Case and Research Letters
Census of Centers That Perform Mohs’ Micrographic Surgery in Spain and Description of Their Activity: A Feasibility Study for the Mohs’ Micrographic Surgery Registry of the Foundation of the Spanish Academy of Dermatology and Venereology
Censo de los centros que realizan cirugía de Mohs en España y descripción de su actividad: estudio de factibilidad para el registro de cirugía de Mohs de la FAEDV
T. Alonso-Alonsoa,
, P. Redondo-Bellonb, O. Sanmartín-Jiménezc, E. de Eusebio-Murillod, I. García-Dovale, M.Á. Rodríguez-Prietoa
Corresponding author
a Dermatología, Hospital Universitario de León, León, Spain
b Dermatología, Clínica Universitaria de Navarra, Pamplona, Navarra, Spain
c Dermatología, Instituto Valenciano de Oncología, Valencia, Spain
d Dermatología, Hospital Universitario de Guadalajara, Guadalajara, Spain
e Dermatología, Fundación Academia Española de Dermatología y Venereología, Madrid, Spain
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"apellidos" => "de Eusebio-Murillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "I." "apellidos" => "García-Doval" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "M.Á." "apellidos" => "Rodríguez-Prieto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Dermatología, Hospital Universitario de León, León, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Dermatología, Clínica Universitaria de Navarra, Pamplona, Navarra, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Dermatología, Instituto Valenciano de Oncología, Valencia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Dermatología, Hospital Universitario de Guadalajara, Guadalajara, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Dermatología, Fundación Academia Española de Dermatología y Venereología, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Censo de los centros que realizan cirugía de Mohs en España y descripción de su actividad: estudio de factibilidad para el registro de cirugía de Mohs de la FAEDV" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Since the forties, when Mohs micrographic surgery was first described,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> the technique has become widely employed in countries such as the United States and Australia.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2–6</span></a> Implantation in Spain<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7–10</span></a> and other European countries came later and has been less uniform. There are several techniques that can be used to perform Mohs micrographic surgery, each requiring different resources and possibly affecting the final outcome. In 2013, the Foundation of the Spanish Academy of Dermatology and Venereology (FAEDV), in association with the Dermatologic Surgery, Laser, and Cutaneous Oncology working group of the AEDV, proposed the launch of a National Mohs Micrographic Surgery Register, the main objectives of which would be to describe the outcomes of Mohs micrographic surgery under conditions of daily practice, to determine the prognostic factors affecting the outcome of Mohs micrographic surgery for skin cancer, and to analyze the possible influence of technical factors on outcomes. Other objectives were to determine whether the indications for the technique were homogeneous in the different centers in terms of tumor and patient characteristics, and the reasons for not using the technique.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A first step towards these objectives was to perform a survey of centers that regularly performed Mohs micrographic surgery and to quantify their activity in order to estimate the viability and statistical power of the register.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We have therefore performed a survey of the centers that perform Mohs micrographic surgery in Spain. Three sources were used: a survey performed in the Surgery Group of the AEDV during the 2012 meeting, and repeated by e-mail in January 2013; a survey sent to all members of the AEDV via the website and returned by Info AEDV in December 2012 and January 2013; and, finally, a key person in Mohs micrographic surgery was contacted in each autonomous community to perform an external review of participating centers, with the aim of identifying those centers that regularly performed Mohs micrographic surgery but had not replied to the survey and inviting them to participate in the register.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In this way we obtained data from 30 centers. Of these, 23 replied to the survey that described their activity (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Overall, these 23 centers performed 160 operations a month, and it was always a dermatologist who performed the Mohs micrographic surgery. In 22 centers (96%), Mohs micrographic surgery was performed using a fresh-tissue technique and in 15 (65%) using a fixed-tissue technique. Interpretation of the histological sections was done by a pathologist in 21 centers (91%), by a dermatologist in 2 (9%), and by both in 2 (9%). With regard to closure of the defect left by the surgery, this was performed by the dermatologist in all the centers, though often with the collaboration of plastic surgeons in 4 of them (17%) and with other specialists in one (4%).</p><p id="par0030" class="elsevierStylePara elsevierViewall">The main finding of this survey was that the availability of Mohs micrographic surgery does not present a homogeneous geographic distribution in our country.