Diagnosis and Treatment of Basal Cell Carcinoma in Specialized Dermatology Units: A Clinical Practice Guideline

array:25 ["pii" => "S1578219020300834" "issn" => "15782190" "doi" => "10.1016/j.adengl.2020.04.009" "estado" => "S300" "fechaPublicacion" => "2020-05-01" "aid" => "2292" "copyright" => "AEDV" "copyrightAnyo" => "2020" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "pgl" "cita" => "Actas Dermosifiliogr. 2020;111:291-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0001731020300016" "issn" => "00017310" "doi" => "10.1016/j.ad.2019.07.006" "estado" => "S300" "fechaPublicacion" => "2020-05-01" "aid" => "2292" "copyright" => "AEDV" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "pgl" "cita" => "Actas Dermosifiliogr. 2020;111:291-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "Documento de Consenso" "titulo" => "Carcinoma basocelular cutáneo: diagnóstico y tratamiento en atención especializada dermatológica. Guía de Práctica Clínica de la AEDV" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "291" "paginaFinal" => "299" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Diagnosis and Treatment of Basal Cell Carcinoma in Specialized Dermatology Units: A Clinical Practice Guideline" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Vílchez-Márquez, P. Borregón-Nofuentes, L. Barchino-Ortiz, A. Ruíz-de-Casas, I. Palacios-Álvarez, A. Soria-Rivas, M.A. Descalzo-Gallego, I. García-Doval, L. Ríos-Buceta, P. Redondo-Bellón" "autores" => array:10 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Vílchez-Márquez" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Borregón-Nofuentes" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Barchino-Ortiz" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Ruíz-de-Casas" ] 4 => array:2 [ "nombre" => "I." "apellidos" => "Palacios-Álvarez" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Soria-Rivas" ] 6 => array:2 [ "nombre" => "M.A." "apellidos" => "Descalzo-Gallego" ] 7 => array:2 [ "nombre" => "I." "apellidos" => "García-Doval" ] 8 => array:2 [ "nombre" => "L." "apellidos" => "Ríos-Buceta" ] 9 => array:2 [ "nombre" => "P." "apellidos" => "Redondo-Bellón" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219020300834" "doi" => "10.1016/j.adengl.2020.04.009" "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/S1578219020300834?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731020300016?idApp=UINPBA000044" "url" => "/00017310/0000011100000004/v3_202009220625/S0001731020300016/v3_202009220625/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S1578219020301219" "issn" => "15782190" "doi" => "10.1016/j.adengl.2019.10.007" "estado" => "S300" "fechaPublicacion" => "2020-05-01" "aid" => "2294" "copyright" => "AEDV" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2020;111:300-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Predictive model for allergic contact dermatitis in patients with hand eczema" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "300" "paginaFinal" => "305" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Modelo predictivo de dermatitis alérgica de contacto en pacientes con eccema de manos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 1429 "Ancho" => 2168 "Tamanyo" => 112343 ] ] "descripcion" => array:1 [ "en" => "Area under the receiver operating characteristic curve (AUC-ROC) for the model applied to the validation data set. The numbers shown on the curve correspond to cut-points. The optimum cut-point that satisfies the criterion of proximity at the top right corer was K=−0.3." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Ponce, L. Borrego, P. Saavedra" "autores" => array:3 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Ponce" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Borrego" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Saavedra" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S000173102030003X" "doi" => "10.1016/j.ad.2019.10.001" "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/S000173102030003X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219020301219?idApp=UINPBA000044" "url" => "/15782190/0000011100000004/v1_202006060751/S1578219020301219/v1_202006060751/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S1578219020301232" "issn" => "15782190" "doi" => "10.1016/j.adengl.2019.06.007" "estado" => "S300" "fechaPublicacion" => "2020-05-01" "aid" => "2293" "copyright" => "AEDV" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "rev" "cita" => "Actas Dermosifiliogr. 2020;111:281-90" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Review" "titulo" => "A review of terms used to define cutaneous squamous cell carcinoma with a poor prognosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "281" "paginaFinal" => "290" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Revisión de los términos que definen un carcinoma epidermoide cutáneo asociado a mal pronóstico" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Cañueto, A. Tejera-Vaquerizo, P. Redondo, R. Botella-Estrada, S. Puig, O. Sanmartin" "autores" => array:6 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Cañueto" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Tejera-Vaquerizo" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Redondo" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Botella-Estrada" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Puig" ] 5 => array:2 [ "nombre" => "O." "apellidos" => "Sanmartin" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731020300028" "doi" => "10.1016/j.ad.2019.06.005" "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/S0001731020300028?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219020301232?idApp=UINPBA000044" "url" => "/15782190/0000011100000004/v1_202006060751/S1578219020301232/v1_202006060751/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "Consensus Document" "titulo" => "Diagnosis and Treatment of Basal Cell Carcinoma in Specialized Dermatology Units: A Clinical Practice Guideline" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "291" "paginaFinal" => "299" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "F. Vílchez-Márquez, P. Borregón-Nofuentes, L. Barchino-Ortiz, A. Ruíz-de-Casas, I. Palacios-Álvarez, A. Soria-Rivas, M.A. Descalzo-Gallego, I. García-Doval, L. Ríos-Buceta, P. Redondo-Bellón" "autores" => array:10 [ 0 => array:4 [ "nombre" => "F." "apellidos" => "Vílchez-Márquez" "email" => array:1 [ 0 => "fvilchezm@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "P." "apellidos" => "Borregón-Nofuentes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Barchino-Ortiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Ruíz-de-Casas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "I." "apellidos" => "Palacios-Álvarez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "A." "apellidos" => "Soria-Rivas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] ] ] 6 => array:3 [ "nombre" => "M.A." "apellidos" => "Descalzo-Gallego" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "g" "identificador" => "aff0035" ] ] ] 7 => array:3 [ "nombre" => "I." "apellidos" => "García-Doval" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "g" "identificador" => "aff0035" ] 1 => array:2 [ "etiqueta" => "h" "identificador" => "aff0040" ] ] ] 8 => array:3 [ "nombre" => "L." "apellidos" => "Ríos-Buceta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "i" "identificador" => "aff0045" ] ] ] 9 => array:3 [ "nombre" => "P." "apellidos" => "Redondo-Bellón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:9 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital de Guadix, Guadix, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Clínica Beteré-Marcos, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Dermatología, Clínica Universidad de Navarra, Pamplona, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Servicio de Oncología, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Unidad de Investigación, Fundación Piel Sana, Academia Española de Dermatología y Venereología, Madrid, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Servicio de Dermatología, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "i" "identificador" => "aff0045" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Carcinoma basocelular cutáneo: diagnóstico y tratamiento en atención especializada dermatológica. Guía de Práctica Clínica de la AEDV" ] ] "textoCompleto" => "IntroductionSkin cancer is a frequent disease in our setting. The incidence of basal cell carcinoma is 253.23 tumors (95% CI, 273.01–69.45) per 100 000 person-years, and this may be increasing.<a class="elsevierStyleCrossRef" href="#bib0400">1</a> Basal cell carcinoma accounts for 80%–90% of all cases of skin cancer and is the most frequently occurring form of cancer in humans. It has major repercussions for quality of life in terms of functional and cosmetic morbidity and generates a considerable burden for dermatologists and the health system.<a class="elsevierStyleCrossRef" href="#bib0405">2</a> Basal cell carcinoma can be treated using many approaches, some are which are new. Treatments vary in clinical practice and differ widely in terms of cost depending on the option selected. Consequently, clinical decision making becomes more complex.While clinical practice guidelines (CPGs) for management of basal cell carcinoma are available, they apply to different settings and only partially cover the problems dermatologists consider to be the most relevant.Therefore, the Healthy Skin Foundation of the Spanish Academy of Dermatology and Venereology (Fundación Piel Sana de la Academia Española de Dermatología y Venereología [AEDV]) has promoted the adaptation of CPGs for the main skin tumors, which now form part of the AEDV White Paper on Skin Cancer (Libro Blanco del Cáncer Cutáneo).The objective of these guidelines is to adapt a series of recommendations to our setting. The recommendations are based on the best evidence possible for decision making in the management of patients with basal cell carcinoma.Material and MethodsAs CPGs were already available, we decided to adapt these using the ADAPTE method. The steps followed during this process are summarized in the Supplementary Material (Supplementary Material, Section 1).<a class="elsevierStyleCrossRefs" href="#bib0410">3,4</a>The panels were selected based on the experience in treating these tumors and on interest in participating in the CPGs among the Members of the Spanish Oncologic Dermatology and Surgery Group (Grupo Español de Dermato-Oncología y Cirugía [GEDOC]) of the AEDV. All of the panelists declared their conflicts of interest before participating.The scope and objectives statement established the objective of the guidelines as that of providing indications on controversial aspects of diagnosis, treatment (medical and surgical), and patient follow-up (Supplementary Material, Section 2). The care setting for the CPGs is that of dermatology departments in Spain, with dermatologists as the target users. Prevention of basal cell carcinoma and patients with multiple tumor syndromes were excluded from the scope of the CPGs.Following the ADAPTE method, the subsequent steps involved a summary of the care process and formulation of relevant clinical questions for each step of the algorithm (Supplementary Material, Section 3). The most relevant questions were selected based on consensus at a face-to-face meeting at the head office of the AEDV in October 2016. In parallel, guidelines were sought on web pages or in specific organizations and sources, as well as in bodies that collect, prepare, or publish guidelines. We also included the main academies of dermatology or cancer (eg, National Guidelines Clearinghouse, Guidelines International Network, Guiasalud, Institute for Clinical Systems Improvement, National Institute for Health and Care Excellence, New Zealand Guidelines Group, Scottish Intercollegiate Guidelines Network, Cochrane Library, British Association of Dermatologists, American Academy of Dermatology, European Academy of Dermatology and Venereology, National Comprehensive Cancer Network). The guidelines were subsequently reviewed and evaluated for their methodological quality using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool.<a class="elsevierStyleCrossRef" href="#bib0420">5</a> The CPGs with the most favorable results were selected for consultation.This information was used to generate the recommendations, which maintained the reference to the original source. Retrievals, the level of evidence, and the grade of recommendation based on the levels of Oxford Centre for Evidence-Based Medicine were always established in pairs.<a class="elsevierStyleCrossRef" href="#bib0425">6</a>Once the draft version was complete, the recommendations were published on the web page of the AEDV (<a href="https://aedv.es/revision-de-las-recomendaciones-de-la-gpc-basocelular/">https://aedv.es/revision-de-las-recomendaciones-de-la-gpc-basocelular/</a>) and underwent external review. A review was requested from all those with an interest in the topic from the AEDV, GEDOC, and pharmaceutical industry, as well as from oncologists. The members of the panel evaluated the reviewers’ objections, and, if these were considered relevant, they were applied to the CPGs.ResultsThe 4 highest-scoring guidelines whose objectives were consistent with the scope and objectives proposed were as follows: British Association of Dermatologists, National Comprehensive Cancer Network, European Dermatology Forum, and the European Academy of Dermatology and Venereology. Despite their high scores in terms of quality, the guidelines of the Agency for Healthcare Research and Quality and those of the National Institute for Health and Care Excellence were excluded because they were aimed at primary care and other specialists and did not address the questions proposed.The clinical questions proposed and the recommendations of the CPGs are set out below. The complete document of the CPGs, which includes a discussion of each question, is available as supplementary material (Supplementary Material, Section 4).Section 1. Second Intervention vs Observation in Basal Cell Carcinoma With Positive MarginsQuestion 1. In the case of patients with basal cell carcinoma with positive margins, does a second intervention reduce the probability of recurrence compared with observation?Summary of EvidenceInvolvement of surgical margins is associated with a higher rate of recurrence after surgery, especially in tumors that affect the center of the face, high-risk histologic subtypes (morpheaform, micronodular, infiltrative), and when the positive margin is deep (Level of evidence, 2a).