Case and Research Letters
Extramammary Paget Disease with Frontotemporal Involvement: A Case Report and Review of the Literature
Enfermedad de Paget extramamaria con afectación de la región fronto-temporal. Presentación de un caso y revisión de la bibliografía
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Presentación de un caso y revisión de la bibliografía" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "355" "paginaFinal" => "357" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Extramammary Paget Disease with Frontotemporal Involvement: A Case Report and Review of the Literature" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1745 "Ancho" => 800 "Tamanyo" => 293628 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Placa eritematosa de 5<span class="elsevierStyleHsp" style=""></span>cm de tamaño, con pigmentación lineal en la periferia localizada en área temporal derecha, que se extiende hacia piel preauricular no pilosa. 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"apellidos" => "Guillén" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731012004024" "doi" => "10.1016/j.ad.2012.07.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731012004024?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000747?idApp=UINPBA000044" "url" => "/15782190/0000010400000004/v1_201304291101/S1578219013000747/v1_201304291101/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219013000723" "issn" => "15782190" "doi" => "10.1016/j.adengl.2012.04.023" "estado" => "S300" "fechaPublicacion" => "2013-05-01" "aid" => "689" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2013;104:353-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3465 "formatos" => array:3 [ "EPUB" => 48 "HTML" => 2691 "PDF" => 726 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Angiolymphoid Hyperplasia With Eosinophilia: Analysis of 7 Cases" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "353" "paginaFinal" => "355" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hiperplasia angiolinfoide con eosinofilia. Revisión de 7 casos" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1828 "Ancho" => 2500 "Tamanyo" => 877507 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histologic features of angiolymphoid hyperplasia. A, Hematoxylin-eosin, original magnification ×40. B, Hematoxylin-eosin, original magnification ×100. C, Hematoxylin-eosin, original magnification ×200. D, Dermoscopic image of angiolymphoid hyperplasia.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Padilla-España, T. Fernández-Morano, J. del Boz, R. Fúnez-Liébana" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L." 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Córdoba, M.E. Iglesias, I. Rodríguez, J.I. Yanguas" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Córdoba" "email" => array:1 [ 0 => "acordobi@cfnavarra.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M.E." "apellidos" => "Iglesias" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "I." "apellidos" => "Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J.I." "apellidos" => "Yanguas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Enfermedad de Paget extramamaria con afectación de la región fronto-temporal. Presentación de un caso y revisión de la bibliografía" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2908 "Ancho" => 1333 "Tamanyo" => 544372 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Erythematous plaque measuring 5<span class="elsevierStyleHsp" style=""></span>cm located in the right temporal region and extending towards preauricular hairless skin, with a periphery marked by linear pigmentation. B, Plaque displaying intense red fluorescence after a 3-hour incubation period with methyl aminolevulinate. C, Complete remission 2 months after the second photodynamic therapy session.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Extramammary Paget disease (EMPD), first described by Crocker<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in 1889, is a form of intraepidermal adenocarcinoma that generally occurs in areas with a high density of apocrine glands. It presents as a scaly, erythematous lesion simulating inflammatory conditions, tumors, and infections. Isolated cases that occur in locations where there are usually no apocrine glands are called ectopic EMPD.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> We report a case of EMPD in the right frontotemporal region, which is only the third case of EMPD affecting the face that has been reported in the literature (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">A 64-year-old woman presented with a plaque measuring 5<span class="elsevierStyleHsp" style=""></span>cm in the right frontotemporal region that extended into the preauricular region; the lesion had appeared 3 years earlier. The plaque had an erythematous, slightly scaly center and slightly pigmented borders (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). A diagnosis of intraepidermal squamous cell carcinoma or seborrheic dermatitis was made and treatment with corticosteroids resulted in a slight improvement.