Practical dermatology
Study and Treatment of Locally Advanced Melanoma
Melanoma Localmente Avanzado. Estudio y Tratamiento
D. Moreno-Ramíreza,
, L. de la Cruzb, L. Ferrándiza, F.M. Camachoa
Corresponding author
dmoreno@e-derma.org
Correspondence: Departamento de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani s/n, 41009 Sevilla, Spain.
Correspondence: Departamento de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani s/n, 41009 Sevilla, Spain.
Read
6282
Timeswas read the article
3032
Total PDF
3250
Total HTML
Share statistics
array:23 [ "pii" => "S1578219009701726" "issn" => "15782190" "doi" => "10.1016/S1578-2190(09)70172-6" "estado" => "S300" "fechaPublicacion" => "2009-11-01" "aid" => "70172" "copyright" => "Academia Española de Dermatología y Venereología and Elsevier España, S.L." "copyrightAnyo" => "2009" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2009;100:767-79" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2751 "formatos" => array:3 [ "EPUB" => 39 "HTML" => 1463 "PDF" => 1249 ] ] "itemSiguiente" => array:18 [ "pii" => "S1578219009701738" "issn" => "15782190" "doi" => "10.1016/S1578-2190(09)70173-8" "estado" => "S300" "fechaPublicacion" => "2009-11-01" "aid" => "70173" "copyright" => "Academia Española de Dermatología y Venereología and Elsevier España, S.L." "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2009;100:780-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2420 "formatos" => array:3 [ "EPUB" => 34 "HTML" => 1471 "PDF" => 915 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original articles</span>" "titulo" => "Full Thickness Skin Grafts Obtained From the Skin Overlying Sentinel Nodes" "tienePdf" => "en" "tieneTextoCompleto" => 0 "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "780" "paginaFinal" => "784" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Injertos de Piel Total Obtenidos de la Zona del Ganglio Centinela" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Clemente-Ruiz de Almirón, S. Serrano-Ortega" "autores" => array:2 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Clemente-Ruiz de Almirón" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Serrano-Ortega" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219009701738?idApp=UINPBA000044" "url" => "/15782190/0000010000000009/v1_201304241507/S1578219009701738/v1_201304241507/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1578219009701714" "issn" => "15782190" "doi" => "10.1016/S1578-2190(09)70171-4" "estado" => "S300" "fechaPublicacion" => "2009-11-01" "aid" => "70171" "copyright" => "Academia Española de Dermatología y Venereología and Elsevier España, S.L." "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2009;100:759-66" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 7103 "formatos" => array:3 [ "EPUB" => 44 "HTML" => 1725 "PDF" => 5334 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Controversies in dermatology</span>" "titulo" => "Problems in Defining Melanoma Regression and Prognostic Implication" "tienePdf" => "en" "tieneTextoCompleto" => 0 "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "759" "paginaFinal" => "766" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Regresión en el Melanoma: Problemas en su Definición e Implicación Pronóstica" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Requena, R. Botella-Estrada, V. Traves, E. Nagore, S. Almenar, C. Guillén" "autores" => array:6 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Requena" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Botella-Estrada" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "Traves" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Nagore" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Almenar" ] 5 => array:2 [ "nombre" => "C." "apellidos" => "Guillén" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219009701714?idApp=UINPBA000044" "url" => "/15782190/0000010000000009/v1_201304241507/S1578219009701714/v1_201304241507/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Practical dermatology</span>" "titulo" => "Study and Treatment of Locally Advanced Melanoma" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "767" "paginaFinal" => "779" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "D. Moreno-Ramírez, L. de la Cruz, L. Ferrándiz, F.M. Camacho" "autores" => array:4 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "Moreno-Ramírez" "email" => array:1 [ 0 => "dmoreno@e-derma.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "de la Cruz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Ferrándiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 3 => array:3 [ "nombre" => "F.M." "apellidos" => "Camacho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen Macarena, Sevilla, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Servicio de Oncología Médica, Hospital Universitario Virgen Macarena, Sevilla, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Correspondence: Departamento de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani s/n, 41009 Sevilla, Spain." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Melanoma Localmente Avanzado. Estudio y Tratamiento" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaAceptado" => "2009-04-16" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec84603" "palabras" => array:5 [ 0 => "melanoma" 1 => "locally advanced melanoma" 2 => "in-transit metastasis" 3 => "satellitosis" 4 => "isolated limb perfusion" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec84604" "palabras" => array:5 [ 0 => "melanoma" 1 => "melanoma localmente avanzado" 2 => "metástasis en tránsito" 3 => "satelitosis" 4 => "perfusión del miembro aislado" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">Locally advanced melanoma is characterized clinically by the appearance of in-transit or satellite metastases, and is considered stage IIIB or IIIC according to the 2002 classification of the American Joint Committee on Cancer. Despite the absence of distant metastases, the management of locally advanced melanoma is complicated and the disease is associated with a reduction in overall survival. The initial step in the approach to the patient with locally advanced melanoma involves restaging in order to exclude the presence of distant metastases. Positron emission tomography-computed tomography is currently accepted as the most accurate restaging technique. Surgical excision of the metastases continues to be the treatment of choice for locally advanced melanoma. In the case of unresectable metastases, hyperthermic isolated limb perfusion with melphalan with or without tumor necrosis factor has achieved complete responses in up to 60% of patients treated, with very rare severe locoregional and systemic toxic effects. Radiation therapy, chemotherapy, and biochemotherapy are options that, even though they have not been tested in patients with only in-transit metastases, may have a role in unresectable, locally advanced melanoma without distant metastases. In any case, therapeutic options for locally advanced melanoma should be individualized, and should take into consideration the availability of each of these techniques as well as the experience of the health care team.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">El melanoma localmente avanzado representa un estadio clínico caracterizado principalmente por la presencia de metástasis en tránsito o satelitosis, estadios IIIB o IIIC de la clasificación <span class="elsevierStyleItalic">American Joint Committee on Cancer</span> de 2002, y que en ausencia de metástasis a distancia, representa un acortamiento en la supervivencia del paciente y un escenario clínico de manejo complejo.</p><p class="elsevierStyleSimplePara elsevierViewall">La aproximación al paciente en este estadio debe iniciarse con una reestadificación que permita descartar la presencia de metástasis a distancia, para lo que se acepta como técnica con mayor validez la tomografía por emisión de positrones-tomografía computarizada. La exéresis quirúrgica de la/s metástasis continúa siendo considerada el tratamiento de primera elección en la enfermedad localmente avanzada.</p><p class="elsevierStyleSimplePara elsevierViewall">En caso de metástasis irresecables la perfusión hipertérmica del miembro aislado con melfalán con o sin factor de necrosis tumoral, proporciona porcentajes de respuesta completa del 60%, con toxicidad sistémica y locorregional grave muy poco frecuente. La radioterapia, quimioterapia y bioquimioterapia son alternativas terapéuticas que, aunque no han sido estudiadas exclusivamente en el paciente con metástasis en tránsito, pueden tener un papel en la enfermedad localmente avanzada irresecable sin metástasis a distancia.</p><p class="elsevierStyleSimplePara elsevierViewall">En cualquier caso, las opciones terapéuticas en el melanoma localmente avanzado clínico deben ser individualizadas para cada paciente y teniendo en cuenta la disponibilidad de cada una de las técnicas y la experiencia del equipo de profesionales con cada una de ellas.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:48 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiología del melanoma en España" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Saenz" 1 => "J. Conejo-Mir" 2 => "A. Cayuela" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2005" "volumen" => "96" "paginaInicial" => "411" "paginaFinal" => "418" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16476268" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Final version of the American Joint Committee on Cancer Staging System for Cutaneous Melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.M. Balch" 1 => "A.C. Buzaid" 2 => "S.J. Soong" 3 => "M.B. Atkins" 4 => "N. Cascinelli" 5 => "D.G. Coit" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/jco.2001.19.16.3635" "Revista" => array:6 [ "tituloSerie" => "J Clin Oncol" "fecha" => "2001" "volumen" => "19" "paginaInicial" => "3635" "paginaFinal" => "3648" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11504745" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of in-transit metastases from cutaneous malignant melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.J. Hayes" 1 => "M.A. Clark" 2 => "M. Harries" 3 => "J.M. Thomas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/bjs.4610" "Revista" => array:6 [ "tituloSerie" => "Br