<a class="elsevierStyleCrossRefs" href="#bib0430">7–14</a>RecommendationsIncompletely excised basal cell carcinomas should be retreated, especially if the center of the face is involved, the deep margin is affected, local flaps or grafts have been used to close the surgical wound, or the histologic subtype is high-risk. The therapeutic approach of choice is standard surgery or Mohs micrographic surgery (especially if the abovementioned requisites are fulfilled). Similarly, clinical checkups could be considered in small nonaggressive tumors on the trunk (Grade of recommendation, B).Section 2. Radiotherapy vs Second Intervention in Basal Cell Carcinoma With Positive MarginsQuestion 2. In patients with basal cell carcinoma and positive surgical margins, does adjuvant radiotherapy reduce the probability of recurrence compared with a second intervention?Summary of EvidenceThere are no studies comparing second intervention with adjuvant radiotherapy in basal cell carcinoma with positive surgical margins. Guidelines recommend reintervention as the first option, with radiotherapy reserved for patients who are not candidates for surgery (contraindication, surgical problems, or patient refusal to undergo the procedure) (Level of evidence, 4).<a class="elsevierStyleCrossRefs" href="#bib0470">15–18</a>RecommendationsRadiotherapy should be reserved for patients with basal cell carcinoma and positive surgical margins who are not candidates for a second intervention (Grade of recommendation, C).Section 3. Surgery vs Nonsurgical Treatment in Low-risk Basal Cell CarcinomaQuestion 3. In patients with low-risk basal cell carcinoma, does nonsurgical treatment affect the probability of recurrence compared with surgery?Summary of EvidenceRecurrence rates are lower with conventional surgery than with nonsurgical approaches. Therefore, conservative treatment should be reserved for cases that are not candidates for surgery.<a class="elsevierStyleCrossRefs" href="#bib0490">19–21</a> Electrodessication and curettage may prove useful as treatment in low-risk basal cell carcinoma, with a lower percentage of persistence of the tumor in carcinomas on the trunk and extremities (Level of evidence, 4).<a class="elsevierStyleCrossRefs" href="#bib0505">22–26</a> Cryosurgery may also be a good therapeutic option in low-risk basal cell carcinoma (Level of evidence, 3b).<a class="elsevierStyleCrossRefs" href="#bib0530">27–33</a> CO2 laser ablation and curettage would be particularly indicated in low-risk basal cell carcinoma in the form of large or multiple tumors (Level of evidence, 4).<a class="elsevierStyleCrossRef" href="#bib0565">34</a> Imiquimod is useful in low-risk basal cell carcinoma, mainly in superficial tumors, and, to a lesser extent, in nodular tumors (Level of evidence, 1b).<a class="elsevierStyleCrossRefs" href="#bib0570">35,36</a> Photodynamic therapy is also useful in superficial basal cell carcinoma, with a higher recurrence rate in nodular basal cell carcinoma (Level of evidence, 1b).<a class="elsevierStyleCrossRefs" href="#bib0580">37–42</a> 5-Fluorouracil could be an option for treatment, although there is insufficient evidence to support its use (Level of evidence, 4).RecommendationsNonsurgical approaches are a good option for the management of low-risk basal cell carcinoma when surgery is not possible (see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> for a summary of risk factors). Electrodessication and curettage is useful in low-risk tumors, especially when these are located on the trunk and extremities (Grade of recommendation, C). Cryosurgery can also be used in low-risk basal cell carcinoma (Grade of recommendation, B). Laser and curettage can be used to treat large or multiple tumors (Grade of recommendation, C). Imiquimod is a good option for superficial basal cell carcinoma (Grade of recommendation, A) and may prove useful in nodular tumors (Grade of recommendation, C). Photodynamic therapy is also useful in superficial basal cell carcinoma (Grade of recommendation, A) and, to a lesser extent, in nodular tumors (Grade of recommendation, B). 5-Fluorouracil could also prove useful in the treatment of low-risk basal cell carcinoma (Grade of recommendation, C).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Section 4. Effectiveness of Mohs SurgeryQuestion 4. In patients with high-risk basal cell carcinoma, does Mohs surgery reduce the probability of recurrence compared with conventional surgery?Summary of EvidenceRecurrence rates for Mohs micrographic surgery are lower than for conventional surgery in recurrent tumors (Level of evidence, 1b). Data for primary tumors are not as clear. Mohs surgery is particularly indicated in high-risk tumors, especially those located on the face (Level of evidence, 1b).<a class="elsevierStyleCrossRefs" href="#bib0610">43–49</a>RecommendationsMohs micrographic surgery is the most appropriate treatment in high-risk basal cell carcinoma, especially those located on the face, and in recurrent tumors (Grade of recommendation, A).Section 5. Risk Associated With ImmunosuppressionQuestion 5. In immunodepressed patients with low-risk basal cell carcinoma, does surgical treatment affect the probability of recurrence compared with nonsurgical treatment?Summary of EvidenceThere are no conclusive data that allow us to state that basal cell carcinoma in immunodepressed patients is riskier than in immunocompetent patients. Similarly, there are no studies comparing surgical treatment with conservative treatment in these patients. However, in the guidelines of the British Association of Dermatology and the National Comprehensive Cancer Network, immunosuppression per se is considered an indicator of poor prognosis (Level of evidence, 5).<a class="elsevierStyleCrossRefs" href="#bib0645">50–52</a>RecommendationsBasal cell carcinoma may be more aggressive in immunodepressed patients. Therefore, surgery should always be the first option, and conservative treatments should be reserved for cases that are not candidates for surgery (Grade of recommendation, D).Section 6. Vismodegib vs Radiotherapy in Locally Advanced Basal Cell CarcinomaQuestion 6. In patients with locally advanced basal cell carcinoma, does treatment with vismodegib improve overall survival or disease-free survival compared with radiotherapy?Summary of EvidenceThere are no studies comparing vismodegib with radiotherapy for the treatment of locally advanced basal cell carcinoma with respect to survival outcomes (overall and disease-free). Clinical trials with vismodegib include patients with basal cell carcinoma who have already received radiotherapy or for whom radiotherapy was considered contraindicated or inappropriate (hypersensitivity to radiotherapy [eg, Gorlin syndrome], limitations arising from the location of the tumor, or cumulative doses of previous radiotherapy) (Level of evidence, 5).<a class="elsevierStyleCrossRefs" href="#bib0660">53–57</a>RecommendationsVismodegib is effective for the treatment of locally advanced or metastatic basal cell carcinoma. Its use is limited to those cases where the patient is not a candidate for surgery, whether because of inoperability, multiple recurrences, or expected surgical morbidity (severe disfigurement, functional defect, and/or cosmetic defect not tolerated by the patient) (Grade of recommendation, D).Section 7. Vismodegib in Neoadjuvant TherapyQuestion 7. In patients with locally advanced basal cell carcinoma that is inoperable owing to the complexity of surgery, does neoadjuvant vismodegib enable surgical rescue or reduce the complexity of surgery sufficiently to enable a second intervention compared with radiotherapy?Summary of EvidenceThere are no studies comparing vismodegib with radiotherapy in terms of reducing the complexity of surgery. Some studies suggest that vismodegib could be useful in neoadjuvant therapy by reducing the size of the tumor and enabling surgical rescue (Level of evidence, 4).<a class="elsevierStyleCrossRefs" href="#bib0685">58–60</a>RecommendationsIn cases of locally advanced basal cell carcinoma where it is difficult to treat the tumor with surgery, treatment with vismodegib for some months could reduce the size of the tumor and thus enable surgery (Grade of recommendation, C).Section 8. Follow-up by Protocol or as Needed for Early Diagnosis of RecurrenceQuestion 8. In patients with high-risk basal cell carcinoma, does follow-up by protocol facilitate early diagnosis in cases of recurrence compared with follow-up as needed?Summary of EvidenceThere are no studies comparing follow-up by protocol with follow-up as needed in patients with high-grade basal cell carcinoma. Similarly, no consensus has been reached on the frequency, periodicity, or total duration of follow-up. However, the different guidelines recommend long-term surveillance of these patients (especially in patients with recurrent, multiple, and high-risk lesions), with checkups every 6–12 months during the first 3–5 years. Checkups can subsequently be scheduled further apart if no other skin tumors appear during this period. Some guidelines recommend lifelong annual checkups as the ideal approach (Level of evidence, 5).<a class="elsevierStyleCrossRefs" href="#bib0700">61,62</a>RecommendationsIn patients with high-risk basal cell carcinoma or recurrent or multiple lesions, follow-up should be every 6–12 months for the first 3–5 years. Follow-up visits can subsequently be scheduled further apart (Grade of recommendation, D).Section 9. Follow-up by Protocol vs Discharge and Follow-up as Needed in Low-risk Basal Cell CarcinomaQuestion 9. In patients with low-risk basal cell carcinoma, does follow-up by protocol facilitate early diagnosis in the case of recurrence compared with discharge and follow-up as needed?Summary of EvidenceThere are no studies comparing follow-up by protocol with checkups as needed or annual checkups in patients with low-grade basal cell carcinoma. The risk of recurrence in patients with appropriately treated low-risk disease is reduced. However, patients with basal cell carcinoma have a greater risk of developing new skin tumors, and this risk is increased in the short term (Level of evidence: 2a). Therefore, the ideal situation would involve regular follow-up of all patients with basal cell carcinoma at least once per year (Level of evidence, 5).<a class="elsevierStyleCrossRefs" href="#bib0700">61–63,9</a>RecommendationsIt is recommended to arrange at least 1 follow-up visit in order to advise the patient on photoprotective measures, the nature of the tumor, and the risk of new lesions. If possible, patients with low-risk basal cell carcinoma should be followed up yearly (Grade of recommendation, D).Section 10. Follow-up After Nonsurgical Techniques in Low-risk Basal Cell CarcinomaQuestion 10. In patients with low-risk basal cell carcinoma treated with nonsurgical techniques (electrodessication and curettage, cryosurgery, CO2 laser, imiquimod, photodynamic therapy, and 5-fluorouracil), does follow-up by protocol facilitate early diagnosis in the case of recurrence compared with consultation as needed by the patient?Summary of EvidenceThere are no studies comparing follow-up by protocol with consultation as needed by the patient with respect to early diagnosis in the case of recurrence. It is important to remember that nonsurgical approaches are to be used mainly in low-risk basal cell carcinomas, although these therapeutic modalities are associated with greater recurrence rates than standard surgery (Level of evidence, 5).<a class="elsevierStyleCrossRefs" href="#bib0715">64,65</a>RecommendationsGiven the lack of sufficient evidence to support a follow-up protocol in these cases, we would extrapolate the follow-up recommendations for low-risk basal cell carcinoma (Grade of recommendation, D).Section 11. Patient Follow-up for Detection of New CarcinomasQuestion 11. In patients previously diagnosed with basal cell carcinoma, does follow-up by protocol facilitate early diagnosis of new basal cell carcinomas compared with consultation requested by the patient?Summary of EvidenceAll patients with basal cell carcinoma have a greater risk of developing new basal cell carcinomas, squamous cell carcinoma, and melanoma, and this risk is greater during the first 3–5 years (Level of evidence, 2a). The number of previous basal cell carcinomas is the best predictor of new basal cell carcinomas (Level of evidence, 1b). Therefore, some experts recommend periodic follow-up of all patients with basal cell carcinoma at least once per year (Level of evidence, 5).<a class="elsevierStyleCrossRefs" href="#bib0710">63,66–79</a>RecommendationsAt least 1 follow-up visit should be scheduled in order to advise the patient on photoprotective measures, explain the risk of developing new lesions, and highlight the importance of self-monitoring. If the health system allows, patients with basal cell carcinoma should be followed-up at least annually (Grade of recommendation, D).DiscussionThe CPG we adapted based on other recent guidelines can aid decision making in the field of dermatology-oncology.The main advantages of the present study were its rigorous and reproducible methodology, the fact that the findings were applied to our setting, and the external review by professionals from various disciplines before publication.A limitation to the approach adopted here could be the fact that the panelists were all dermatologists. We followed this approach because the scope and objectives statement limited the CPGs to dermatology, the original CPGs are multidisciplinary, and the draft versions of the CPGs underwent multidisciplinary external review.The recommendations will remain in force but must be reviewed during the next 3 years.As with any guidelines, these recommendations are not mandatory but should be applied with some flexibility depending on local availability of resources, the physician's experience, and the patient's preferences.FundingThe AEDV White Paper on Skin Cancer was fully funded by Fundación Piel Sana AEDV. Neither external companies nor the pharmaceutical industry played a role in its drafting (except for possible external review [Roche Pharma], as with other interested parties).Conflicts of InterestA. Ruiz-de-Casas and P. Redondo-Bellón have given paid talks for Roche. I. Palacios-Álvarez has given paid talks for Roche and IFC. The remaining authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1344882" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1237564" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1344881" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1237563" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and Methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:11 [ 0 => array:3 [ "identificador" => "sec0020" "titulo" => "Section 1. Second Intervention vs Observation in Basal Cell Carcinoma With Positive Margins" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Summary of Evidence" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Recommendations" ] ] ] 1 => array:3 [ "identificador" => "sec0035" "titulo" => "Section 2. Radiotherapy vs Second Intervention in Basal Cell Carcinoma With Positive Margins" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Summary of Evidence" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Recommendations" ] ] ] 2 => array:3 [ "identificador" => "sec0050" "titulo" => "Section 3. Surgery vs Nonsurgical Treatment in Low-risk