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Histologic study of 2 biopsies, 1 from the center and 1 from the edge of the lesion, revealed the occupation of the epidermis by a population of large cells with clear cytoplasm and atypical nuclei, arranged singly or in nests and accompanied by little melanin pigment. These cells had spread to the adnexa but there was no dermal infiltration (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> A and B). The atypical cells occupying the epidermis were positive for cytokeratin 7 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>G) and cytokeratin CAM 5.2, but these markers were not expressed in the surrounding epidermis. The nuclei tested positive for estrogen receptors (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C). Her2 membrane expression was intense and continuous (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>D). Other positive markers were carcinoembryonic antigen (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>E), gross cystic disease fluid protein 15 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>H), and MUC-1 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>F). The lesion was S-100 negative. These findings led to a diagnosis of ectopic EMPD.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In view of the size of the plaque, we considered that surgery as a first choice would probably be disfiguring or offer unsatisfactory esthetic results for a 64-year-old patient. Photodynamic therapy was performed in 2 sessions with a week between them. Topical methyl aminolevulinate was applied in accordance with the protocol of the dermatology department. Under Wood light, fluorescence was observed in the lesion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). A very good response to treatment was observed in the follow-up visit 2 months after the second session of photodynamic therapy (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). The lesion recurred partially 18 months after treatment. We therefore prescribed a second cycle of 2 sessions of photodynamic therapy, which led to a partial response. On the last visit imiquimod treatment was added to the regimen.</p><p id="par0025" class="elsevierStylePara elsevierViewall">EMPD affecting facial skin was first described in 2002 by Chilukuri et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> in a 67-year-old male patient who had an erythematous plaque on the cheek that had appeared 10 years earlier and had been treated as Bowen disease. In 2004 another case affecting the face was reported,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> presenting in a 61-year-old man in the form of a pink plaque in the frontotemporal region near the left lateral canthus. In both cases the treatment chosen was Mohs micrographic surgery.The differential diagnosis of EMPD in the frontotemporal area should be established with seborrheic dermatitis, nummular eczema, Bowen disease and, less frequently, with lichen-sclerosus et atrophicus and lichen simplex chronicus. The histological differential diagnosis should be made with other malignancies that occupy the epidermis and are characterized by cells with clear cytoplasm and patchy distribution, mainly superficial spreading melanoma and malignant lentigo, in which case the epithelial markers would be negative and the melanocytic markers (S-100, Melan-A, HMB-45, etc.) positive. P63 can be used to differentiate EMPD from the Pagetoid variant of Bowen disease.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In general, EMPD is only locally aggressive. However, in cases of advanced or metastatic EMPD,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> systemic chemotherapy is indicated.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,7,9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Surgery is the treatment of choice in EMPD.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> However, recurrence rates are high even when the lesions are removed with wide surgical margins. Recurrence is probably due to the multifocal nature of the disease and subclinical involvement of skin that is apparently unaffected. Recurrence rates are higher in cases of invasive disease.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,7</span></a> The use of Mohs micrographic surgery improves cure rates but does not prevent recurrence. Radiation therapy may be useful as adjuvant therapy in patients at high risk of recurrence.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Because EMPD has a patchy distribution and the affected area often extends beyond the clinically visible tumor, photodynamic therapy may be a useful treatment when there is intraepithelial involvement and surgery is high-risk or when there is a high risk of morbidity due to the anatomical location of the lesion. However, because of the small number of studies and case reports of patients treated with this technique, photodynamic therapy should only be used when other approaches are not feasible.