225;stica&#46; Hasta donde somos conscientes&#44; el presente es el primer estudio con este objetivo que se realiza en la comunidad aut&#243;noma canaria&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">La mayor incidencia de CBC se ha comunicado en Australia &#40;1&#46;541&#47;100&#46;000 por a&#241;o<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a>&#41;&#44; seguido de EE&#46;UU&#46; y Europa<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;2&#44;23&#8211;25</span></a>&#46; En Espa&#241;a se estima que la incidencia global cruda es de 113&#44;05&#47;100&#46;000 personas-a&#241;o<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a>&#46; Es plausible que&#44; en Canarias&#44; localizada en latitud subtropical&#44; y con un &#237;ndice UV muy superior al de la Espa&#241;a continental y otras regiones del norte de Europa&#44; muestre caracter&#237;sticas diferentes en la epidemiolog&#237;a del CBC&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">La mayor&#237;a de CBC aparecen en adultos&#44; sobre todo en mayores de 50 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a>&#46; En el ASSTF la mediana de edad al diagn&#243;stico fue de 71 a&#241;os&#46; Diferentes estudios sugieren que el CBC es m&#225;s frecuente en varones<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a>&#46; Bassas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> y Nagore et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> comunicaron un predominio masculino &#40;57&#44;2&#37; y 63&#37; varones&#44; respectivamente&#41;&#46; En la presente serie&#44; el 51&#44;6&#37; de los CBC fueron diagnosticados en varones&#46; Kumar et al&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> observaron que el 50&#44;2&#37; eran varones&#46; En el presente estudio&#44; al analizar la edad de diagn&#243;stico en funci&#243;n del sexo no se hallaron diferencias significativas&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Coincidiendo con otras series<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#8211;10</span></a>&#44; en el ASSTF la mayor&#237;a &#40;71&#44;5&#37;&#41; de los CBC son abordados por el servicio de Dermatolog&#237;a &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41; y el tratamiento de elecci&#243;n es la extirpaci&#243;n quir&#250;rgica<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a>&#46; En el estudio retrospectivo de Bassas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a>&#44; Dermatolog&#237;a extirp&#243; el 59&#44;6&#37; de los CBC&#44; Cirug&#237;a Pl&#225;stica el 21&#44;5&#37; y Cirug&#237;a General el 15&#44;5&#37;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">En lo que respecta al n&#250;mero de CBC por paciente&#44; en el presente trabajo observamos que el 17&#37; present&#243; m&#225;s de un tumor diagnosticado durante el mismo a&#241;o del estudio&#46; Bassas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> comunicaron resultados similares&#59; el 18&#37; de los pacientes presentaron m&#225;s de un CBC&#46; Kumar et al&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> publicaron que el 26&#44;9&#37; de los pacientes presentaron m&#225;s de un CBC&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">La cara es la zona donde diagnosticamos m&#225;s CBC &#40;59&#44;1&#37;&#41;&#44; siendo la nariz la localizaci&#243;n m&#225;s prevalente &#40;21&#44;2&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Exceptuando la cara&#44; el tronco es el &#225;rea predominante &#40;20&#37;&#41;&#46; Encontramos resultados similares en la literatura&#44; con la mayor&#237;a de los CBC localizados en &#225;reas fotoexpuestas&#44; sobre todo en la cara<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;6&#44;8&#44;9&#44;11&#44;13&#44;14&#44;16&#44;18&#44;19&#44;23&#44;26</span></a>&#44; y m&#225;s concretamente en la nariz<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;12&#44;14&#44;20&#44;23</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">En el trabajo aqu&#237; presentado&#44; el patr&#243;n histol&#243;gico m&#225;s frecuente fue el nodular &#40;64&#44;6&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#44; seguido del infiltrante &#40;20&#44;6&#37;&#41;&#46; Estos datos coinciden con los publicados en otras series<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;7&#44;8&#44;14&#8211;16&#44;18&#44;20</span></a>&#46; Para Emmet<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a> el 45&#37; fueron nodulares&#44; 35&#37; multifocales&#44; 8&#44;9&#37; morfeiformes y 8&#37; infiltrantes&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Diferentes estudios han analizado el porcentaje de m&#225;rgenes afectos tras cirug&#237;a con intenci&#243;n curativa y este dato oscila entre el 4 y 24&#37;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;6&#44;7&#44;9&#8211;15&#44;18&#44;20&#44;21&#44;26&#8211;28</span></a>&#46; En nuestra serie&#44; el 17&#37; de los tumores presentaban m&#225;rgenes afectos&#44; siendo m&#225;s alto en aquellos localizados en la cara &#40;29&#44;6&#37;&#41; y los de patr&#243;n histol&#243;gico de alto riesgo &#40;25&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46; Nagore et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> comunicaron que los tumores faciales ten&#237;an mayor porcentaje de margen afecto &#40;20-38&#37; vs&#46; 8&#37; en otras localizaciones&#41;&#44; y dentro de las faciales la nariz y la zona perioral &#40;38&#37; y 35&#37;&#44; respectivamente&#41;&#46; Adem&#225;s&#44; el subtipo morfeiforme present&#243; margen afecto en el 40&#37; de los casos&#44; mientras que en el superficial era pr&#225;cticamente inexistente la afectaci&#243;n de m&#225;rgenes&#46; Fleischer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> describen la localizaci&#243;n en cabeza-cuello como factor de riesgo significativo para tener m&#225;rgenes afectos&#46; Sin embargo&#44; Bozan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> no encontraron diferencias