Basal Cell Carcinoma" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Summary of Evidence" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Recommendations" ] ] ] 3 => array:3 [ "identificador" => "sec0065" "titulo" => "Section 4. Effectiveness of Mohs Surgery" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0070" "titulo" => "Summary of Evidence" ] 1 => array:2 [ "identificador" => "sec0075" "titulo" => "Recommendations" ] ] ] 4 => array:3 [ "identificador" => "sec0080" "titulo" => "Section 5. Risk Associated With Immunosuppression" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0085" "titulo" => "Summary of Evidence" ] 1 => array:2 [ "identificador" => "sec0090" "titulo" => "Recommendations" ] ] ] 5 => array:3 [ "identificador" => "sec0095" "titulo" => "Section 6. Vismodegib vs Radiotherapy in Locally Advanced Basal Cell Carcinoma" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0100" "titulo" => "Summary of Evidence" ] 1 => array:2 [ "identificador" => "sec0105" "titulo" => "Recommendations" ] ] ] 6 => array:3 [ "identificador" => "sec0110" "titulo" => "Section 7. Vismodegib in Neoadjuvant Therapy" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0115" "titulo" => "Summary of Evidence" ] 1 => array:2 [ "identificador" => "sec0120" "titulo" => "Recommendations" ] ] ] 7 => array:3 [ "identificador" => "sec0125" "titulo" => "Section 8. Follow-up by Protocol or as Needed for Early Diagnosis of Recurrence" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0130" "titulo" => "Summary of Evidence" ] 1 => array:2 [ "identificador" => "sec0135" "titulo" => "Recommendations" ] ] ] 8 => array:3 [ "identificador" => "sec0140" "titulo" => "Section 9. Follow-up by Protocol vs Discharge and Follow-up as Needed in Low-risk Basal Cell Carcinoma" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0145" "titulo" => "Summary of Evidence" ] 1 => array:2 [ "identificador" => "sec0150" "titulo" => "Recommendations" ] ] ] 9 => array:3 [ "identificador" => "sec0155" "titulo" => "Section 10. Follow-up After Nonsurgical Techniques in Low-risk Basal Cell Carcinoma" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0160" "titulo" => "Summary of Evidence" ] 1 => array:2 [ "identificador" => "sec0165" "titulo" => "Recommendations" ] ] ] 10 => array:3 [ "identificador" => "sec0170" "titulo" => "Section 11. Patient Follow-up for Detection of New Carcinomas" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0175" "titulo" => "Summary of Evidence" ] 1 => array:2 [ "identificador" => "sec0180" "titulo" => "Recommendations" ] ] ] ] ] 7 => array:2 [ "identificador" => "sec0185" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0190" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0195" "titulo" => "Conflicts of Interest" ] 10 => array:2 [ "identificador" => "xack465617" "titulo" => "Acknowledgments" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-10-14" "fechaAceptado" => "2019-07-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1237564" "palabras" => array:5 [ 0 => "Basal cell carcinoma" 1 => "Clinical practice guidelines" 2 => "Neoplasms of skin" 3 => "Therapy" 4 => "Evidence-based medicine" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1237563" "palabras" => array:5 [ 0 => "Carcinoma basocelular" 1 => "Guía de práctica clínica" 2 => "Neoplasias de piel" 3 => "Terapia" 4 => "Medicina basada en la evidencia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Background and objectiveBasal cell carcinoma (BCC) is the most common skin cancer in the general population. BCC is managed in a variety of ways, and available international guidelines are difficult to put into practice in Spain. This guideline aims to improve the management of BCC based on current evidence and provide a point of reference for Spanish dermatologists. Material and methodsMembers of the Spanish Oncologic Dermatology and Surgery Group (GEDOC) with experience treating BCC were invited to participate in drafting this guideline. The drafters used the ADAPTE collaboration process to develop the new guideline based on existing ones, first summarizing the care pathway and posing relevant clinical questions. They then searched for guidelines, assessed them with the AGREE II (Appraisal of Guidelines for Research and Evaluation) tool, and searched the selected guidelines for answers to the clinical questions. Finally, the recommendations were drafted and submitted for external review. ResultsThe highest-scoring guidelines were from the Association of Dermatologists, the National Comprehensive Cancer Network, the European Dermatology Forum, and the European Academy of Dermatology and Venereology. A total of 11 clinical questions were answered. ConclusionsThis new guideline answers the working group's clinical questions about the routine management of BCC in Spain. It provides dermatologists with a tool they can use for decision-making while taking into consideration the resources available and patient preferences." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Antecedentes y objetivoEl carcinoma basocelular supone el cáncer de piel más frecuente en la población. Hay una gran variabilidad en su manejo y las diferentes guías extranjeras que existen son difícilmente aplicables en nuestro medio. El objetivo de la presente guía es servir de referencia a los dermatólogos españoles para mejorar el manejo de este tumor basándose en la evidencia actual. Materiales y métodosSe escogió a miembros del Grupo Español de Dermato-Oncología y Cirugía (GEDOC) con experiencia en el tratamiento de estos tumores y con interés en participar en la elaboración de la guía. Se hizo una adaptación de las guías de práctica clínica existentes mediante el método ADAPTE, se resumió el proceso de atención, y se elaboraron las preguntas clínicas relevantes. Se seleccionaron las guías mejor puntuadas mediante el instrumento AGREE II, realizando la búsqueda de las respuestas en dichas guías y elaborando posteriormente las recomendaciones. Finalmente se sometió la guía a revisión externa. ResultadosLas guías con mejor puntuación fueron las de la British Association of Dermatologits (BAD), del National Comprehensive Cancer Network (NCCN), del European Dermatology Forum (EDF) y de la European Academy of Dermatology and Venereology (EADV). Se obtuvieron en total 11 preguntas clínicas, contestadas a partir de estas guías. ConclusionesEsta guía responde a preguntas habituales sobre el manejo del carcinoma basocelular en la práctica clínica diaria y sirve a los dermatólogos como referencia en la toma de decisiones, siempre teniendo en cuenta los recursos y las preferencias del paciente." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Vílchez-Márquez F, Borregón-Nofuentes P, Barchino-Ortiz L, Ruíz-de-Casas A, Palacios-Álvarez I, Soria-Rivas A, et al. Carcinoma basocelular cutáneo: diagnóstico y tratamiento en atención especializada dermatológica. Guía de Práctica Clínica de la AEDV. Actas Dermosifiliogr. 2020;111:291–299." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Supplementary Data" "identificador" => "sec0205" ] ] ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Area H: center of the face, eyelids, eyebrows, periorbital skin, nose, lips, chin, mandible, preauricular area, retroauricular area, pinna, temple, genitals, hands, and feet. Area L: trunk and extremities. Area M: cheeks, forehead, neck, scalp, and neck." "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"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Low Risk \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">High Risk \t\t\t\t\t\t\n \t\t\t\t\t\t</th></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 " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical criteria</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Location/Size \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">Area L<20mmArea M<10mmArea H<6mm \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">Area L>20mmArea M>10mmArea H>6mm \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Borders \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">Well defined \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">Poorly defined \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Primary vs recurrent \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">Primary \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">Recurrent \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Immunosuppression \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">No \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">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Previous radiotherapy \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">No \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">Yes \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 " colspan="3" align="left" valign="\n \t\t\t\t\ttop\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 " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Histopathologic criteria</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Subtype \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">Nodular/Superficial \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">Sclerodermiform, basosquamous, sclerosing, infiltrative, micronodular \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perineural invasion \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">No \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">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2307215.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Risk Factors." ] ] 1 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 543840 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:79 [ 0 => array:3 [ "identificador" => "bib0400" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Skin cancer incidence and mortality in Spain: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Tejera-Vaquerizo" 1 => "M.A. Descalzo-Gallego" 2 => "M.M. Otero-Rivas" 3 => "C. Posada-García" 4 => "L. Rodríguez-Pazos" 5 => "I. Pastushenko" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2015.12.008" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2016" "volumen" => "107" "paginaInicial" => "318" "paginaFinal" => "328" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26852370" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0405" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outpatient dermatological diagnoses in Spain: results from the National DIADERM Random Sampling Project" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Buendía-Eisman" 1 => "S. Arias-Santiago" 2 => "A. Molina-Leyva" 3 => "Y. Gilaberte" 4 => "P. Fernández-Crehuet" …1 ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2018.02.003" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2018" "volumen" => "109" "paginaInicial" => "416" "paginaFinal" => "423" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0410" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Grupo de trabajo sobre actualización de GPC. Actualización de Guías de Práctica Clínica en el Sistema Nacional de Salud. Manual Metodológico. Plan de Calidad para el Sistema Nacional de Salud del Ministerio de Sanidad y Política Social. Instituto Aragonés de Ciencias de la Salud-I+CS; 2009. Guías de Práctica Clínica en el SNS: I+CS N.° 2007/02-01." ] ] ] 3 => array:3 [ "identificador" => "bib0415" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guideline adaptation: an approach to enhance efficiency in guideline development and improve utilisation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmjqs.2010.043257" "Revista" => array:7 [ "tituloSerie" => "BMJ Qual Saf" "fecha" => "2011" "volumen" => "20" "paginaInicial" => "228" "paginaFinal" => "236" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S0264410X1630264X" "estado" => "S300" "issn" => "0264410X" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0420" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "AGREEII: advancing guideline development, reporting and evaluation in health care" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jclinepi.2010.07.001" "Revista" => array:6 [ "tituloSerie" => "J Clin Epidemiol" "fecha" => "2010" "volumen" => "63" "paginaInicial" => "1308" "paginaFinal" => "1311" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0425" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Oxford Centre for Evidence-based Medicine — Levels of Evidence (March 2009). Available at: <a target="_blank" href="https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/">https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/</a> [Accessed 21 Jun 2018]" ] ] ] 6 => array:3 [ "identificador" => "bib0430" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Positive margins in basal cell carcinoma: relationship to clinical features and recurrence risk. A retrospective study of 248 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1046/j.1468-3083.2003.00535.x" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2003" "volumen" => "17" "paginaInicial" => "167" "paginaFinal" => "170" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0435" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recurrence rate of positive margin basal cell carcinoma: results of a five-year prospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/jso.2930280117" "Revista" => array:6 [ "tituloSerie" => "J Surg Oncol" "fecha" => "1985" "volumen" => "28" "paginaInicial" => "72" "paginaFinal" => "74" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0440" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Basal cell carcinomas: do they need to be followed up?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J R Coll Surg Edinb" "fecha" => "1994" "volumen" => "39" "paginaInicial" => "109" "paginaFinal" => "111" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0445" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Excision limits and reoperation in cutaneous carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Ann Dermatol Venereol" "fecha" => "1997" "volumen" => "124" "paginaInicial" => "421" "paginaFinal" => "426" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S0264410X14012547" "estado" => "S300" "issn" => "0264410X" ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0450" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical management of incompletely excised basal cell carcinomas of the head and neck" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bjoms.2004.02.030" "Revista" => array:6 [ "tituloSerie" => "Br J Oral Maxillofac Surg" "fecha" => "2004" "volumen" => "42" "paginaInicial" => "311" "paginaFinal" => "314" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0455" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Histological evolution of recurrent basal cell carcinoma and therapeutic implications for incompletely excised lesions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2004.06135.