</p><p id="par0045" class="elsevierStylePara elsevierViewall">We report the third case of EMPD affecting the face (the frontotemporal region). We call attention to the need to include this disease in the list of lesions that simulate other dermatoses and to the fact that its diagnosis requires immunohistochemical evaluation of the usual breast tumor markers. Ours is the first case treated with photodynamic therapy. The patient achieved complete temporary remission, so this treatment may be a good therapeutic option when involvement is exclusively intraepidermal and when a surgical approach is difficult.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Córdoba A, et al. Enfermedad de Paget extramamaria con afectación de la región fronto-temporal. Presentación de un caso y revisión de la bibliografía. Actas Dermosifiliogr. 2013;104:355–7.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2908 "Ancho" => 1333 "Tamanyo" => 544372 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Erythematous plaque measuring 5<span class="elsevierStyleHsp" style=""></span>cm located in the right temporal region and extending towards preauricular hairless skin, with a periphery marked by linear pigmentation. B, Plaque displaying intense red fluorescence after a 3-hour incubation period with methyl aminolevulinate. C, Complete remission 2 months after the second photodynamic therapy session.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2388 "Ancho" => 2167 "Tamanyo" => 1112655 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A and B, Histologic images of the lesion showing isolated clear cells in the epidermis (hematoxylin-eosin, original magnification ×400). C, Nuclear expression of estrogen receptors in the atypical cells (hematoxylin-eosin, original magnification ×200). D, Intense Her2 membrane staining (hematoxylin-eosin, original magnification ×200). E, The intraepidermal tumor cells were positive for carcinoembryonic antigen (hematoxylin-eosin, original magnification ×200). F, Cytoplasmic staining for MUC1 (hematoxylin-eosin, original magnification ×200). G, Cytoplasmic staining for cytokeratin 7 (hematoxylin-eosin, original magnification ×200). H, Gross cystic disease fluid protein 15 is positive in EMPD (hematoxylin-eosin, original magnification ×200).</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Case \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Author \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Age/Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Clinical Diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Size \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Location \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\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">Chilukuri,<span class="elsevierStyleSup">2</span> 2002 \t\t\t\t\t\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">67/man \t\t\t\t\t\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">Bowen \t\t\t\t\t\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<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>20 cm \t\t\t\t\t\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">Cheek \t\t\t\t\t\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">Mohs chemotherapy \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\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">Cohen,<span class="elsevierStyleSup">3</span> 2004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61/man \t\t\t\t\t\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">-- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1 cm \t\t\t\t\t\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">Right temporal region \t\t\t\t\t\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">Photodynamic therapy \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\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">Córdoba, 2011 \t\t\t\t\t\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">64/woman \t\t\t\t\t\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">Bowen/seborrheic dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>6 cm \t\t\t\t\t\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">Right temporal region \t\t\t\t\t\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">Photodynamic therapy \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab185602.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Literature Review of Cases of Extramammary Paget Disease Affecting the Face.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ 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Van Der Putte" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/DAD.0b013e31820fdc7d" "Revista" => array:6 [ "tituloSerie" => "Am J Dermatopathol" "fecha" => "2011" "volumen" => "33" "paginaInicial" => "811" "paginaFinal" => "818" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21785325" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Her2/neu expression in extramammary Paget disease: a clinicopathologic and immunohistochemical study of 47 cases with and without underlying malignancy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.A. Plaza" 1 => "C. Torres-Cabal" 2 => "D. Ivan" 3 => "V.G. 