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The limitations of our study include the absence of a detailed description of all the centers that perform Mohs micrographic surgery because the centers did not receive or reply to the questionnaires, as can occur in all surveys, or the experts consulted did not identify all the centers. There may also have been bias in the declaration of the activity. Furthermore, the results are not static but may vary over time. Finally, the concept of Mohs micrographic surgery includes various techniques with different degrees of complexity and this variable complexity may not be adequately reflected in our results.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Based on the data from this study, we consider it possible to draw up a register of Mohs micrographic surgery, and the sample size and the statistical power have been established. In addition, we will be able to determine to what degree the results of the register are representative of Mohs micrographic surgery in Spain. The results may also be useful to plan health care and evaluate the geographic distribution of this type of service, and to facilitate appropriate patient referral and dermatologist training.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Alonso-Alonso T, Redondo-Bellon P, Sanmartín-Jiménez O, de Eusebio-Murillo E, García-Doval I, Rodríguez-Prieto MÁ. Censo de los centros que realizan cirugía de Mohs en España y descripción de su actividad: estudio de factibilidad para el registro de cirugía de Mohs de la FAEDV. 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black">City \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Center \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Andalusia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Malaga \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital Virgen de la Victoria \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Seville \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital Virgen del Rocío \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Seville \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital Virgen Macarena \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Castile and Leon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Leon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital General Universitario de León \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Castile-La Mancha \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Guadalajara \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital Universitario de Guadalajara \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Catalonia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Barcelona \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital Clínic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Barcelona \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital del Mar \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Barcelona \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital de la Santa Creu i Sant Pau \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Barcelona \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital Universitario Sagrado Corazón \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Barcelona \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Centro Médico Teknon \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Barcelona \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Clínica Dexeus Iderma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Barcelona \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Instituto Pablo Umbert. Clínica Corachan \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Madrid Community \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Madrid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital Clínico San Carlos \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Madrid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital de Alcorcón \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Madrid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital de la Princesa \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Madrid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital Gregorio Marañón \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MadridMadrid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital Ramón y CajalHospital Virgen de la Paloma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Madrid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital La Zarzuela \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Madrid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital Moncloa \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Madrid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital Quirón Madrid \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Valencian Community \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Valencia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital de Manises \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Valencia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Instituto Valenciano de Oncología \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Basque Country \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Barakaldo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital Universitario de Cruces \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">San Sebastian \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Policlínica