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2004" "volumen" => "151" "paginaInicial" => "623" "paginaFinal" => "626" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0460" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recurrent basal cell carcinoma after incomplete resection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.136.1.24" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2000" "volumen" => "136" "paginaInicial" => "24" "paginaFinal" => "1318" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0465" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of Mohs micrographic surgery for determination of residual tumor in incompletely excised basal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0190-9622(92)70106-p" "Revista" => array:7 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1992" "volumen" => "26" "numero" => "Pt 1" "paginaInicial" => "754" "paginaFinal" => "756" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0470" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A management approach to incompletely excised basal cell carcinomas of skin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0360-3016(91)90052-6" "Revista" => array:7 [ "tituloSerie" => "Int J Radiat Oncol Biol Phys" "fecha" => "1991" "volumen" => "20" "paginaInicial" => "423" "paginaFinal" => "428" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S0002937811004558" "estado" => "S300" "issn" => "00029378" ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0475" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radiotherapy of recurrent basal and squamous cell skin carcinomas: a study of 249 retreated carcinomas in 229 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Dermatol" "fecha" => "2001" "volumen" => "11" "paginaInicial" => "25" "paginaFinal" => "28" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0480" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update of the European guidelines for basal cell carcinoma management" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1684/ejd.2014.2271" "Revista" => array:6 [ "tituloSerie" => "Eur J Dermatol" "fecha" => "2014" "volumen" => "24" "paginaInicial" => "312" "paginaFinal" => "329" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0485" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radiotherapy for perineural invasion in cutaneous head and neck carcinomas: toward a risk-adapted treatment approach" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hed.20991" "Revista" => array:6 [ "tituloSerie" => "Head Neck" "fecha" => "2009" "volumen" => "31" "paginaInicial" => "604" "paginaFinal" => "610" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0490" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical treatment of basal cell carcinomas using standard postoperative histological assessment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1440-0960.2006.00216.x" "Revista" => array:7 [ "tituloSerie" => "Australas J Dermatol" "fecha" => "2006" "volumen" => "47" "paginaInicial" => "1" "paginaFinal" => "12" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S0022347617313112" "estado" => "S300" "issn" => "00223476" ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0495" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Curative and aesthetic results of surgical treatment of 138 basal-cell carcinomas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1524-4725.1982.tb00302.x" "Revista" => array:6 [ "tituloSerie" => "J Dermatol Surg Oncol" "fecha" => "1982" "volumen" => "8" "paginaInicial" => "379" "paginaFinal" => "387" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0500" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Do basal cell carcinomas recur after complete conventional surgical excision?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bjps.2005.02.010" "Revista" => array:6 [ "tituloSerie" => "Br J Plast Surg" "fecha" => "2005" "volumen" => "58" "paginaInicial" => "795" "paginaFinal" => "805" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0505" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of basal cell carcinoma with curettage alone" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2006.01.041" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2006" "volumen" => "54" "paginaInicial" => "1039" "paginaFinal" => "1045" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0510" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of basal cell epithelioma by curettage and electrodesiccation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0190-9622(84)80457-0" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1984" "volumen" => "11" "paginaInicial" => "808" "paginaFinal" => "814" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0515" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Curettage-electrodesiccation treatment of basal cell carcinomas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Arch Dermatol" "fecha" => "1977" "volumen" => "113" "paginaInicial" => "439" "paginaFinal" => "443" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S0264410X12015253" "estado" => "S300" "issn" => "0264410X" ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0520" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Basal cell carcinoma on the lower extremity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1524-4725.1994.tb01621.x" "Revista" => array:6 [ "tituloSerie" => "J Dermatol Surg Oncol" "fecha" => "1994" "volumen" => "20" "paginaInicial" => "258" "paginaFinal" => "259" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0525" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Failure of curettage and electrodesiccation for removal of basal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "1984" "volumen" => "120" "paginaInicial" => "1456" "paginaFinal" => "1460" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0530" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evidence-based review of the use of cryosurgery in treatment of basal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg" "fecha" => "2003" "volumen" => "29" "paginaInicial" => "566" "paginaFinal" => "571" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0535" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cryosurgery of basal cell carcinoma: a study of 358 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Dermatol Venereol" "fecha" => "2000" "volumen" => "127" "paginaInicial" => "175" "paginaFinal" => "179" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0540" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The five-year cure rate achieved by cryosurgery for skin cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0190-9622(91)70160-4" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1991" "volumen" => "24" "paginaInicial" => "1002" "paginaFinal" => "1004" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0545" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cryosurgery for skin cancer: 30-year experience and cure rates" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1524-4725.2004.30090.x" "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg" "fecha" => "2004" "volumen" => "30" "paginaInicial" => "297" "paginaFinal" => "300" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0550" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of basal-cell carcinoma: comparison of radiotherapy and cryotherapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0009-9260(86)80161-1" "Revista" => array:7 [ "tituloSerie" => "Clin Radiol" "fecha" => "1986" "volumen" => "37" "paginaInicial" => "33" "paginaFinal" => "34" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S0264410X13003654" "estado" => "S300" "issn" => "0264410X" ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0555" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cryosurgery in difficult to treat basal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Dermatol" "fecha" => "2000" "volumen" => "39" "paginaInicial" => "223" "paginaFinal" => "229" ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0560" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cryotherapy for eyelid and periocular basal cell carcinomas: outcome in 166 cases over an 8-year period" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/BF00183593" "Revista" => array:6 [ "tituloSerie" => "Graefes Arch Clin Exp Ophthalmol" "fecha" => "1995" "volumen" => "233" "paginaInicial" => "205" "paginaFinal" => "208" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0565" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrapulse CO2 used for the successful treatment of basal cell carcinomas found in patients with basal cell nevus syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1046/j.1524-4725.2002.01080.x" "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg" "fecha" => "2002" "volumen" => "28" "paginaInicial" => "287" "paginaFinal" => "290" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0570" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Imiquimod 5% cream for the treatment of superficial basal cell carcinoma: results from two phase III, randomized, vehicle-controlled studies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2003.11.066" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2004" "volumen" => "50" "paginaInicial" => "722" "paginaFinal" => "733" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0575" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cost-effectiveness of treatment of superficial basal cell carcinoma: surgical excision vs. imiquimod 5% cream" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2006.07726.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2007" "volumen" => "156" "paginaInicial" => "769" "paginaFinal" => "771" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0580" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Photodynamic therapy using topical methyl aminolevulinate vs surgery for nodular basal cell carcinoma. Results of a multicenter randomized prospective trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.140.1.17" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2004" "volumen" => "140" "paginaInicial" => "17" "paginaFinal" => "23" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0585" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Five year follow-up of a randomized, prospective trial of methyl aminolevulinate photodynamic therapy vs surgery for nodular basal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.143.9.1131" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2007" "volumen" => "143" "paginaInicial" => "1131" "paginaFinal" => "1136" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0590" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fractionated aminolevulinic acid-photodynamic therapy provides additional evidence for the use of PDT for non-melanoma skin cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-3083.2007.02445.x" "Revista" => array:7 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2008" "volumen" => "22" "paginaInicial" => "426" "paginaFinal" => "430" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S0264410X14010743" "estado" => "S300" "issn" => "0264410X" ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0595" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fractionated 5-aminolaevulinic acid-photodynamic therapy vs. surgical excision in the treatment of nodular basal cell carcinoma: results of a randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2008.08787.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2008" "volumen" => "159" "paginaInicial" => "864" "paginaFinal" => "870" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0600" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A clinical study comparing methyl aminolevulinate photodynamic therapy and surgery in small superficial basal cell carcinoma (8–20mm), with a 12-month followup" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-3083.2008.02803.x" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2008" "volumen" => "22" "paginaInicial" => "1302" "paginaFinal" => "1311" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0605" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A randomized study of minimal curettage followed by topical photodynamic therapy compared with surgical excision for low risk nodular BCC" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2007.07996.x" "Revista" => array:7 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2007" "volumen" => "157" "paginaInicial" => "401" "paginaFinal" => "403" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S0264410X14013206" "estado" => "S300" "issn" => "0264410X" ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0610" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term recurrence rates in previously untreated (primary) basal cell carcinoma: Implications for patient follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Dermatol Surg Oncol" "fecha" => "1989" "volumen" => "15" "paginaInicial" => "315" "paginaFinal" => "328" ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0615" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Australian Mohs database, part II: periocular basal cell carcinoma outcome at 5-year follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ophtha.2003.11.004" "Revista" => array:6 [ "tituloSerie" => "Ophthalmology" "fecha" => "2004" "volumen" => "111" "paginaInicial" => "631" "paginaFinal" => "636" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0620" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Basal cell carcinoma treated with Mohs surgery in Australia II. Outcome at 5-year follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2005.04.087" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2005" "volumen" => "53" "paginaInicial" => "452" "paginaFinal" => "457" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0625" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mohs’ micrographic surgery for treatment of basal cell carcinoma of the face: results of a retrospective study and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2004.06047.