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Shindo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1346-8138.2009.00676.x" "Revista" => array:7 [ "tituloSerie" => "J Dermatol" "fecha" => "2009" "volumen" => "36" "paginaInicial" => "457" "paginaFinal" => "461" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19691751" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0010782411000035" "estado" => "S300" "issn" => "00107824" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010400000004/v1_201304291101/S1578219013000735/v1_201304291101/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010400000004/v1_201304291101/S1578219013000735/v1_201304291101/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000735?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 9 | 20 |
| 2024 October | 76 | 49 | 125 |
| 2024 September | 68 | 40 | 108 |
| 2024 August | 117 | 52 | 169 |
| 2024 July | 94 | 44 | 138 |
| 2024 June | 98 | 33 | 131 |
| 2024 May | 87 | 42 | 129 |
| 2024 April | 69 | 22 | 91 |
| 2024 March | 62 | 34 | 96 |
| 2024 February | 83 | 33 | 116 |
| 2024 January | 72 | 42 | 114 |
| 2023 December | 62 | 28 | 90 |
| 2023 November | 84 | 24 | 108 |
| 2023 October | 64 | 19 | 83 |
| 2023 September | 94 | 30 | 124 |
| 2023 August | 62 | 26 | 88 |
| 2023 July | 67 | 38 | 105 |
| 2023 June | 62 | 26 | 88 |
| 2023 May | 82 | 20 | 102 |
| 2023 April | 78 | 26 | 104 |
| 2023 March | 57 | 30 | 87 |
| 2023 February | 45 | 25 | 70 |
| 2023 January | 39 | 25 | 64 |
| 2022 December | 63 | 40 | 103 |
| 2022 November | 40 | 30 | 70 |
| 2022 October | 36 | 26 | 62 |
| 2022 September | 31 | 35 | 66 |
| 2022 August | 29 | 32 | 61 |
| 2022 July | 33 | 30 | 63 |
| 2022 June | 35 | 32 | 67 |
| 2022 May | 69 | 36 | 105 |
| 2022 April | 58 | 43 | 101 |
| 2022 March | 50 | 60 | 110 |
| 2022 February | 57 | 34 | 91 |
| 2022 January | 42 | 49 | 91 |
| 2021 December | 35 | 35 | 70 |
| 2021 November | 46 | 43 | 89 |
| 2021 October | 50 | 55 | 105 |
| 2021 September | 38 | 65 | 103 |
| 2021 August | 37 | 50 | 87 |
| 2021 July | 22 | 19 | 41 |
| 2021 June | 35 | 34 | 69 |
| 2021 May | 52 | 37 | 89 |
| 2021 April | 83 | 41 | 124 |
| 2021 March | 81 | 20 | 101 |
| 2021 February | 69 | 20 | 89 |
| 2021 January | 42 | 24 | 66 |
| 2020 December | 31 | 19 | 50 |
| 2020 November | 20 | 14 | 34 |
| 2020 October | 14 | 10 | 24 |
| 2020 September | 23 | 18 | 41 |
| 2020 August | 24 | 23 | 47 |
| 2020 July | 23 | 20 | 43 |
| 2020 June | 33 | 26 | 59 |
| 2020 May | 27 | 18 | 45 |
| 2020 April | 26 | 24 | 50 |
| 2020 March | 31 | 19 | 50 |
| 2020 February | 2 | 15 | 17 |
| 2020 January | 4 | 7 | 11 |
| 2019 December | 6 | 5 | 11 |
| 2019 November | 4 | 2 | 6 |
| 2019 October | 0 | 1 | 1 |
| 2019 September | 0 | 1 | 1 |
| 2019 August | 6 | 4 | 10 |
| 2019 July | 4 | 3 | 7 |
| 2019 June | 4 | 0 | 4 |
| 2019 May | 4 | 1 | 5 |
| 2019 April | 2 | 4 | 6 |
| 2019 March | 2 | 10 | 12 |
| 2019 February | 0 | 4 | 4 |
| 2019 January | 4 | 1 | 5 |
| 2018 December | 0 | 7 | 7 |
| 2018 November | 1 | 0 | 1 |
| 2018 October | 3 | 0 | 3 |
| 2018 September | 2 | 0 | 2 |
| 2018 February | 26 | 2 | 28 |
| 2018 January | 44 | 3 | 47 |
| 2017 December | 38 | 9 | 47 |
| 2017 November | 36 | 3 | 39 |
| 2017 October | 25 | 5 | 30 |
| 2017 September | 31 | 5 | 36 |
| 2017 August | 58 | 3 | 61 |
| 2017 July | 17 | 3 | 20 |
| 2017 June | 41 | 9 | 50 |
| 2017 May | 50 | 3 | 53 |
| 2017 April | 47 | 18 | 65 |
| 2017 March | 41 | 6 | 47 |
| 2017 February | 38 | 6 | 44 |
| 2017 January | 27 | 9 | 36 |
| 2016 December | 44 | 18 | 62 |
| 2016 November | 47 | 14 | 61 |
| 2016 October | 70 | 11 | 81 |
| 2016 September | 61 | 14 | 75 |
| 2016 August | 29 | 5 | 34 |
| 2016 July | 31 | 8 | 39 |
| 2016 June | 6 | 5 | 11 |
| 2016 May | 7 | 11 | 18 |
| 2016 April | 8 | 6 | 14 |
| 2016 March | 5 | 5 | 10 |
| 2016 February | 4 | 8 | 12 |
| 2016 January | 8 | 0 | 8 |
| 2015 December | 10 | 0 | 10 |
| 2015 November | 10 | 1 | 11 |
| 2015 October | 10 | 5 | 15 |
| 2015 September | 11 | 0 | 11 |
| 2015 August | 12 | 1 | 13 |
| 2015 July | 48 | 119 | 167 |
| 2015 June | 62 | 12 | 74 |
| 2015 May | 65 | 9 | 74 |
| 2015 April | 20 | 4 | 24 |
| 2015 March | 29 | 3 | 32 |
| 2015 February | 19 | 6 | 25 |
| 2015 January | 22 | 0 | 22 |
| 2014 December | 29 | 3 | 32 |
| 2014 November | 21 | 0 | 21 |
| 2014 October | 39 | 4 | 43 |
| 2014 September | 25 | 5 | 30 |
| 2014 August | 19 | 2 | 21 |
| 2014 July | 15 | 7 | 22 |
| 2014 June | 40 | 1 | 41 |
| 2014 May | 40 | 6 | 46 |
| 2014 April | 44 | 7 | 51 |
| 2014 March | 40 | 9 | 49 |
| 2014 February | 42 | 4 | 46 |
| 2014 January | 34 | 10 | 44 |
| 2013 December | 36 | 7 | 43 |
| 2013 November | 26 | 7 | 33 |
| 2013 October | 6 | 3 | 9 |
| 2013 September | 10 | 15 | 25 |
| 2013 August | 21 | 7 | 28 |
| 2013 July | 4 | 5 | 9 |
| 2013 June | 2 | 7 | 9 |
| 2013 May | 4 | 2 | 6 |
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