Practical Dermoscopy
When We Can’t See the Forest for the Trees
Cuando los árboles no dejan ver el bosque
A. Mateos-Mayo
, A. Sánchez-Herrero, J.A. Avilés-Izquierdo
Corresponding author
Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
Read
4294
Timeswas read the article
1546
Total PDF
2748
Total HTML
Share statistics
array:25 [ "pii" => "S1578219020300081" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.05.041" "estado" => "S300" "fechaPublicacion" => "2020-03-01" "aid" => "2181" "copyright" => "AEDV" "copyrightAnyo" => "2019" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2020;111:159-60" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0001731019301152" "issn" => "00017310" "doi" => "10.1016/j.ad.2018.05.016" "estado" => "S300" "fechaPublicacion" => "2020-03-01" "aid" => "2181" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2020;111:159-60" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 50 "formatos" => array:2 [ "HTML" => 40 "PDF" => 10 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Dermatoscopia práctica</span>" "titulo" => "Cuando los árboles no dejan ver el bosque" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "159" "paginaFinal" => "160" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "When We Can’t See the Forest for the Trees" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1288 "Ancho" => 905 "Tamanyo" => 135649 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A) Vasos telangiectásicos sobre fondo anaranjado y pigmentación marrón periférica. B) Telangiectasias arboriformes periféricas y área central amarillenta.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Mateos-Mayo, A. Sánchez-Herrero, J.A. Avilés-Izquierdo" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Mateos-Mayo" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Sánchez-Herrero" ] 2 => array:2 [ "nombre" => "J.A." "apellidos" => "Avilés-Izquierdo" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219020300081" "doi" => "10.1016/j.adengl.2018.05.041" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219020300081?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731019301152?idApp=UINPBA000044" "url" => "/00017310/0000011100000002/v2_202009190635/S0001731019301152/v2_202009190635/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S1578219020300123" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.10.026" "estado" => "S300" "fechaPublicacion" => "2020-03-01" "aid" => "2270" "copyright" => "AEDV" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2020;111:161-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Resident’s Forum</span>" "titulo" => "RF-Cemiplimab: First Drug Approved for the Treatment of Metastatic or Unresectable Cutaneous Squamous Cell Carcinoma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "161" "paginaFinal" => "163" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR-Cemiplimab, primer fármaco aprobado para el tratamiento del carcinoma cutáneo de células escamosas metastásico o irresecable" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Morgado-Carrasco, X. Bosch-Amate, X. Fustà-Novell, P. Giavedoni" "autores" => array:4 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Morgado-Carrasco" ] 1 => array:2 [ "nombre" => "X." "apellidos" => "Bosch-Amate" ] 2 => array:2 [ "nombre" => "X." "apellidos" => "Fustà-Novell" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Giavedoni" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731019303692" "doi" => "10.1016/j.ad.2018.10.025" "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/S0001731019303692?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219020300123?idApp=UINPBA000044" "url" => "/15782190/0000011100000002/v1_202004140647/S1578219020300123/v1_202004140647/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S1578219020300111" "issn" => "15782190" "doi" => "10.1016/j.adengl.2020.01.008" "estado" => "S300" "fechaPublicacion" => "2020-03-01" "aid" => "2256" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2020;111:157-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>" "titulo" => "Recent Onset of Multiple Asymptomatic Brownish Papules" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "157" "paginaFinal" => "158" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Múltiples pápulas parduzcas asintomáticas de reciente aparición en el tronco" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 538 "Ancho" => 717 "Tamanyo" => 61289 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Quintana-Codina, M.T. Fernández-Figueras, M. Salleras Redonnet" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Quintana-Codina" ] 1 => array:2 [ "nombre" => "M.T." "apellidos" => "Fernández-Figueras" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Salleras Redonnet" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731019303060" "doi" => "10.1016/j.ad.2018.06.029" "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/S0001731019303060?