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2004" "volumen" => "151" "paginaInicial" => "141" "paginaFinal" => "147" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0630" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Five-year results of Mohs’ micrographic surgery for aggressive facial basal cell carcinoma in Sweden" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/000155599750010292" "Revista" => array:6 [ "tituloSerie" => "Acta Derm Venereol" "fecha" => "1999" "volumen" => "79" "paginaInicial" => "370" "paginaFinal" => "372" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib0635" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical excision versus Mohs’ micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomised controlled trial with 5-years’ follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1470-2045(08)70260-2" "Revista" => array:6 [ "tituloSerie" => "Lancet Oncol" "fecha" => "2008" "volumen" => "9" "paginaInicial" => "1149" "paginaFinal" => "1156" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib0640" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical excision versus Mohs’ micrographic surgery for basal cell carcinoma of the face: a randomised clinical trial with 10 year follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejca.2014.08.018" "Revista" => array:6 [ "tituloSerie" => "Eur J Cancer" "fecha" => "2014" "volumen" => "50" "paginaInicial" => "3011" "paginaFinal" => "3020" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 49 => array:3 [ "identificador" => "bib0645" "etiqueta" => "50" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Basal cell carcinomas developing in solid organ transplant recipients: clinicopathologic study of 176 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.139.9.1133" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2003" "volumen" => "139" "paginaInicial" => "1133" "paginaFinal" => "1137" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 50 => array:3 [ "identificador" => "bib0650" "etiqueta" => "51" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinicopathologic features of skin cancer in organ transplant recipients: a retrospective case-control series" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2005.10.049" "Revista" => array:7 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2006" "volumen" => "54" "paginaInicial" => "290" "paginaFinal" => "300" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S0264410X16302110" "estado" => "S300" "issn" => "0264410X" ] ] ] ] ] ] ] 51 => array:3 [ "identificador" => "bib0655" "etiqueta" => "52" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aggressive behavior of nonmelanotic skin cancers in solid organ transplant recipients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/TP.0b013e3181ec7228" "Revista" => array:7 [ "tituloSerie" => "Transplantation" "fecha" => "2010" "volumen" => "90" "paginaInicial" => "683" "paginaFinal" => "687" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S0264410X15004739" "estado" => "S300" "issn" => "0264410X" ] ] ] ] ] ] ] 52 => array:3 [ "identificador" => "bib0660" "etiqueta" => "53" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ficha técnica de vismodegib [consultado 25 May 2017]. Available at: <a target="_blank" href="http://www.ema.europa.eu/docs/es%20ES/document%20library/EPAR-Product%20Information/human/002602/WC500146817.pdf">http://www.ema.europa.eu/docs/es ES/document library/EPAR-Product Information/human/002602/WC500146817.pdf</a>" ] ] ] 53 => array:3 [ "identificador" => "bib0665" "etiqueta" => "54" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy and safety of vismodegib in advanced basal-cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1113713" "Revista" => array:7 [ "tituloSerie" => "N Engl J Med" "fecha" => "2012" "volumen" => "366" "paginaInicial" => "2171" "paginaFinal" => "2179" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S0264410X17303730" "estado" => "S300" "issn" => "0264410X" ] ] ] ] ] ] ] 54 => array:3 [ "identificador" => "bib0670" "etiqueta" => "55" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pivotal ERIVANCE basal cell carcinoma (BCC) study: 12-month update of efficacy and safety of vismodegib in advanced BCC" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2015.03.021" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2015" "volumen" => "72" "paginaInicial" => "1021" "paginaFinal" => "1026" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 55 => array:3 [ "identificador" => "bib0675" "etiqueta" => "56" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Expanded access study of patients with advanced basal cell carcinoma treated with the Hedgehog pathway inhibitor, vismodegib" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2013.09.012" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2014" "volumen" => "70" "paginaInicial" => "60" "paginaFinal" => "69" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 56 => array:3 [ "identificador" => "bib0680" "etiqueta" => "57" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vismodegib in patients with advanced basal cell carcinoma (STEVIE): a pre-planned interim analysis of an international, open-label trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1470-2045(15)70198-1" "Revista" => array:6 [ "tituloSerie" => "Lancet Oncol" "fecha" => "2015" "volumen" => "16" "paginaInicial" => "729" "paginaFinal" => "736" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 57 => array:3 [ "identificador" => "bib0685" "etiqueta" => "58" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An investigator-initiated open-label clinical trial of vismodegib as a neoadjuvant to surgery for high-risk basal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2014.05.020" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2014" "volumen" => "71" "paginaInicial" => "904" "paginaFinal" => "911.e1" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 58 => array:3 [ "identificador" => "bib0690" "etiqueta" => "59" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update to an open-label clinical trial of vismodegib as neoadjuvant before surgery for high-risk basal cell carcinoma (BCC)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2016.02.1235" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2016" "volumen" => "75" "paginaInicial" => "213" "paginaFinal" => "215" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 59 => array:3 [ "identificador" => "bib0695" "etiqueta" => "60" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of neoadjuvant hedgehog inhibitor therapy on the surgical treatment of extensive basal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SAP.0000000000000452" "Revista" => array:8 [ "tituloSerie" => "Ann Plast Surg" "fecha" => "2015" "volumen" => "74" "numero" => "Suppl. 4" "paginaInicial" => "S193" "paginaFinal" => "S197" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S0264410X18315731" "estado" => "S300" "issn" => "0264410X" ] ] ] ] ] ] ] 60 => array:3 [ "identificador" => "bib0700" "etiqueta" => "61" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recurrence rates of treated basal cell carcinomas part 2: curettage-electrodesiccation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Dermatol Surg Oncol" "fecha" => "1991" "volumen" => "14" "paginaInicial" => "720" "paginaFinal" => "726" ] ] ] ] ] ] 61 => array:3 [ "identificador" => "bib0705" "etiqueta" => "62" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow up" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1524-4725.1989.tb03166.x" "Revista" => array:6 [ "tituloSerie" => "J Dermatol Surg Oncol" "fecha" => "1989" "volumen" => "15" "paginaInicial" => "315" "paginaFinal" => "328" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 62 => array:3 [ "identificador" => "bib0710" "etiqueta" => "63" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Occurrence of metachronous basal cell carcinomas: a prognostic model" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjd.15771" "Revista" => array:7 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2017" "volumen" => "177" "paginaInicial" => "1113" "paginaFinal" => "1121" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S0264410X15011688" "estado" => "S300" "issn" => "0264410X" ] ] ] ] ] ] ] 63 => array:3 [ "identificador" => "bib0715" "etiqueta" => "64" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "National Comprehensive Cancer Network. NCCN Guideline for Treatment of Basal Cell Skin Cancer [consultado 16 May 2017]. Available at: <a target="_blank" href="http://www.nccn.org/professionals/physician_gls/pdf/nmsc/pdf">http://www.nccn.org/professionals/physician_gls/pdf/nmsc/pdf</a>" ] ] ] 64 => array:3 [ "identificador" => "bib0720" "etiqueta" => "65" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European guidelines for topical photodynamic therapy part 1: Treatment delivery and current indications — actinic keratoses Bowen's disease, basal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jdv.12031" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2013" "volumen" => "27" "paginaInicial" => "536" "paginaFinal" => "544" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 65 => array:3 [ "identificador" => "bib0725" "etiqueta" => "66" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk of developing a subsequent nonmelanoma skin cancer in patients with a history of nonmelanoma skin cancer: a critical review of the literature and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.136.12.1524" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2000" "volumen" => "136" "paginaInicial" => "1524" "paginaFinal" => "1530" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 66 => array:3 [ "identificador" => "bib0730" "etiqueta" => "67" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High incidence of second basal cell skin cancers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ijc.22000" "Revista" => array:7 [ "tituloSerie" => "Int J Cancer" "fecha" => "2006" "volumen" => "119" "paginaInicial" => "1505" "paginaFinal" => "1507" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S0264410X09005404" "estado" => "S300" "issn" => "0264410X" ] ] ] ] ] ] ] 67 => array:3 [ "identificador" => "bib0735" "etiqueta" => "68" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk factors for single and multiple basal cell carcinomas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archdermatol.2010.155" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2010" "volumen" => "146" "paginaInicial" => "848" "paginaFinal" => "855" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 68 => array:3 [ "identificador" => "bib0740" "etiqueta" => "69" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Risk of subsequent basal cell carcinoma and squamous cell carcinoma of the skin among patients with prior skin cancer. Skin Cancer Prevention Study Group" "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "JAMA" "fecha" => "1992" "volumen" => "267" "paginaInicial" => "10" "paginaFinal" => "3305" ] ] ] ] ] ] 69 => array:3 [ "identificador" => "bib0745" "etiqueta" => "70" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cumulative risks and rates of subsequent basal cell carcinomas in the Netherlands" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2011.10488.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2011" "volumen" => "165" "paginaInicial" => "874" "paginaFinal" => "881" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 70 => array:3 [ "identificador" => "bib0750" "etiqueta" => "71" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Follow-up and prevention (basal cell carcinoma)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "editores" => "S.J.Miller, M.E.Maloney" "titulo" => "Cutaneous oncology pathophysiology, diagnosis and management" "paginaInicial" => "695" "paginaFinal" => "698" "serieFecha" => "1998" ] ] ] ] ] ] 71 => array:3 [ "identificador" => "bib0755" "etiqueta" => "72" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patients with both basal and squamous cell carcinomas are at a lower risk of further basal cell carcinomas than patients with only a basal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2009.03.015" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2009" "volumen" => "61" "paginaInicial" => "247" "paginaFinal" => "251" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 72 => array:3 [ "identificador" => "bib0760" "etiqueta" => "73" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk of subsequent cutaneous malignancy in patients with prior keratinocyte carcinoma: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejca.2013.03.010" "Revista" => array:6 [ "tituloSerie" => "Eur J Cancer" "fecha" => "2013" "volumen" => "49" "paginaInicial" => "2365" "paginaFinal" => "2375" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 73 => array:3 [ "identificador" => "bib0765" "etiqueta" => "74" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Basal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/1097-0142(20000901)89:5<1012::aid-cncr10>3.0.co;2-o" "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "2000" "volumen" => "89" "paginaInicial" => "1012" "paginaFinal" => "1018" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 74 => array:3 [ "identificador" => "bib0770" "etiqueta" => "75" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous basal cell carcinomas: distinct host factors are associated with the development of tumors on the trunk and head and neck" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/1097-0142(20010715)92:2<354::aid-cncr1330>3.0.co;2-f" "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "2001" "volumen" => "92" "paginaInicial" => "354" "paginaFinal" => "358" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 75 => array:3 [ "identificador" => "bib0775" "etiqueta" => "76" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Associations between ultraviolet radiation, basal cell carcinoma site and histology, host characteristics, and rate of development of further tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2004.08.060" "Revista" => array:7 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2005" "volumen" => "52" "numero" => "Pt 1" "paginaInicial" => "468" "paginaFinal" => "473" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 76 => array:3 [ "identificador" => "bib0780" "etiqueta" => "77" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predicting the risk of a second basal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/jid.2015.244" "Revista" => array:6 [ "tituloSerie" => "J Invest Dermatol" "fecha" => "2015" "volumen" => "135" "paginaInicial" => "2649" "paginaFinal" => "2656" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 77 => array:3 [ "identificador" => "bib0785" "etiqueta" => "78" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognostic factors for a subsequent basal cell carcinoma: implications for follow up" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2005.06911.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2005" "volumen" => "153" "paginaInicial" => "1078" "paginaFinal" => "1080" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 78 => array:3 [ "identificador" => "bib0790" "etiqueta" => "79" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for the management of basal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2008.08666.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2008" "volumen" => "159" "paginaInicial" => "35" "paginaFinal" => "48" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack465617" "titulo" => "Acknowledgments" "texto" => "The present guidelines form part of the White Paper on Skin Cancer of Fundación Piel Sana of the AEDV." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011100000004/v1_202006060751/S1578219020300834/v1_202006060751/en/main.assets" "Apartado" => array:4 [ "identificador" => "6228" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Consensus document" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011100000004/v1_202006060751/S1578219020300834/v1_202006060751/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219020300834?idApp=UINPBA000044"]