J Surg" "fecha" => "2004" "volumen" => "91" "paginaInicial" => "673" "paginaFinal" => "682" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15164434" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors and natural histor y of in-transit melanoma after sentinel lymphadenectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T.M. Pawlik" 1 => "M.I. Ross" 2 => "M.M. Johnson" 3 => "C.W. Schacherer" 4 => "D.M. McClain" 5 => "P.F. Mansfield" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1245/ASO.2005.05.025" "Revista" => array:6 [ "tituloSerie" => "Ann Surg Oncol" "fecha" => "2005" "volumen" => "12" "paginaInicial" => "587" "paginaFinal" => "596" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16021533" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognosis and surgical management of patients with palpable inguinal lymph node metastases from melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T.M. Hughes" 1 => "R.P. A’Hern" 2 => "J.M. Thomas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1046/j.1365-2168.2000.01439.x" "Revista" => array:6 [ "tituloSerie" => "Br J Surg" "fecha" => "2000" "volumen" => "87" "paginaInicial" => "892" "paginaFinal" => "901" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10931025" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A prospective analysis of positron emission tomography and conventional imaging for detection of stage IV metastatic melanoma in patients undergoing metastasectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.E. Finkelstein" 1 => "J.A. Carrasquillo" 2 => "J.M. Hoffman" 3 => "B. Galen" 4 => "P. Choyke" 5 => "D.E. White" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1245/ASO.2004.01.023" "Revista" => array:6 [ "tituloSerie" => "Ann Surg Oncol" "fecha" => "2004" "volumen" => "11" "paginaInicial" => "731" "paginaFinal" => "738" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15249335" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Malignant melanoma: staging with whole body positron emission tomography and 2-(F-18)fluoro-2deoxy-Dglucose" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H.C. Steinert" 1 => "R.A. Huch Boni" 2 => "A. Buck" 3 => "R. Boni" 4 => "T. Berthold" 5 => "B. Marincek" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiology.195.3.7753998" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "1995" "volumen" => "195" "paginaInicial" => "705" "paginaFinal" => "709" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7753998" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of fluorine-18 deoxyglucose positron emission tomography in the management of patients with metastatic melanoma: impact on surgical decision making" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.A. Gulec" 1 => "M.B. Faries" 2 => "C.C. Lee" 3 => "D. Kirgan" 4 => "C. Glass" 5 => "D.L. Morton" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.rlu.0000099805.36471.aa" "Revista" => array:6 [ "tituloSerie" => "Clin Nucl Med" "fecha" => "2003" "volumen" => "28" "paginaInicial" => "961" "paginaFinal" => "965" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14663316" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "PET-TAC: Indicaciones, revisión sistemática y metaanálisis. Agencia de Evaluación de Tecnologías Sanitarias (AETS)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Rodríguez Garrido" 1 => "C. Asensio del Barrio" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "titulo" => "Instituto de Salud Carlos III, Ministerio de Sanidad y Consumo" "fecha" => "2004" "editorial" => "Instituto de Salud Carlos III" "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hyperthermic isolated limb perfusion with low-dose tumor necrosis factor and melphalan for bulky in-transit melanoma metastases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.R. Rossi" 1 => "M. Foletto" 2 => "S. Mocellin" 3 => "P. Pilati" 4 => "M. Lise" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Surg Oncol" "fecha" => "2004" "volumen" => "11" "paginaInicial" => "173" "paginaFinal" => "177" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14761920" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of hyperthermic isolated limb perfusion for extremity-confined recurrent melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Brobeil" 1 => "C. Berman" 2 => "C.W. Cruse" 3 => "R. De Conti" 4 => "A. Cantor" 5 => "G.H. Lyman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Surg Oncol" "fecha" => "1998" "volumen" => "5" "paginaInicial" => "376" "paginaFinal" => "383" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9641461" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Major amputation for advanced malignant melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.P. Jaques" 1 => "D.G. Coit" 2 => "M.F. Brennan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Surg Gynaecol Obstet" "fecha" => "1989" "volumen" => "169" "paginaInicial" => "1" "paginaFinal" => "6" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Major amputation for intractable extremity melanoma after failure of isolated limb perfusion" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.R. Kapma" 1 => "B.C. Vrouenraets" 2 => "O.E. Nieweg" 3 => "A.N. Van Geel" 4 => "E.M. Noorda" 5 => "A.M. Eggermont" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejso.2004.10.003" "Revista" => array:6 [ "tituloSerie" => "Eur J Surg Oncol" "fecha" => "2005" "volumen" => "31" "paginaInicial" => "95" "paginaFinal" => "99" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15642433" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of carbon dioxide laser to manage cutaneous metastases from malignant melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Hill" 1 => "J.M. Thomas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Br J Surg" "fecha" => "1996" "volumen" => "83" "paginaInicial" => "509" "paginaFinal" => "512" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8665245" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1552526010000774" "estado" => "S300" "issn" => "15525260" ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carbon dioxide laser for cutaneous melanoma metastases: indications and limitations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Strobbe" 1 => "O. Nieweg" 2 => "B. Kroon" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Surg Oncol" "fecha" => "1997" "volumen" => "23" "paginaInicial" => "435" "paginaFinal" => "438" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9393574" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Experiences with Isolation-Perfusion Technics in the Treatment of Cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "O. Creech" 1 => "E.T. Krementz" 2 => "R.F. Ryan" 3 => "K. Reemtsa" 4 => "J.N. Winblad" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "1959" "volumen" => "149" "paginaInicial" => "627" "paginaFinal" => "639" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13637680" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Randomized multicenter trial of hyperthermic isolated limb perfusion with melphalan alone compared with melphalan plus tumor necrosis factor: American College of Surgeons Oncology Group Trial Z0020" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W.R. Cornett" 1 => "L.M. McCall" 2 => "R.P. Petersen" 3 => "M.I. Ross" 4 => "H.A. Briele" 5 => "R.D. Noyes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J ClinOncol" "fecha" => "2006" "volumen" => "24" "paginaInicial" => "4196" "paginaFinal" => "4201" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Isolated limb perfusion: what is the evidence for its use?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E.M. Noorda" 1 => "B.C. Vrouenraets" 2 => "O.E. Nieweg" 3 => "F. Van Coevorden" 4 => "B.B. Kroon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1245/ASO.2004.12.042" "Revista" => array:7 [ "tituloSerie" => "Ann Surg Oncol" "fecha" => "2004" "volumen" => "11" "paginaInicial" => "837" "paginaFinal" => "845" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15313738" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1474442209702996" "estado" => "S300" "issn" => "14744422" ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of extremity recurrences after complete responses to isolated limb perfusion in patients with melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.L. Feldman" 1 => "H.R. Alexander" 2 => "D.L. Bartlett" 3 => "D.L. Fraker" 4 => "S.K. Libitti" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Surg Oncol" "fecha" => "1999" "volumen" => "6" "paginaInicial" => "562" "paginaFinal" => "567" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10493624" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib20" "etiqueta" => "20." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Repeat isolated limb perfusion with TNFa and melphalan for recurrent limb melanoma after failure of previous perfusion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E.M. Noorda" 1 => "B.C. Vrouenraets" 2 => "O.E. Nieweg" 3 => "A.N. van Geel" 4 => "A.MM. Eggermont" 5 => "B.BR. Kroon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejso.2005.10.009" "Revista" => array:6 [ "tituloSerie" => "Eur J Surg Oncol" "fecha" => "2006" "volumen" => "32" "paginaInicial" => "318" "paginaFinal" => "324" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16412605" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib21" "etiqueta" => "21." "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Moreno-Ramírez D, de la Cruz L, Ferrándiz L,Villegas-Portero R. Perfusión del miembro aislado en el tratamiento del melanoma y sarcoma de partes blandas. Informe técnico de evaluación. Agencia de evaluación de Tecnologías Sanitarias. In press, 2008." ] ] ] 21 => array:3 [ "identificador" => "bib22" "etiqueta" => "22." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tratamiento tópico de las metástasis cutáneas de melanoma con imiquimod" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Sigüenza" 1 => "A. Pizarro" 2 => "M. Mayor" 3 => "C. Vidaurrázaga" 4 => "L. Miralles" 5 => "M. González-Beato" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2005" "volumen" => "96" "paginaInicial" => "111" "paginaFinal" => "115" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16476347" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib23" "etiqueta" => "23." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Topical imiquimod treatment of a cutaneous melanoma metastasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Steinmann" 1 => "J.O. Funk" 2 => "G. Schuler" 3 => "P. von den Driesch" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2000" "volumen" => "43" "paginaInicial" => "556" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10954676" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib24" "etiqueta" => "24." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Topical imiquimod eradicates skin metastases of malignant melanoma but fails to prevent rapid lymphogenous metastatic spread" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Ugurel" 1 => "A. Wagner" 2 => "C. Pföhler" 3 => "W. Tilgen" 4 => "U. Reinhold" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2002" "volumen" => "147" "paginaInicial" => "621" "paginaFinal" => "624" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12207622" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib25" "etiqueta" => "25." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Imiquimod, a topical immune response modifier, in the treatment of cutaneous metastases of malignant melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.B. Bong" 1 => "B. Bonnekoh" 2 => "I. Franke" 3 => "M.P. Schön" 4 => "J. Ulrich" 5 => "H. Gollnick" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "63904" "Revista" => array:6 [ "tituloSerie" => "Dermatology" "fecha" => "2002" "volumen" => "205" "paginaInicial" => "135" "paginaFinal" => "138" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12218228" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib26" "etiqueta" => "26." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Topical imiquimod in the treatment of metastatic melanoma to skin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "I.H. Wolf" 1 => "J. Smolle" 2 => "B. Binder" 3 => "L. Cerroni" 4 => "E. Richtig" 5 => "H. Kerl" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2003" "volumen" => "139" "paginaInicial" => "273" "paginaFinal" => "276" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12622616" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib27" "etiqueta" => "27." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of cutaneous locoregional recurrences of melanoma: a new therapeutic perspective with imiquimod" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Vereecken" 1 => "A. Mathieu" 2 => "M. Laporte" 3 => "M. Petein" 4 => "T. Velu" 5 => "A. Awada" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "68901" "Revista" => array:7 [ "tituloSerie" => "Dermatology" "fecha" => "2003" "volumen" => "206" "paginaInicial" => "279" "paginaFinal" => "280" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12673091" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1552526010000142" "estado" => "S300" "issn" => "15525260" ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib28" "etiqueta" => "28." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "In vivo and in situ modulation of the expression of genes involved in metastasis and angiogenesis in a patient treated with topical imiquimod for melanoma skin metastases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Hesling" 1 => "M. D’Incan" 2 => "S. Mansard" 3 => "F. Franck" 4 => "A. Corbin-Duval" 5 => "C. Chèvenet" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.0007-0963.2004.05898.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2004" "volumen" => "150" "paginaInicial" => "761" "paginaFinal" => "767" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15099376" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib29" "etiqueta" => "29." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Imiquimod para el tratamiento de las metástasis cutáneas de melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Nagore" 1 => "O. Sanmartín" 2 => "R. Botella-Estrada" 3 => "C. Guillén" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2005" "volumen" => "96" "paginaInicial" => "549" "paginaFinal" => "550" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16476296" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib30" "etiqueta" => "30." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phase I/II study of topical imiquimod and intralesional interleukin-2 in the treatment of accessible metastases in malignant melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.S. Green" 1 => "M.D. Bodman-Smith" 2 => "A.G. Dalgleish" 3 => "M.D. Fischer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2006.07664.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2007" "volumen" => "156" "paginaInicial" => "337" "paginaFinal" => "345" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17223875" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib31" "etiqueta" => "31." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phase II trial of intralesional therapy with interleukin-2 in soft-tissue melanoma metastases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Radny" 1 => "U.M. Carola" 2 => "J. Bauer" 3 => "T. Paul" 4 => "C. Schlegel" 5 => "T.K. Eigentler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/sj.bjc.6601320" "Revista" => array:6 [ "tituloSerie" => "Br J Cancer" "fecha" => "2003" "volumen" => "89" "paginaInicial" => "1620" "paginaFinal" => "1626" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14583759" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib32" "etiqueta" => "32." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perilesional injection of R-GM-CSF in patients with cutaneous melanoma metastases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Hoeller" 1 => "B. Jansen" 2 => "E. Heere-Ress" 3 => "T. Pustelnik" 4 => "U. Mossbacher" 5 => "H. Schlagbauer-Wadl" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1046/j.0022-202x.2001.01427.x" "Revista" => array:6 [ "tituloSerie" => "J Invest Dermatol" "fecha" => "2001" "volumen" => "117" "paginaInicial" => "371" "paginaFinal" => "374" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11511318" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib33" "etiqueta" => "33." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Randomized controlled study of electrochemotherapy in the local treatment of skin metastases of melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Gaudy" 1 => "M.A. Richard" 2 => "G. Folchetti" 3 => "J.J. Bonerandi" 4 => "J.J. Grob" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Cutan Med Surg" "fecha" => "2006" "volumen" => "10" "paginaInicial" => "115" "paginaFinal" => "121" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17241586" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib34" "etiqueta" => "34." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of metastatic melanoma using electroporation therapy with bleomycin (electrochemotherapy)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.M. Byrne" 1 => "J.F. Thompson" 2 => "H. Johnston" 3 => "P. Hersey" 4 => "M.J. Quinn" 5 => "T. Michael Hughes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Melanoma Res" "fecha" => "2005" "volumen" => "15" "paginaInicial" => "45" "paginaFinal" => "51" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15714120" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib35" "etiqueta" => "35." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dispelling the myths surrounding radiotherapy for treatment of cutaneous melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Stevens" 1 => "M.J. McKay" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1470-2045(06)70758-6" "Revista" => array:6 [ "tituloSerie" => "Lancet Oncol" "fecha" => "2006" "volumen" => "7" "paginaInicial" => "575" "paginaFinal" => "583" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16814209" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib36" "etiqueta" => "36." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The spectrum of in vitro radiosensitivity in four human melanoma cell lines is not accounted for by differential induction or rejoining of DNA double strand breaks" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.J. McKay" 1 => "R.F. Kefford" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Radiat Oncol Biol Phys" "fecha" => "1995" "volumen" => "31" "paginaInicial" => "345" "paginaFinal" => "352" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7836088" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib37" "etiqueta" => "37." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Randomised trial of hyperthermia as adjuvant to radiotherapy for recurrent or metastatic malignant melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Overgaard" 1 => "D. González González" 2 => "M.C. Hulshof" 3 => "G. Arcangeli" 4 => "O. Dahl" 5 => "O. Mella" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1995" "volumen" => "345" "paginaInicial" => "540" "paginaFinal" => "543" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7776772" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib38" "etiqueta" => "38." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fraction size in external beam radiation therapy in the treatment of melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W.T. Sause" 1 => "J.S. Cooper" 2 => "S. Rush" 3 => "C.T. Ago" 4 => "D. Cosmatos" 5 => "C.T. Coughlin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Radiat OncolBiol Phys" "fecha" => "1991" "volumen" => "20" "paginaInicial" => "429" "paginaFinal" => "432" ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib39" "etiqueta" => "39." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Locally advanced melanoma: results of postoperative hypofractionated radiation therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Stevens" 1 => "J.F. Thompson" 2 => "I. Firth" 3 => "C.J. O’Brien" 4 => "W.H. McCarthy" 5 => "M.J. Quinn" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "2000" "volumen" => "88" "paginaInicial" => "88" "paginaFinal" => "94" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10618610" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib40" "etiqueta" => "40." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systemic chemotherapy for the treatment of metastatic melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Y. Li" 1 => "E.F. McClay" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Semin Oncol" "fecha" => "2002" "volumen" => "29" "paginaInicial" => "413" "paginaFinal" => "426" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12407507" "web" => "Medline" ] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib41" "etiqueta" => "41." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Re-evaluating the role of dacarbazine in metastatic melanoma: what have we learned in 30 years?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.M.M. Eggermont" 1 => "J.M. Kirkwood" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejca.2004.04.030" "Revista" => array:6 [ "tituloSerie" => "Eur J Cancer" "fecha" => "2004" "volumen" => "40" "paginaInicial" => "1825" "paginaFinal" => "1836" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15288283" "web" => "Medline" ] ] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib42" "etiqueta" => "42." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chemotherapy for metastatic melanoma. Time for a change?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H.J. Gogas" 1 => "J.M. Kirkwood" 2 => "V.K. Sondak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/cncr.22427" "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "2007" "volumen" => "109" "paginaInicial" => "455" "paginaFinal" => "464" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17200963" "web" => "Medline" ] ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib43" "etiqueta" => "43." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Randomized phase III study of temozolomide versus dacarbazine in the treatment of patients with advanced metastatic malignant melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.R. Middleton" 1 => "J.J. Grob" 2 => "N. Aaronson" 3 => "G. Fierlbeck" 4 => "W. Tilgen" 5 => "S. Seiter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/jco.2000.18.1.158" "Revista" => array:6 [ "tituloSerie" => "J Clin Oncol" "fecha" => "2000" "volumen" => "18" "paginaInicial" => "158" "paginaFinal" => "166" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10623706" "web" => "Medline" ] ] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib44" "etiqueta" => "44." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phase III multicenter randomized trial of Dartmouth regimen versus dacarbazine in patients with metastatic melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.B. Chapman" 1 => "L. Einhorn" 2 => "M.L. Meyers" 3 => "S. Saxman" 4 => "A.N. Destro" 5 => "K.S. Panageas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/jco.1999.17.9.2745" "Revista" => array:6 [ "tituloSerie" => "J Clin Oncol" "fecha" => "1999" "volumen" => "17" "paginaInicial" => "2745" "paginaFinal" => "2761" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10561349" "web" => "Medline" ] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib45" "etiqueta" => "45." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Combination chemotherapy with or without s.c. IL-2 and IFN-α: results of a prospectively randomized trial of the Cooperative Advanced Malignant Melanoma Chemoimmunotherapy Group" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Atzpodien" 1 => "K. Neuber" 2 => "D. Kamanabrou" 3 => "M. Fluck" 4 => "E.B. Bröcker" 5 => "C. Neumann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/sj.bjc.6600043" "Revista" => array:6 [ "tituloSerie" => "Br J Cancer" "fecha" => "2002" "volumen" => "86" "paginaInicial" => "179" "paginaFinal" => "184" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11870502" "web" => "Medline" ] ] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib46" "etiqueta" => "46." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multiinstitutional Phase II trial of intensive combination chemoimmunotherapy for metastatic melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.B. Atkins" 1 => "K.R. O’ Boyle" 2 => "J.A. Sosma" 3 => "G.R. Weiss" 4 => "K.A. Margolin" 5 => "M.L. Ernest" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/jco.1994.12.8.1553" "Revista" => array:6 [ "tituloSerie" => "J Clin Oncol" "fecha" => "1994" "volumen" => "12" "paginaInicial" => "1553" "paginaFinal" => "1560" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8040667" "web" => "Medline" ] ] ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib47" "etiqueta" => "47." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development of a biochemotherapy regimen with concurrent administration of cisplatin, vinblastine, dacarbazine, interferon alfa, and interleukin-2 for patients with metastatic melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.S. Legha" 1 => "S. Ring" 2 => "O. Eton" 3 => "A. Bedikian" 4 => "A.C. Buzaid" 5 => "C. Plager" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/jco.1998.16.5.1752" "Revista" => array:7 [ "tituloSerie" => "J Clin Oncol" "fecha" => "1998" "volumen" => "16" "paginaInicial" => "1752" "paginaFinal" => "1759" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9586888" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0022510X9700141X" "estado" => "S300" "issn" => "0022510X" ] ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib48" "etiqueta" => "48." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A Phase II study of dacarbazine and cisplatin in combination with outpatient administered interleukin-2 in metastatic malignant melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.E. Flaherty" 1 => "W. Robinson" 2 => "B.G. Redman" 3 => "R. González" 4 => "S. Martino" 5 => "M. Kraut" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "1993" "volumen" => "71" "paginaInicial" => "3520" "paginaFinal" => "3525" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8490900" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010000000009/v1_201304241507/S1578219009701726/v1_201304241507/en/main.assets" "Apartado" => array:4 [ "identificador" => "6151" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Practical Dermatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010000000009/v1_201304241507/S1578219009701726/v1_201304241507/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219009701726?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 7 | 9 |
| 2024 October | 60 | 45 | 105 |
| 2024 September | 56 | 24 | 80 |
| 2024 August | 86 | 62 | 148 |
| 2024 July | 55 | 25 | 80 |
| 2024 June | 67 | 35 | 102 |
| 2024 May | 49 | 27 | 76 |
| 2024 April | 51 | 26 | 77 |
| 2024 March | 68 | 42 | 110 |
| 2024 February | 45 | 35 | 80 |
| 2024 January | 47 | 44 | 91 |
| 2023 December | 45 | 36 | 81 |
| 2023 November | 53 | 27 | 80 |
| 2023 October | 39 | 15 | 54 |
| 2023 September | 45 | 45 | 90 |
| 2023 August | 34 | 26 | 60 |
| 2023 July | 28 | 39 | 67 |
| 2023 June | 47 | 32 | 79 |
| 2023 May | 37 | 22 | 59 |
| 2023 April | 31 | 29 | 60 |
| 2023 March | 22 | 22 | 44 |
| 2023 February | 18 | 20 | 38 |
| 2023 January | 24 | 30 | 54 |
| 2022 December | 30 | 36 | 66 |
| 2022 November | 14 | 26 | 40 |
| 2022 October | 15 | 20 | 35 |
| 2022 September | 20 | 49 | 69 |
| 2022 August | 13 | 37 | 50 |
| 2022 July | 14 | 32 | 46 |
| 2022 June | 14 | 31 | 45 |
| 2022 May | 27 | 39 | 66 |
| 2022 April | 37 | 53 | 90 |
| 2022 March | 29 | 50 | 79 |
| 2022 February | 20 | 34 | 54 |
| 2022 January | 32 | 39 | 71 |
| 2021 December | 15 | 45 | 60 |
| 2021 November | 28 | 51 | 79 |
| 2021 October | 30 | 57 | 87 |
| 2021 September | 23 | 41 | 64 |
| 2021 August | 28 | 29 | 57 |
| 2021 July | 12 | 33 | 45 |
| 2021 June | 12 | 23 | 35 |
| 2021 May | 14 | 23 | 37 |
| 2021 April | 27 | 65 | 92 |
| 2021 March | 41 | 29 | 70 |
| 2021 February | 52 | 41 | 93 |
| 2021 January | 31 | 14 | 45 |
| 2020 December | 27 | 14 | 41 |
| 2020 November | 17 | 12 | 29 |
| 2020 October | 25 | 17 | 42 |
| 2020 September | 20 | 11 | 31 |
| 2020 August | 24 | 19 | 43 |
| 2020 July | 10 | 14 | 24 |
| 2020 June | 20 | 27 | 47 |
| 2020 May | 19 | 20 | 39 |
| 2020 April | 18 | 14 | 32 |
| 2020 March | 20 | 21 | 41 |
| 2020 February | 0 | 3 | 3 |
| 2020 January | 0 | 11 | 11 |
| 2019 December | 0 | 6 | 6 |
| 2019 November | 0 | 3 | 3 |
| 2019 September | 0 | 6 | 6 |
| 2019 August | 0 | 3 | 3 |
| 2019 July | 0 | 4 | 4 |
| 2019 June | 0 | 19 | 19 |
| 2019 May | 0 | 60 | 60 |
| 2019 April | 0 | 31 | 31 |
| 2019 March | 0 | 7 | 7 |
| 2019 February | 0 | 10 | 10 |
| 2019 January | 0 | 5 | 5 |
| 2018 December | 0 | 5 | 5 |
| 2018 September | 0 | 6 | 6 |
| 2018 August | 0 | 23 | 23 |
| 2018 July | 0 | 5 | 5 |
| 2018 June | 0 | 15 | 15 |
| 2018 May | 0 | 15 | 15 |
| 2018 April | 0 | 3 | 3 |
| 2018 March | 0 | 9 | 9 |
| 2018 February | 15 | 16 | 31 |
| 2018 January | 9 | 17 | 26 |
| 2017 December | 15 | 12 | 27 |
| 2017 November | 7 | 17 | 24 |
| 2017 October | 14 | 12 | 26 |
| 2017 September | 10 | 32 | 42 |
| 2017 August | 11 | 11 | 22 |
| 2017 July | 8 | 28 | 36 |
| 2017 June | 17 | 26 | 43 |
| 2017 May | 15 | 22 | 37 |
| 2017 April | 24 | 36 | 60 |
| 2017 March | 15 | 24 | 39 |
| 2017 February | 11 | 14 | 25 |
| 2017 January | 9 | 26 | 35 |
| 2016 December | 31 | 19 | 50 |
| 2016 November | 28 | 17 | 45 |
| 2016 October | 22 | 33 | 55 |
| 2016 September | 33 | 16 | 49 |
| 2016 August | 23 | 17 | 40 |
| 2016 July | 31 | 6 | 37 |
| 2016 June | 11 | 10 | 21 |
| 2016 May | 12 | 4 | 16 |
| 2016 April | 9 | 11 | 20 |
| 2016 March | 3 | 15 | 18 |
| 2016 February | 7 | 1 | 8 |
| 2016 January | 4 | 15 | 19 |
| 2015 December | 6 | 19 | 25 |
| 2015 November | 16 | 17 | 33 |
| 2015 October | 6 | 19 | 25 |
| 2015 September | 10 | 14 | 24 |
| 2015 August | 11 | 5 | 16 |
| 2015 July | 34 | 5 | 39 |
| 2015 June | 35 | 5 | 40 |
| 2015 May | 70 | 7 | 77 |
| 2015 April | 36 | 10 | 46 |
| 2015 March | 26 | 14 | 40 |
| 2015 February | 25 | 10 | 35 |
| 2015 January | 11 | 10 | 21 |
| 2014 December | 25 | 5 | 30 |
| 2014 November | 24 | 5 | 29 |
| 2014 October | 33 | 8 | 41 |
| 2014 September | 35 | 10 | 45 |
| 2014 August | 52 | 15 | 67 |
| 2014 July | 49 | 17 | 66 |
| 2014 June | 55 | 9 | 64 |
| 2014 May | 44 | 13 | 57 |
| 2014 April | 45 | 9 | 54 |
| 2014 March | 43 | 25 | 68 |
| 2014 February | 36 | 15 | 51 |
| 2014 January | 32 | 13 | 45 |
| 2013 December | 30 | 16 | 46 |
| 2013 November | 25 | 17 | 42 |
| 2013 October | 28 | 20 | 48 |
| 2013 September | 27 | 19 | 46 |
| 2013 August | 13 | 29 | 42 |
| 2013 July | 30 | 40 | 70 |
| 2013 June | 29 | 42 | 71 |
| 2013 May | 22 | 19 | 41 |
| 2013 April | 27 | 30 | 57 |
| 2013 March | 33 | 21 | 54 |
| 2013 February | 36 | 9 | 45 |
| 2013 January | 10 | 4 | 14 |
Show all