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219020300111?idApp=UINPBA000044" "url" => "/15782190/0000011100000002/v1_202004140647/S1578219020300111/v1_202004140647/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Practical Dermoscopy</span>" "titulo" => "When We Can’t See the Forest for the Trees" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "159" "paginaFinal" => "160" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Mateos-Mayo, A. Sánchez-Herrero, J.A. Avilés-Izquierdo" "autores" => array:3 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Mateos-Mayo" "email" => array:1 [ 0 => "ana.mateosm@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Sánchez-Herrero" ] 2 => array:2 [ "nombre" => "J.A." "apellidos" => "Avilés-Izquierdo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cuando los árboles no dejan ver el bosque" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1289 "Ancho" => 905 "Tamanyo" => 318901 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Nodule on the scalp. B, Nodule in the area of the right scapula.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Description</span><p id="par0005" class="elsevierStylePara elsevierViewall">We present 2 cases that had previously been diagnosed as basal cell carcinoma based on the presence of arborizing vessels in dermoscopy. The first involved a 49-year-old woman, in whom the tumor was located on the scalp (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), and the second a 70-year-old woman, in whom the tumor was located in the area of the right scapula (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">[[?]]<span class="elsevierStyleBold">What is your diagnosis?</span></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Comment</span><p id="par0015" class="elsevierStylePara elsevierViewall">In the first case, dermoscopy revealed arborizing vessels on a flesh-colored background with peripheral nonspecific brown areas (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). The patient was receiving treatment for disseminated carcinoma of the breast. Biopsy confirmed the definitive diagnosis of skin metastasis resulting from mammary carcinoma.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In the second case, dermoscopy revealed peripherally distributed arborizing vessels surrounding a central ulcerated area with a central yellowish background (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). Pressure released keratinizing material, thus confirming the diagnosis of infundibular epidermal cyst.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Arborizing vessels, also known as telangiectasias or “tree-like” vessels, are defined morphologically as large-caliber structures that are intensely red in color and branch into finer secondary vessels.</p><p id="par0030" class="elsevierStylePara elsevierViewall">This type of vessel is one of the most characteristic dermatoscopic criteria of basal cell carcinoma.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The literature contains numerous cases of lesions that mimic basal cell carcinoma owing to the presence of arborizing vessels. These include various types of adnexal tumors<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and infundibular cysts,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> as in the second case we report.</p><p id="par0040" class="elsevierStylePara elsevierViewall">A study on the presence of arborizing lesions in conditions other than basal cell carcinoma revealed that up to 46% of lesions with arborizing vessels in dermoscopy were not basal cell carcinoma.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> These lesions included various cystic tumors (infundibular cyst, digital mucous cyst, milium), noncystic tumors (dermatofibroma, hypertrophic scars, intradermal nevi, and xanthogranulomas), and, albeit less frequently, nontumoral lesions such as necrobiosis lipoidica and morphea.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The presence of arborizing vessels has also been described in some cases of skin metastasis from visceral tumors, such as those affecting the colon or ovary.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Skin metastases from breast cancer often present pigmented structures that mimic melanoma more than basal cell carcinoma.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">While dermoscopy is very useful for increasing diagnostic accuracy, excessive attention to detail can sometimes present us from seeing the whole picture, as in the 2 cases we report. In no cases is the presence of a single dermatoscopic structure sufficient to confirm a diagnosis. Therefore, the presence of arborizing vessels in dermoscopy of a lesion should point us to other diagnoses in addition to basal cell carcinoma and to alternative clinical or dermatoscopic findings that help to establish a diagnosis.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Description" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Comment" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Mateos-Mayo A, et al. Cuando los árboles no dejan ver el bosque. Actas Dermosifiliogr. 2020;111:159–160.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1289 "Ancho" => 905 "Tamanyo" => 318901 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Nodule on the scalp. B, Nodule in the area of the right scapula.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1289 "Ancho" => 905 "Tamanyo" => 139094 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Telangiectasias on an orange background and peripheral brown pigmentation. B, Peripheral arborizing telangiectasias and a yellowish central area.