significativas en cuanto a la localizaci&#243;n&#44; ni al subtipo histol&#243;gico &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Las gu&#237;as europeas<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> y americanas<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> recomiendan predecir el riesgo de m&#225;rgenes afectos teniendo en cuenta el tama&#241;o&#44; el patr&#243;n histol&#243;gico y la localizaci&#243;n del tumor&#46; En ellas&#44; los tumores localizados en la zona H &#40;&#225;rea nasal&#44; pabellones&#44; ment&#243;n&#44; sienes&#41; se consideran de alto riesgo&#46; En otros estudios&#44; el tama&#241;o del CBC &#40;mayor de 2<span class="elsevierStyleHsp" style=""></span>cm&#41; tambi&#233;n se considera factor de riesgo para no obtener una escisi&#243;n completa del mismo<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">11&#44;12&#44;14&#44;15&#44;27</span></a>&#46; En el presente estudio hemos observado que los CBC localizados en la cara &#40;29&#44;6&#37;&#41;&#44; y m&#225;s concretamente en pabellones auriculares y &#225;rea nasal&#44; tienen m&#225;s riesgo de escisi&#243;n incompleta&#46; Lo mismo ocurre con los subtipos histol&#243;gicos de alto riesgo &#40;25&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46; Relacionando estas dos variables&#44; el riesgo de extirpaci&#243;n incompleta es a&#250;n mayor &#40;31&#37; en el &#225;rea nasal&#59; 50&#37; en los pabellones auriculares&#41;&#46; Los resultados aqu&#237; presentados coinciden con los de Kappelin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a>&#46; Su porcentaje de resecciones incompletas fue superior en los CBC localizados en la cara&#44; sobre todo en la regi&#243;n nasal &#40;20&#44;3&#37;&#41; y el pabell&#243;n auricular &#40;23&#44;7&#37;&#41;&#44; as&#237; como en los subtipos histol&#243;gicos agresivos &#40;morfeiforme 26&#44;5&#37;&#59; infiltrante 7&#44;5&#37;&#41;&#46; Adem&#225;s&#44; en la nariz y el pabell&#243;n auricular&#44; el riesgo de m&#225;rgenes afectos era a&#250;n mayor cuando el subtipo histol&#243;gico del CBC era morfeiforme&#46; No obstante&#44; el porcentaje de resecciones incompletas en todas las localizaciones que comunicaron fue del 4&#44;6&#37;&#46; Una explicaci&#243;n a la diferencia respecto a nuestros resultados puede radicar en el tama&#241;o de los tumores&#46; Un menor di&#225;metro de los CBC podr&#237;a explicar un mayor &#237;ndice de resecciones completas&#46; Sin embargo&#44; el tama&#241;o es un par&#225;metro del que existe escasa informaci&#243;n en la literatura<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a>&#46; En estudios que controlaron el di&#225;metro tumoral<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> se observ&#243; que un tama&#241;o<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>9<span class="elsevierStyleHsp" style=""></span>mm era factor de riesgo para que la resecci&#243;n quir&#250;rgica primaria fuera incompleta&#46; Por el contrario&#44; Kumar et al&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> as&#237; como Fleischer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> no encontraron diferencias al respecto&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">El presente estudio demuestra que la concordancia entre el hallazgo de bordes laterales o profundos afectos &#40;42&#37; en nuestra serie&#41; se encuentra en el l&#237;mite bajo de la considerada como moderada &#40;41-60&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a>&#46; En la mayor parte de los estudios&#44; el margen lateral se encuentra afecto con mayor frecuencia que el profundo<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;8&#44;12&#8211;15&#44;27</span></a>&#46; Por ejemplo&#44; Nagore et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> describieron el margen lateral afecto en el 21&#37; de los tumores&#44; mientras que el profundo lo estuvo en el 15&#37; de los casos&#46; Griffiths et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> obtuvieron margen lateral afecto en el 5&#44;3&#37; de los casos&#44; profundo en el 2&#44;3&#37; y ambos m&#225;rgenes afectos en el 0&#44;8&#37; de los casos&#46;</p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Limitaciones del estudio</span><p id="par0115" class="elsevierStylePara elsevierViewall">El dise&#241;o retrospectivo del presente trabajo impidi&#243; analizar variables cl&#237;nicas &#40;di&#225;metro tumoral&#44; etc&#46;&#41; que de forma rutinaria no se recog&#237;an en la historia&#46; Tambi&#233;n influy&#243; en la p&#233;rdida puntual de informaci&#243;n en variables estudiadas &#40;localizaci&#243;n&#44; etc&#46;&#41; e impidi&#243; el an&#225;lisis topogr&#225;fico correspondiente a la influencia de la zona H&#46; La instauraci&#243;n en 2014 de la historia cl&#237;nica electr&#243;nica&#44; con su consiguiente periodo de adaptaci&#243;n&#44; puede haber supuesto una desventaja inicial para el registro de datos&#44; como los referentes a los servicios responsables del tratamiento&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusiones</span><p id="par0120" class="elsevierStylePara elsevierViewall">En el ASSTF&#44; las caracter&#237;sticas de los pacientes con CBC se asemejan a las descritas en otras localizaciones geogr&#225;ficas&#46; Apoyando los resultados de estudios previos&#44; los aqu&#237; presentados evidencian que la localizaci&#243;n facial y&#44; en menor medida&#44; el subtipo histol&#243;gico son factores de riesgo para la resecci&#243;n incompleta del CBC&#46; Dicha resecci&#243;n incompleta&#44; fundamentalmente en localizaciones de riesgo&#44; puede tener importantes consecuencias<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> funcionales y est&#233;ticas para el paciente&#46; Por lo tanto&#44; el abordaje quir&#250;rgico inicial de los CBC con estas caracter&#237;sticas ha de planearse de forma cuidadosa&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicto de intereses</span><p id="par0125" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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    "fechaAceptado" => "2023-04-10"