Gipuzkoa \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Balearic Islands \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Manacor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital Son Llàtzer \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Palma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hospital Quirón Palmaplanas \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Canary Islands \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Las Palmas Gran Canaria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Complejo Hospitalario Universitario Insular Materno-Infantil \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Las Palmas Gran Canaria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Consulta Dr. Jiménez Acosta \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Navarra \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pamplona \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Clínica Universidad de Navarra \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab940656.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Centers That Performed Mohs Micrographic Surgery in January 2013 and Were Thus Included in the Survey.</p>" ] ] 1 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.docx" "ficheroTamanyo" => 140977 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chemosurgery: A microscopically controlled method of cancer excision" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F.E. 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Toll" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Actas Dermosifilogr" "fecha" => "2012" "volumen" => "103" "paginaInicial" => "61" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of basal cell carcinoma with positive margins [Article in Spanish]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Ríos-Buceta" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Dermosifilogr" "fecha" => "2007" "volumen" => "98" "paginaInicial" => "679" "paginaFinal" => "687" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cost analysis of Mohs micrographic surgery in high-risk facial basal cell carcinoma [Article in Spanish]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N. Blázquez-Sánchez" 1 => "M. de Troya-Martín" 2 => "M. Frieyro-Elicegui" 3 => "R. Fúnez-Liébana" 4 => "L. Martín-Márquez" 5 => "F. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 4 | 9 |
| 2024 October | 73 | 31 | 104 |
| 2024 September | 71 | 18 | 89 |
| 2024 August | 98 | 68 | 166 |
| 2024 July | 71 | 26 | 97 |
| 2024 June | 73 | 28 | 101 |
| 2024 May | 63 | 30 | 93 |
| 2024 April | 76 | 35 | 111 |
| 2024 March | 73 | 26 | 99 |
| 2024 February | 47 | 23 | 70 |
| 2024 January | 49 | 40 | 89 |
| 2023 December | 57 | 22 | 79 |
| 2023 November | 62 | 35 | 97 |
| 2023 October | 61 | 27 | 88 |
| 2023 September | 60 | 36 | 96 |
| 2023 August | 37 | 17 | 54 |
| 2023 July | 52 | 48 | 100 |
| 2023 June | 49 | 19 | 68 |
| 2023 May | 35 | 30 | 65 |
| 2023 April | 43 | 34 | 77 |
| 2023 March | 25 | 26 | 51 |
| 2023 February | 33 | 34 | 67 |
| 2023 January | 24 | 28 | 52 |
| 2022 December | 37 | 40 | 77 |
| 2022 November | 24 | 25 | 49 |
| 2022 October | 25 | 36 | 61 |
| 2022 September | 23 | 39 | 62 |
| 2022 August | 24 | 48 | 72 |
| 2022 July | 21 | 37 | 58 |
| 2022 June | 29 | 31 | 60 |
| 2022 May | 38 | 44 | 82 |
| 2022 April | 48 | 30 | 78 |
| 2022 March | 51 | 45 | 96 |
| 2022 February | 46 | 28 | 74 |
| 2022 January | 67 | 33 | 100 |
| 2021 December | 37 | 57 | 94 |
| 2021 November | 41 | 47 | 88 |
| 2021 October | 49 | 52 | 101 |
| 2021 September | 49 | 40 | 89 |
| 2021 August | 35 | 32 | 67 |
| 2021 July | 36 | 30 | 66 |
| 2021 June | 25 | 54 | 79 |
| 2021 May | 36 | 25 | 61 |
| 2021 April | 83 | 49 | 132 |
| 2021 March | 76 | 18 | 94 |
| 2021 February | 57 | 24 | 81 |
| 2021 January | 38 | 20 | 58 |
| 2020 December | 44 | 15 | 59 |
| 2020 November | 26 | 24 | 50 |
| 2020 October | 21 | 17 | 38 |
| 2020 September | 48 | 18 | 66 |
| 2020 August | 25 | 24 | 49 |
| 2020 July | 37 | 15 | 52 |
| 2020 June | 26 | 27 | 53 |
| 2020 May | 16 | 19 | 35 |
| 2020 April | 23 | 14 | 37 |
| 2020 March | 27 | 27 | 54 |
| 2020 February | 3 | 10 | 13 |
| 2020 January | 0 | 9 | 9 |
| 2019 December | 4 | 10 | 14 |
| 2019 November | 0 | 3 | 3 |
| 2019 October | 0 | 3 | 3 |
| 2019 September | 0 | 2 | 2 |
| 2019 August | 0 | 8 | 8 |
| 2019 July | 4 | 18 | 22 |
| 2019 June | 0 | 15 | 15 |
| 2019 May | 3 | 30 | 33 |
| 2019 April | 0 | 16 | 16 |
| 2019 March | 0 | 6 | 6 |
| 2019 February | 2 | 3 | 5 |
| 2019 January | 2 | 0 | 2 |
| 2018 December | 2 | 4 | 6 |
| 2018 November | 2 | 3 | 5 |
| 2018 October | 1 | 0 | 1 |
| 2018 September | 5 | 0 | 5 |
| 2018 April | 0 | 1 | 1 |
| 2018 February | 27 | 5 | 32 |
| 2018 January | 19 | 4 | 23 |
| 2017 December | 25 | 7 | 32 |
| 2017 November | 18 | 4 | 22 |
| 2017 October | 19 | 9 | 28 |
| 2017 September | 13 | 3 | 16 |
| 2017 August | 29 | 5 | 34 |
| 2017 July | 22 | 7 | 29 |
| 2017 June | 22 | 7 | 29 |
| 2017 May | 24 | 13 | 37 |
| 2017 April | 12 | 9 | 21 |
| 2017 March | 12 | 38 | 50 |
| 2017 February | 16 | 9 | 25 |
| 2017 January | 12 | 5 | 17 |
| 2016 December | 23 | 13 | 36 |
| 2016 November | 33 | 21 | 54 |
| 2016 October | 16 | 23 | 39 |
| 2016 September | 0 | 2 | 2 |
| 2016 August | 0 | 1 | 1 |
| 2016 July | 0 | 1 | 1 |
| 2016 June | 1 | 1 | 2 |
| 2016 May | 1 | 7 | 8 |
| 2016 April | 0 | 12 | 12 |
| 2016 February | 0 | 3 | 3 |
| 2016 January | 0 | 3 | 3 |
| 2015 November | 0 | 1 | 1 |
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