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surface microscopy of pigmented basal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.W. Menzies" 1 => "K. Westerhoff" 2 => "H. Rabinovitz" 3 => "A.W. Kopf" 4 => "W.H. McCarthy" 5 => "B. Katz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.136.8.1012" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2000" "volumen" => "136" "paginaInicial" => "1012" "paginaFinal" => "1016" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10926737" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vascularización en dermatoscopia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.M. Martín" 1 => "R. Bella-Navarro" 2 => "E. Jordá" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2011.11.005" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2012" "volumen" => "103" "paginaInicial" => "357" "paginaFinal" => "375" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22463770" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Usefulness of Dermoscopy in the Differential Diagnosis of Ruptured and Unruptured Epidermal Cysts" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.S. Suh" 1 => "D.Y. Kang" 2 => "J.B. Park" 3 => "M.H. Yang" 4 => "J.H. Kim" 5 => "K.H. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5021/ad.2017.29.1.33" "Revista" => array:6 [ "tituloSerie" => "Ann Dermatol" "fecha" => "2017" "volumen" => "29" "paginaInicial" => "33" "paginaFinal" => "38" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28223744" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Arborizing Vessels on Dermoscopy in Various Skin Diseases Other Than Basal Cell Carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Jin" 1 => "M.-Y. Yang" 2 => "J.-M. Kim" 3 => "G.-W. Kim" 4 => "H.-S. Kim" 5 => "H.-C. Ko" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5021/ad.2017.29.3.288" "Revista" => array:6 [ "tituloSerie" => "Ann Dermatol" "fecha" => "2017" "volumen" => "29" "paginaInicial" => "288" "paginaFinal" => "294" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28566904" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermoscopic findings in cutaneous metastases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K.A. Chernoff" 1 => "A.A. Marghoob" 2 => "M.E. Lacouture" 3 => "L. Deng" 4 => "K.J. Busam" 5 => "P.L. Myskowski" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamadermatol.2013.8502" "Revista" => array:6 [ "tituloSerie" => "JAMA Dermatol" "fecha" => "2014" "volumen" => "150" "paginaInicial" => "429" "paginaFinal" => "433" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24430974" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pigmented Cutaneous Metastasis of Breast Carcinoma Mimicking a Melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N. Ubillos" 1 => "M. Vola" 2 => "M.E. Mazzei" 3 => "J. Magliano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2016.04.007" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2016" "volumen" => "107" "paginaInicial" => "699" "paginaFinal" => "701" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27206606" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011100000002/v1_202004140647/S1578219020300081/v1_202004140647/en/main.assets" "Apartado" => array:4 [ "identificador" => "19289" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Practical Dermoscopy" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011100000002/v1_202004140647/S1578219020300081/v1_202004140647/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219020300081?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 14 | 23 |
| 2024 October | 62 | 51 | 113 |
| 2024 September | 58 | 26 | 84 |
| 2024 August | 81 | 54 | 135 |
| 2024 July | 61 | 35 | 96 |
| 2024 June | 69 | 32 | 101 |
| 2024 May | 71 | 34 | 105 |
| 2024 April | 49 | 24 | 73 |
| 2024 March | 66 | 36 | 102 |
| 2024 February | 64 | 25 | 89 |
| 2024 January | 55 | 30 | 85 |
| 2023 December | 55 | 14 | 69 |
| 2023 November | 61 | 25 | 86 |
| 2023 October | 78 | 23 | 101 |
| 2023 September | 57 | 32 | 89 |
| 2023 August | 39 | 12 | 51 |
| 2023 July | 64 | 26 | 90 |
| 2023 June | 63 | 18 | 81 |
| 2023 May | 48 | 22 | 70 |
| 2023 April | 40 | 19 | 59 |
| 2023 March | 73 | 26 | 99 |
| 2023 February | 43 | 28 | 71 |
| 2023 January | 52 | 30 | 82 |
| 2022 December | 74 | 26 | 100 |
| 2022 November | 52 | 32 | 84 |
| 2022 October | 48 | 14 | 62 |
| 2022 September | 35 | 30 | 65 |
| 2022 August | 41 | 45 | 86 |
| 2022 July | 40 | 36 | 76 |
| 2022 June | 25 | 23 | 48 |
| 2022 May | 63 | 41 | 104 |
| 2022 April | 56 | 25 | 81 |
| 2022 March | 42 | 44 | 86 |
| 2022 February | 46 | 27 | 73 |
| 2022 January | 60 | 38 | 98 |
| 2021 December | 31 | 30 | 61 |
| 2021 November | 45 | 37 | 82 |
| 2021 October | 58 | 46 | 104 |
| 2021 September | 31 | 32 | 63 |
| 2021 August | 68 | 30 | 98 |
| 2021 July | 58 | 19 | 77 |
| 2021 June | 27 | 35 | 62 |
| 2021 May | 37 | 38 | 75 |
| 2021 April | 83 | 64 | 147 |
| 2021 March | 26 | 22 | 48 |
| 2021 February | 53 | 22 | 75 |
| 2021 January | 31 | 14 | 45 |
| 2020 December | 28 | 19 | 47 |
| 2020 November | 23 | 17 | 40 |
| 2020 October | 27 | 16 | 43 |
| 2020 September | 42 | 11 | 53 |
| 2020 August | 43 | 15 | 58 |
| 2020 July | 26 | 12 | 38 |
| 2020 June | 29 | 16 | 45 |
| 2020 May | 47 | 13 | 60 |
| 2020 April | 29 | 15 | 44 |
| 2020 March | 5 | 6 | 11 |
| 2020 February | 1 | 0 | 1 |
Show all