Statistics

Consensus Document

Diagnosis and Treatment of Basal Cell Carcinoma in Specialized Dermatology Units: A Clinical Practice Guideline

Carcinoma basocelular cutáneo: diagnóstico y tratamiento en atención especializada dermatológica. Guía de Práctica Clínica de la AEDV

F. Vílchez-Márqueza,

Corresponding author

fvilchezm@hotmail.com

Corresponding author.

, P. Borregón-Nofuentesb, L. Barchino-Ortizc, A. Ruíz-de-Casasd, I. Palacios-Álvareze, A. Soria-Rivasf, M.A. Descalzo-Gallegog, I. García-Dovalg,h, L. Ríos-Bucetai, P. Redondo-Bellóne

a Servicio de Dermatología, Hospital de Guadix, Guadix, Granada, Spain

b Servicio de Dermatología, Clínica Beteré-Marcos, Madrid, Spain

c Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain

d Servicio de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, Spain

e Servicio de Dermatología, Clínica Universidad de Navarra, Pamplona, Spain

f Servicio de Oncología, Hospital Universitario Ramón y Cajal, Madrid, Spain

g Unidad de Investigación, Fundación Piel Sana, Academia Española de Dermatología y Venereología, Madrid, Spain

h Servicio de Dermatología, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain

i Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain

Read

6768

Times
was read the article

2525

Total PDF

4243

Total HTML

Share statistics

 array:25 [
  "pii" => "S1578219020300834"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2020.04.009"
  "estado" => "S300"
  "fechaPublicacion" => "2020-05-01"
  "aid" => "2292"
  "copyright" => "AEDV"
  "copyrightAnyo" => "2020"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "pgl"
  "cita" => "Actas Dermosifiliogr. 2020;111:291-9"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:20 [
      "pii" => "S0001731020300016"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2019.07.006"
      "estado" => "S300"
      "fechaPublicacion" => "2020-05-01"
      "aid" => "2292"
      "copyright" => "AEDV"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "pgl"
      "cita" => "Actas Dermosifiliogr. 2020;111:291-9"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:1 [
        "total" => 0
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Documento de Consenso</span>"
        "titulo" => "Carcinoma basocelular cut&#225;neo&#58; diagn&#243;stico y tratamiento en atenci&#243;n especializada dermatol&#243;gica&#46; Gu&#237;a de Pr&#225;ctica Cl&#237;nica de la AEDV"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "291"
            "paginaFinal" => "299"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Diagnosis and Treatment of Basal Cell Carcinoma in Specialized Dermatology Units&#58; A Clinical Practice Guideline"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "F&#46; V&#237;lchez-M&#225;rquez, P&#46; Borreg&#243;n-Nofuentes, L&#46; Barchino-Ortiz, A&#46; Ru&#237;z-de-Casas, I&#46; Palacios-&#193;lvarez, A&#46; Soria-Rivas, M&#46;A&#46; Descalzo-Gallego, I&#46; Garc&#237;a-Doval, L&#46; R&#237;os-Buceta, P&#46; Redondo-Bell&#243;n"
            "autores" => array:10 [
              0 => array:2 [
                "nombre" => "F&#46;"
                "apellidos" => "V&#237;lchez-M&#225;rquez"
              ]
              1 => array:2 [
                "nombre" => "P&#46;"
                "apellidos" => "Borreg&#243;n-Nofuentes"
              ]
              2 => array:2 [
                "nombre" => "L&#46;"
                "apellidos" => "Barchino-Ortiz"
              ]
              3 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Ru&#237;z-de-Casas"
              ]
              4 => array:2 [
                "nombre" => "I&#46;"
                "apellidos" => "Palacios-&#193;lvarez"
              ]
              5 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Soria-Rivas"
              ]
              6 => array:2 [
                "nombre" => "M&#46;A&#46;"
                "apellidos" => "Descalzo-Gallego"
              ]
              7 => array:2 [
                "nombre" => "I&#46;"
                "apellidos" => "Garc&#237;a-Doval"
              ]
              8 => array:2 [
                "nombre" => "L&#46;"
                "apellidos" => "R&#237;os-Buceta"
              ]
              9 => array:2 [
                "nombre" => "P&#46;"
                "apellidos" => "Redondo-Bell&#243;n"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1578219020300834"
          "doi" => "10.1016/j.adengl.2020.04.009"
          "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/S1578219020300834?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731020300016?idApp=UINPBA000044"
      "url" => "/00017310/0000011100000004/v3_202009220625/S0001731020300016/v3_202009220625/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S1578219020301219"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2019.10.007"
    "estado" => "S300"
    "fechaPublicacion" => "2020-05-01"
    "aid" => "2294"
    "copyright" => "AEDV"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Actas Dermosifiliogr. 2020;111:300-5"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Predictive model for allergic contact dermatitis in patients with hand eczema"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "300"
          "paginaFinal" => "305"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Modelo predictivo de dermatitis al&#233;rgica de contacto en pacientes con eccema de manos"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "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" => 1429
              "Ancho" => 2168
              "Tamanyo" => 112343
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Area under the receiver operating characteristic curve &#40;AUC-ROC&#41; for the model applied to the validation data set&#46; The numbers shown on the curve correspond to cut-points&#46; The optimum cut-point that satisfies the criterion of proximity at the top right corer was <span class="elsevierStyleItalic">K</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;3&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "S&#46; Ponce, L&#46; Borrego, P&#46; Saavedra"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Ponce"
            ]
            1 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Borrego"
            ]
            2 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Saavedra"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S000173102030003X"
        "doi" => "10.1016/j.ad.2019.10.001"
        "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/S000173102030003X?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219020301219?idApp=UINPBA000044"
    "url" => "/15782190/0000011100000004/v1_202006060751/S1578219020301219/v1_202006060751/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S1578219020301232"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2019.06.007"
    "estado" => "S300"
    "fechaPublicacion" => "2020-05-01"
    "aid" => "2293"
    "copyright" => "AEDV"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "rev"
    "cita" => "Actas Dermosifiliogr. 2020;111:281-90"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Review</span>"
      "titulo" => "A review of terms used to define cutaneous squamous cell carcinoma with a poor prognosis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "281"
          "paginaFinal" => "290"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Revisi&#243;n de los t&#233;rminos que definen un carcinoma epidermoide cut&#225;neo asociado a mal pron&#243;stico"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46; Ca&#241;ueto, A&#46; Tejera-Vaquerizo, P&#46; Redondo, R&#46; Botella-Estrada, S&#46; Puig, O&#46; Sanmartin"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Ca&#241;ueto"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Tejera-Vaquerizo"
            ]
            2 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Redondo"
            ]
            3 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Botella-Estrada"
            ]
            4 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Puig"
            ]
            5 => array:2 [
              "nombre" => "O&#46;"
              "apellidos" => "Sanmartin"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731020300028"
        "doi" => "10.1016/j.ad.2019.06.005"
        "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/S0001731020300028?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219020301232?idApp=UINPBA000044"
    "url" => "/15782190/0000011100000004/v1_202006060751/S1578219020301232/v1_202006060751/en/main.assets"
  ]
  "en" => array:21 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Consensus Document</span>"
    "titulo" => "Diagnosis and Treatment of Basal Cell Carcinoma in Specialized Dermatology Units&#58; A Clinical Practice Guideline"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "291"
        "paginaFinal" => "299"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "F&#46; V&#237;lchez-M&#225;rquez, P&#46; Borreg&#243;n-Nofuentes, L&#46; Barchino-Ortiz, A&#46; Ru&#237;z-de-Casas, I&#46; Palacios-&#193;lvarez, A&#46; Soria-Rivas, M&#46;A&#46; Descalzo-Gallego, I&#46; Garc&#237;a-Doval, L&#46; R&#237;os-Buceta, P&#46; Redondo-Bell&#243;n"
        "autores" => array:10 [
          0 => array:4 [
            "nombre" => "F&#46;"
            "apellidos" => "V&#237;lchez-M&#225;rquez"
            "email" => array:1 [
              0 => "fvilchezm@hotmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "P&#46;"
            "apellidos" => "Borreg&#243;n-Nofuentes"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "L&#46;"
            "apellidos" => "Barchino-Ortiz"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Ru&#237;z-de-Casas"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "I&#46;"
            "apellidos" => "Palacios-&#193;lvarez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Soria-Rivas"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "aff0030"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "M&#46;A&#46;"
            "apellidos" => "Descalzo-Gallego"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "aff0035"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "I&#46;"
            "apellidos" => "Garc&#237;a-Doval"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "aff0035"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">h</span>"
                "identificador" => "aff0040"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "L&#46;"
            "apellidos" => "R&#237;os-Buceta"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">i</span>"
                "identificador" => "aff0045"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "P&#46;"
            "apellidos" => "Redondo-Bell&#243;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:9 [
          0 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital de Guadix&#44; Guadix&#44; Granada&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Cl&#237;nica Beter&#233;-Marcos&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital General Universitario Gregorio Mara&#241;&#243;n&#44; Madrid&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital Universitario Virgen Macarena&#44; Sevilla&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Cl&#237;nica Universidad de Navarra&#44; Pamplona&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
          5 => array:3 [
            "entidad" => "Servicio de Oncolog&#237;a&#44; Hospital Universitario Ram&#243;n y Cajal&#44; Madrid&#44; Spain"
            "etiqueta" => "f"
            "identificador" => "aff0030"
          ]
          6 => array:3 [
            "entidad" => "Unidad de Investigaci&#243;n&#44; Fundaci&#243;n Piel Sana&#44; Academia Espa&#241;ola de Dermatolog&#237;a y Venereolog&#237;a&#44; Madrid&#44; Spain"
            "etiqueta" => "g"
            "identificador" => "aff0035"
          ]
          7 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Complexo Hospitalario Universitario de Vigo&#44; Vigo&#44; Pontevedra&#44; Spain"
            "etiqueta" => "h"
            "identificador" => "aff0040"
          ]
          8 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital Universitario Ram&#243;n y Cajal&#44; Madrid&#44; Spain"
            "etiqueta" => "i"
            "identificador" => "aff0045"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Carcinoma basocelular cut&#225;neo&#58; diagn&#243;stico y tratamiento en atenci&#243;n especializada dermatol&#243;gica&#46; Gu&#237;a de Pr&#225;ctica Cl&#237;nica de la AEDV"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Skin cancer is a frequent disease in our setting&#46; The incidence of basal cell carcinoma is 253&#46;23 tumors &#40;95&#37; CI&#44; 273&#46;01&#8211;69&#46;45&#41; per 100 000 person-years&#44; and this may be increasing&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">1</span></a> Basal cell carcinoma accounts for 80&#37;&#8211;90&#37; of all cases of skin cancer and is the most frequently occurring form of cancer in humans&#46; It has major repercussions for quality of life in terms of functional and cosmetic morbidity and generates a considerable burden for dermatologists and the health system&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">2</span></a> Basal cell carcinoma can be treated using many approaches&#44; some are which are new&#46; Treatments vary in clinical practice and differ widely in terms of cost depending on the option selected&#46; Consequently&#44; clinical decision making becomes more complex&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">While clinical practice guidelines &#40;CPGs&#41; for management of basal cell carcinoma are available&#44; they apply to different settings and only partially cover the problems dermatologists consider to be the most relevant&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Therefore&#44; the Healthy Skin Foundation of the Spanish Academy of Dermatology and Venereology &#40;Fundaci&#243;n Piel Sana de la Academia Espa&#241;ola de Dermatolog&#237;a y Venereolog&#237;a &#91;AEDV&#93;&#41; has promoted the adaptation of CPGs for the main skin tumors&#44; which now form part of the AEDV White Paper on Skin Cancer &#40;Libro Blanco del C&#225;ncer Cut&#225;neo&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The objective of these guidelines is to adapt a series of recommendations to our setting&#46; The recommendations are based on the best evidence possible for decision making in the management of patients with basal cell carcinoma&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">As CPGs were already available&#44; we decided to adapt these using the ADAPTE method&#46; The steps followed during this process are summarized in the Supplementary Material &#40;Supplementary Material&#44; Section 1&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The panels were selected based on the experience in treating these tumors and on interest in participating in the CPGs among the Members of the Spanish Oncologic Dermatology and Surgery Group &#40;Grupo Espa&#241;ol de Dermato-Oncolog&#237;a y Cirug&#237;a &#91;GEDOC&#93;&#41; of the AEDV&#46; All of the panelists declared their conflicts of interest before participating&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The scope and objectives statement established the objective of the guidelines as that of providing indications on controversial aspects of diagnosis&#44; treatment &#40;medical and surgical&#41;&#44; and patient follow-up &#40;Supplementary Material&#44; Section 2&#41;&#46; The care setting for the CPGs is that of dermatology departments in Spain&#44; with dermatologists as the target users&#46; Prevention of basal cell carcinoma and patients with multiple tumor syndromes were excluded from the scope of the CPGs&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Following the ADAPTE method&#44; the subsequent steps involved a summary of the care process and formulation of relevant clinical questions for each step of the algorithm &#40;Supplementary Material&#44; Section 3&#41;&#46; The most relevant questions were selected based on consensus at a face-to-face meeting at the head office of the AEDV in October 2016&#46; In parallel&#44; guidelines were sought on web pages or in specific organizations and sources&#44; as well as in bodies that collect&#44; prepare&#44; or publish guidelines&#46; We also included the main academies of dermatology or cancer &#40;eg&#44; National Guidelines Clearinghouse&#44; Guidelines International Network&#44; Guiasalud&#44; Institute for Clinical Systems Improvement&#44; National Institute for Health and Care Excellence&#44; New Zealand Guidelines Group&#44; Scottish Intercollegiate Guidelines Network&#44; Cochrane Library&#44; British Association of Dermatologists&#44; American Academy of Dermatology&#44; European Academy of Dermatology and Venereology&#44; National Comprehensive Cancer Network&#41;&#46; The guidelines were subsequently reviewed and evaluated for their methodological quality using the Appraisal of Guidelines for Research and Evaluation &#40;AGREE&#41; II tool&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">5</span></a> The CPGs with the most favorable results were selected for consultation&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">This information was used to generate the recommendations&#44; which maintained the reference to the original source&#46; Retrievals&#44; the level of evidence&#44; and the grade of recommendation based on the levels of Oxford Centre for Evidence-Based Medicine were always established in pairs&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Once the draft version was complete&#44; the recommendations were published on the web page of the AEDV &#40;<a href="https://aedv.es/revision-de-las-recomendaciones-de-la-gpc-basocelular/">https&#58;&#47;&#47;aedv&#46;es&#47;revision-de-las-recomendaciones-de-la-gpc-basocelular&#47;</a>&#41; and underwent external review&#46; A review was requested from all those with an interest in the topic from the AEDV&#44; GEDOC&#44; and pharmaceutical industry&#44; as well as from oncologists&#46; The members of the panel evaluated the reviewers&#8217; objections&#44; and&#44; if these were considered relevant&#44; they were applied to the CPGs&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">The 4 highest-scoring guidelines whose objectives were consistent with the scope and objectives proposed were as follows&#58; British Association of Dermatologists&#44; National