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          "palabras" => array:6 [
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            1 => "Basocelular"
            2 => "Epidemiolog&#237;a"
            3 => "Ex&#233;resis"
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            1 => "Basal cell carcinoma"
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    "resumen" => array:2 [
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes y objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El tratamiento de elecci&#243;n inicial del carcinoma basocelular &#40;CBC&#41; es la escisi&#243;n quir&#250;rgica&#46; Esta deber&#237;a ser completa para reducir el riesgo de recidiva&#46; Nuestro objetivo es conocer las caracter&#237;sticas de los CBC en nuestra &#225;rea de salud&#44; el porcentaje de m&#225;rgenes afectos&#44; y los factores de riesgo para una resecci&#243;n quir&#250;rgica incompleta&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional retrospectivo de los CBC intervenidos en el &#193;rea de Salud del Hospital Universitario Nuestra Se&#241;ora de Candelaria entre el 1 de enero de 2014 y el 31 de diciembre de 2014&#46; Recogemos datos demogr&#225;ficos&#44; cl&#237;nicos e histol&#243;gicos&#44; servicio responsable&#44; abordaje quir&#250;rgico y estado de los m&#225;rgenes&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se diagnosticaron 966 CBC correspondientes a 776 pacientes&#44; siendo el 9&#37; biopsias&#44; el 89&#37; escisiones y el 2&#37; rebanados&#46; La mediana de edad fue de 71 a&#241;os y el 52&#37; eran hombres&#46; La localizaci&#243;n m&#225;s frecuente fue la cara &#40;59&#44;1&#37;&#41;&#46; Se analizaron los m&#225;rgenes quir&#250;rgicos en 506 CBC&#46; El 17&#37; present&#243; afectaci&#243;n de m&#225;rgenes&#46; El porcentaje de m&#225;rgenes afectos fue significativamente mayor en los tumores de la cara &#40;22&#37; cara vs&#46; 10&#37; otra localizaci&#243;n&#41; y en los de subtipo histol&#243;gico de alto riesgo &#40;OMS&#41; &#40;25&#37; subtipo de alto riesgo vs&#46; 15&#37; bajo riesgo&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Las caracter&#237;sticas de nuestros pacientes con CBC se asemejan a las descritas previamente&#46; La localizaci&#243;n facial y el subtipo histol&#243;gico son factores de riesgo para la resecci&#243;n incompleta del CBC&#46; Por lo tanto&#44; el abordaje quir&#250;rgico inicial de los CBC con estas caracter&#237;sticas ha de planearse de forma cuidadosa&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background and objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Surgical excision is the treatment of choice for basal cell carcinoma &#40;BCC&#41;&#46; Complete excision with clear margins is important for reducing the risk of recurrence&#46; The aims of this study were to describe the characteristics of BCCs in our health care area&#44; calculate the percentage of positive margins after surgical excision&#44; and determine the risk factors for incomplete excision&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Retrospective observational study of BCCs that were surgically removed at Hospital Universitario Nuestra Se&#241;ora de Candelaria&#44; in Santa Cruz de Tenerife&#44; Spain&#44; between January 1&#44; 2014 and December 31&#44; 2014&#46; Information was collected on demographic&#44; clinical&#44; and histologic variables&#44; surgical approach&#44; margin status&#44; and the department responsible&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">In total&#44; 966 BCCs were diagnosed in 776 patients&#46; Nine percent of tumors with complete data were biopsied&#44; 89&#37; were surgically excised&#44; and 2&#37; were removed by shave excision&#46; The median age of patients with excised tumors was 71 years and 52&#37; were men&#46; BCCs were most often located on the face &#40;59&#46;1&#37;&#41;&#46; Surgical margins were analyzed in 506 cases&#44; 17&#37; of which had positive margins&#46; Incomplete excision was significantly more common in tumors located on the face &#40;22&#37; vs&#46; 10&#37; for other locations&#41; and in high-risk subtypes according to the World Health Organization classification &#40;25&#37; vs&#46; 15&#37; for low-risk subtypes&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The characteristics of BCCs in our health care area are similar to those described elsewhere&#46; Facial location and histologic subtype are risk factors for incomplete excision&#46; Careful surgical planning is therefore important in the initial management of BCCs with these characteristics&#46;</p></span>"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cuello&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">57&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>EE&#46;II&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pabell&#243;n auricular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="3" align="left" valign="\n
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                  \t\t\t\t  " colspan="3" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Patr&#243;n histol&#243;gico detallado</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleItalic">&#40;datos disponibles en 810 tumores&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nodular&#47;s&#243;lido&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">523&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infiltrante&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Superficial&#47;multic&#233;ntrico&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">41&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Patr&#243;n histol&#243;gico de riesgo</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleItalic">&#40;datos disponibles en 827 tumores&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Pabell&#243;n auricular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#44;0&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">Nariz&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">160&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;9&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">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">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">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;0&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">Cuello&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;3&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">Cara<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;3&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">EE&#46;II&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;0&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">EE&#46;SS&#46;&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">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">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#44;2&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">Tronco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">156&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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            0 => array:3 [
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            1 => array:3 [
              "identificador" => "tblfn0030"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Datos disponibles en 766 tumores&#46;</p>"
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            2 => array:3 [
              "identificador" => "tblfn0035"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Excluyendo nariz y pabell&#243;n auricular&#46;</p>"
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Frecuencia de tumores con patr&#243;n histol&#243;gico de alto riesgo<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a> seg&#250;n su localizaci&#243;n anat&#243;mica<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a></p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">a</span> Datos disponibles en 506 tumores&#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="" 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\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">Frecuencia de resecci&#243;n incompleta&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">&#37;&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Seg&#250;n margen afecto<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lateral&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">73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " 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">Profundo&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">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " 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">Lateral o profundo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;0&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">Seg&#250;n patr&#243;n histol&#243;gico<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">c</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0050"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bajo riesgo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " 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">Alto riesgo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;0&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">Seg&#250;n localizaci&#243;n<a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nariz&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " 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">Pabell&#243;n 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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " 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">Cara<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " 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">Cuello&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " 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">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">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">15&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " 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">EE&#46;II&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " 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">EE&#46;SS&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " 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">Tronco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&#44;3&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">Seg&#250;n localizaci&#243;n agrupada<a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">e</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0065"><span class="elsevierStyleSup">g</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cara&#44; nariz y orejas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " 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">Otras&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis de los m&#225;rgenes quir&#250;rgicos en los pacientes intervenidos por Dermatolog&#237;a</p>"
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          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:30 [
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              "identificador" => "bib0155"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis and treatment of basal cell carcinoma&#58; European consensus&#8211;based interdisciplinary guidelines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Peris"
                            1 => "M&#46; Fargnoli"
                            2 => "C&#46; Garbe"
                            3 => "R&#46; Kaufmann"
                            4 => "L&#46; Bastholt"
                            5 => "N&#46; Seguin"
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                        ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur J Cancer"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A systematic review of worldwide incidence of nonmelanoma skin cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Lomas"
                            1 => "J&#46; Leonardi-Bee"
                            2 => "F&#46; Bath-Hextall"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2012.10830.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2012"
                        "volumen" => "166"
                        "paginaInicial" => "1069"
                        "paginaFinal" => "1080"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22251204"
                            "web" => "Medline"
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              "identificador" => "bib0165"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Gobierno de Canarias&#46; Servicio del Plan de Salud e Investigaci&#243;n&#46; Caracter&#237;sticas generales&#58; geograf&#237;a&#46; Disponible en&#58; <a target="_blank" href="https://www3.gobiernodecanarias.org/sanidad/scs/scs/1/plansalud/psc02/psc02_11.htm">https&#58;&#47;&#47;www3&#46;gobiernodecanarias&#46;org&#47;sanidad&#47;scs&#47;scs&#47;1&#47;plansalud&#47;psc02&#47;psc02&#95;11&#46;htm</a>"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "WHO classification of skin tumors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46;J&#46; Elder"
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                            2 => "R&#46;A&#46; Scolyer"
                            3 => "R&#46; Willemze"
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                      "Libro" => array:2 [
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              "etiqueta" => "5"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical treatment of basal cell carcinoma&#58; a case series on factors influencing the risk of an incomplete primary excision"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Kappelin"
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                      "doi" => "10.1111/jdv.16327"
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                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
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              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Positive compared with negative margins in a single-centre retrospective study on 3957 consecutive excisions of basal cell carcinomas&#46; Associated risk factors and preferred surgical management"
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                        0 => array:2 [
                          "etal" => true
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                            3 => "S&#46; Bruschi"
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                        "paginaInicial" => "38"
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              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluaci&#243;n de los m&#225;rgenes quir&#250;rgicos del carcinoma basocelular seg&#250;n la especialidad del cirujano"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "H&#46; Hilari"
                            2 => "D&#46; Bodet"
                            3 => "M&#46; Serra"
                            4 => "F&#46; Kennedy"
                            5 => "V&#46; Garc&#237;a-Patos"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ad.2012.06.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2013"
                        "volumen" => "104"
                        "paginaInicial" => "133"
                        "paginaFinal" => "140"
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                          0 => array:2 [
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              "identificador" => "bib0190"
              "etiqueta" => "8"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence of incomplete excision in surgically treated basal cell carcinoma&#58; A retrospective clinical audit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46; Kumar"
                            1 => "C&#46;I&#46; Orton"
                            2 => "L&#46;J&#46; McWilliam"
                            3 => "S&#46; Watson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Br J Plast Surg"
                        "fecha" => "2000"
                        "volumen" => "53"
                        "paginaInicial" => "563"
                        "paginaFinal" => "566"
                      ]
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              "identificador" => "bib0195"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Differences in rate of complete excision of basal cell carcinoma by dermatologists&#44; plastic surgeons and general practitioners&#58; A large cross-sectional study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Ramdas"
                            1 => "C&#46; Van Lee"
                            2 => "S&#46; Beck"
                            3 => "P&#46; Bindels"
                            4 => "V&#46; Noordhoek Hegt"
                            5 => "L&#46; Pardo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatology"
                        "fecha" => "2018"
                        "volumen" => "234"
                        "paginaInicial" => "86"
                        "paginaFinal" => "91"
                        "itemHostRev" => array:3 [
                          "pii" => "S1098301516301115"
                          "estado" => "S300"
                          "issn" => "10983015"
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              "identificador" => "bib0200"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The specialty of the treating physician affects the likelihood of tumor-free resection margins for basal cell carcinoma&#58; results from a multi-institutional retrospective study"
                      "autores" => array:1 [
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