Comprehensive Cancer Network&#44; European Dermatology Forum&#44; and the European Academy of Dermatology and Venereology&#46; Despite their high scores in terms of quality&#44; the guidelines of the Agency for Healthcare Research and Quality and those of the National Institute for Health and Care Excellence were excluded because they were aimed at primary care and other specialists and did not address the questions proposed&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The clinical questions proposed and the recommendations of the CPGs are set out below&#46; The complete document of the CPGs&#44; which includes a discussion of each question&#44; is available as supplementary material &#40;Supplementary Material&#44; Section 4&#41;&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Section 1&#46; Second Intervention vs Observation in Basal Cell Carcinoma With Positive Margins</span><p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Question 1&#46;</span> In the case of patients with basal cell carcinoma with positive margins&#44; does a second intervention reduce the probability of recurrence compared with observation&#63;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Summary of Evidence</span><p id="par0070" class="elsevierStylePara elsevierViewall">Involvement of surgical margins is associated with a higher rate of recurrence after surgery&#44; especially in tumors that affect the center of the face&#44; high-risk histologic subtypes &#40;morpheaform&#44; micronodular&#44; infiltrative&#41;&#44; and when the positive margin is deep &#40;Level of evidence&#44; 2a&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0430"><span class="elsevierStyleSup">7&#8211;14</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Recommendations</span><p id="par0075" class="elsevierStylePara elsevierViewall">Incompletely excised basal cell carcinomas should be retreated&#44; especially if the center of the face is involved&#44; the deep margin is affected&#44; local flaps or grafts have been used to close the surgical wound&#44; or the histologic subtype is high-risk&#46; The therapeutic approach of choice is standard surgery or Mohs micrographic surgery &#40;especially if the abovementioned requisites are fulfilled&#41;&#46; Similarly&#44; clinical checkups could be considered in small nonaggressive tumors on the trunk &#40;Grade of recommendation&#44; B&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Section 2&#46; Radiotherapy vs Second Intervention in Basal Cell Carcinoma With Positive Margins</span><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Question 2&#46;</span> In patients with basal cell carcinoma and positive surgical margins&#44; does adjuvant radiotherapy reduce the probability of recurrence compared with a second intervention&#63;</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Summary of Evidence</span><p id="par0085" class="elsevierStylePara elsevierViewall">There are no studies comparing second intervention with adjuvant radiotherapy in basal cell carcinoma with positive surgical margins&#46; Guidelines recommend reintervention as the first option&#44; with radiotherapy reserved for patients who are not candidates for surgery &#40;contraindication&#44; surgical problems&#44; or patient refusal to undergo the procedure&#41; &#40;Level of evidence&#44; 4&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0470"><span class="elsevierStyleSup">15&#8211;18</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Recommendations</span><p id="par0090" class="elsevierStylePara elsevierViewall">Radiotherapy should be reserved for patients with basal cell carcinoma and positive surgical margins who are not candidates for a second intervention &#40;Grade of recommendation&#44; C&#41;&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Section 3&#46; Surgery vs Nonsurgical Treatment in Low-risk Basal Cell Carcinoma</span><p id="par0095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Question 3&#46;</span> In patients with low-risk basal cell carcinoma&#44; does nonsurgical treatment affect the probability of recurrence compared with surgery&#63;</p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Summary of Evidence</span><p id="par0100" class="elsevierStylePara elsevierViewall">Recurrence rates are lower with conventional surgery than with nonsurgical approaches&#46; Therefore&#44; conservative treatment should be reserved for cases that are not candidates for surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">19&#8211;21</span></a> Electrodessication and curettage may prove useful as treatment in low-risk basal cell carcinoma&#44; with a lower percentage of persistence of the tumor in carcinomas on the trunk and extremities &#40;Level of evidence&#44; 4&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0505"><span class="elsevierStyleSup">22&#8211;26</span></a> Cryosurgery may also be a good therapeutic option in low-risk basal cell carcinoma &#40;Level of evidence&#44; 3b&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0530"><span class="elsevierStyleSup">27&#8211;33</span></a> CO<span class="elsevierStyleInf">2</span> laser ablation and curettage would be particularly indicated in low-risk basal cell carcinoma in the form of large or multiple tumors &#40;Level of evidence&#44; 4&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">34</span></a> Imiquimod is useful in low-risk basal cell carcinoma&#44; mainly in superficial tumors&#44; and&#44; to a lesser extent&#44; in nodular tumors &#40;Level of evidence&#44; 1b&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0570"><span class="elsevierStyleSup">35&#44;36</span></a> Photodynamic therapy is also useful in superficial basal cell carcinoma&#44; with a higher recurrence rate in nodular basal cell carcinoma &#40;Level of evidence&#44; 1b&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0580"><span class="elsevierStyleSup">37&#8211;42</span></a> 5-Fluorouracil could be an option for treatment&#44; although there is insufficient evidence to support its use &#40;Level of evidence&#44; 4&#41;&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Recommendations</span><p id="par0105" class="elsevierStylePara elsevierViewall">Nonsurgical approaches are a good option for the management of low-risk basal cell carcinoma when surgery is not possible &#40;see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> for a summary of risk factors&#41;&#46; Electrodessication and curettage is useful in low-risk tumors&#44; especially when these are located on the trunk and extremities &#40;Grade of recommendation&#44; C&#41;&#46; Cryosurgery can also be used in low-risk basal cell carcinoma &#40;Grade of recommendation&#44; B&#41;&#46; Laser and curettage can be used to treat large or multiple tumors &#40;Grade of recommendation&#44; C&#41;&#46; Imiquimod is a good option for superficial basal cell carcinoma &#40;Grade of recommendation&#44; A&#41; and may prove useful in nodular tumors &#40;Grade of recommendation&#44; C&#41;&#46; Photodynamic therapy is also useful in superficial basal cell carcinoma &#40;Grade of recommendation&#44; A&#41; and&#44; to a lesser extent&#44; in nodular tumors &#40;Grade of recommendation&#44; B&#41;&#46; 5-Fluorouracil could also prove useful in the treatment of low-risk basal cell carcinoma &#40;Grade of recommendation&#44; C&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Section 4&#46; Effectiveness of Mohs Surgery</span><p id="par0110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Question 4&#46;</span> In patients with high-risk basal cell carcinoma&#44; does Mohs surgery reduce the probability of recurrence compared with conventional surgery&#63;</p><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Summary of Evidence</span><p id="par0115" class="elsevierStylePara elsevierViewall">Recurrence rates for Mohs micrographic surgery are lower than for conventional surgery in recurrent tumors &#40;Level of evidence&#44; 1b&#41;&#46; Data for primary tumors are not as clear&#46; Mohs surgery is particularly indicated in high-risk tumors&#44; especially those located on the face &#40;Level of evidence&#44; 1b&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0610"><span class="elsevierStyleSup">43&#8211;49</span></a></p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Recommendations</span><p id="par0120" class="elsevierStylePara elsevierViewall">Mohs micrographic surgery is the most appropriate treatment in high-risk basal cell carcinoma&#44; especially those located on the face&#44; and in recurrent tumors &#40;Grade of recommendation&#44; A&#41;&#46;</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Section 5&#46; Risk Associated With Immunosuppression</span><p id="par0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Question 5&#46;</span> In immunodepressed patients with low-risk basal cell carcinoma&#44; does surgical treatment affect the probability of recurrence compared with nonsurgical treatment&#63;</p><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Summary of Evidence</span><p id="par0130" class="elsevierStylePara elsevierViewall">There are no conclusive data that allow us to state that basal cell carcinoma in immunodepressed patients is riskier than in immunocompetent patients&#46; Similarly&#44; there are no studies comparing surgical treatment with conservative treatment in these patients&#46; However&#44; in the guidelines of the British Association of Dermatology and the National Comprehensive Cancer Network&#44; immunosuppression per se is considered an indicator of poor prognosis &#40;Level of evidence&#44; 5&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0645"><span class="elsevierStyleSup">50&#8211;52</span></a></p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Recommendations</span><p id="par0135" class="elsevierStylePara elsevierViewall">Basal cell carcinoma may be more aggressive in immunodepressed patients&#46; Therefore&#44; surgery should always be the first option&#44; and conservative treatments should be reserved for cases that are not candidates for surgery &#40;Grade of recommendation&#44; D&#41;&#46;</p></span></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Section 6&#46; Vismodegib vs Radiotherapy in Locally Advanced Basal Cell Carcinoma</span><p id="par0140" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Question 6&#46;</span> In patients with locally advanced basal cell carcinoma&#44; does treatment with vismodegib improve overall survival or disease-free survival compared with radiotherapy&#63;</p><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Summary of Evidence</span><p id="par0145" class="elsevierStylePara elsevierViewall">There are no studies comparing vismodegib with radiotherapy for the treatment of locally advanced basal cell carcinoma with respect to survival outcomes &#40;overall and disease-free&#41;&#46; Clinical trials with vismodegib include patients with basal cell carcinoma who have already received radiotherapy or for whom radiotherapy was considered contraindicated or inappropriate &#40;hypersensitivity to radiotherapy &#91;eg&#44; Gorlin syndrome&#93;&#44; limitations arising from the location of the tumor&#44; or cumulative doses of previous radiotherapy&#41; &#40;Level of evidence&#44; 5&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0660"><span class="elsevierStyleSup">53&#8211;57</span></a></p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Recommendations</span><p id="par0150" class="elsevierStylePara elsevierViewall">Vismodegib is effective for the treatment of locally advanced or metastatic basal cell carcinoma&#46; Its use is limited to those cases where the patient is not a candidate for surgery&#44; whether because of inoperability&#44; multiple recurrences&#44; or expected surgical morbidity &#40;severe disfigurement&#44; functional defect&#44; and&#47;or cosmetic defect not tolerated by the patient&#41; &#40;Grade of recommendation&#44; D&#41;&#46;</p></span></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Section 7&#46; Vismodegib in Neoadjuvant Therapy</span><p id="par0155" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Question 7&#46;</span> In patients with locally advanced basal cell carcinoma that is inoperable owing to the complexity of surgery&#44; does neoadjuvant vismodegib enable surgical rescue or reduce the complexity of surgery sufficiently to enable a second intervention compared with radiotherapy&#63;</p><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Summary of Evidence</span><p id="par0160" class="elsevierStylePara elsevierViewall">There are no studies comparing vismodegib with radiotherapy in terms of reducing the complexity of surgery&#46; Some studies suggest that vismodegib could be useful in neoadjuvant therapy by reducing the size of the tumor and enabling surgical rescue &#40;Level of evidence&#44; 4&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0685"><span class="elsevierStyleSup">58&#8211;60</span></a></p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Recommendations</span><p id="par0165" class="elsevierStylePara elsevierViewall">In cases of locally advanced basal cell carcinoma where it is difficult to treat the tumor with surgery&#44; treatment with vismodegib for some months could reduce the size of the tumor and thus enable surgery &#40;Grade of recommendation&#44; C&#41;&#46;</p></span></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Section 8&#46; Follow-up by Protocol or as Needed for Early Diagnosis of Recurrence</span><p id="par0170" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Question 8&#46;</span> In patients with high-risk basal cell carcinoma&#44; does follow-up by protocol facilitate early diagnosis in cases of recurrence compared with follow-up as needed&#63;</p><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0190">Summary of Evidence</span><p id="par0175" class="elsevierStylePara elsevierViewall">There are no studies comparing follow-up by protocol with follow-up as needed in patients with high-grade basal cell carcinoma&#46; Similarly&#44; no consensus has been reached on the frequency&#44; periodicity&#44; or total duration of follow-up&#46; However&#44; the different guidelines recommend long-term surveillance of these patients &#40;especially in patients with recurrent&#44; multiple&#44; and high-risk lesions&#41;&#44; with checkups every 6&#8211;12 months during the first 3&#8211;5 years&#46; Checkups can subsequently be scheduled further apart if no other skin tumors appear during this period&#46; Some guidelines recommend lifelong annual checkups as the ideal approach &#40;Level of evidence&#44; 5&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0700"><span class="elsevierStyleSup">61&#44;62</span></a></p></span><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0195">Recommendations</span><p id="par0180" class="elsevierStylePara elsevierViewall">In patients with high-risk basal cell carcinoma or recurrent or multiple lesions&#44; follow-up should be every 6&#8211;12 months for the first 3&#8211;5 years&#46; Follow-up visits can subsequently be scheduled further apart &#40;Grade of recommendation&#44; D&#41;&#46;</p></span></span><span id="sec0140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0200">Section 9&#46; Follow-up by Protocol vs Discharge and Follow-up as Needed in Low-risk Basal Cell Carcinoma</span><p id="par0185" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Question 9&#46;</span> In patients with low-risk basal cell carcinoma&#44; does follow-up by protocol facilitate early diagnosis in the case of recurrence compared with discharge and follow-up as needed&#63;</p><span id="sec0145" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0205">Summary of Evidence</span><p id="par0190" class="elsevierStylePara elsevierViewall">There are no studies comparing follow-up by protocol with checkups as needed or annual checkups in patients with low-grade basal cell carcinoma&#46; The risk of recurrence in patients with appropriately treated low-risk disease is reduced&#46; However&#44; patients with basal cell carcinoma have a greater risk of developing new skin tumors&#44; and this risk is increased in the short term &#40;Level of evidence&#58; 2a&#41;&#46; Therefore&#44; the ideal situation would involve regular follow-up of all patients with basal cell carcinoma at least once per year &#40;Level of evidence&#44; 5&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0700"><span class="elsevierStyleSup">61&#8211;63&#44;9</span></a></p></span><span id="sec0150" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0210">Recommendations</span><p id="par0195" class="elsevierStylePara elsevierViewall">It is recommended to arrange at least 1 follow-up visit in order to advise the patient on photoprotective measures&#44; the nature of the tumor&#44; and the risk of new lesions&#46; If possible&#44; patients with low-risk basal cell carcinoma should be followed up yearly &#40;Grade of recommendation&#44; D&#41;&#46;</p></span></span><span id="sec0155" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0215">Section 10&#46; Follow-up After Nonsurgical Techniques in Low-risk Basal Cell Carcinoma</span><p id="par0200" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Question 10&#46;</span> In patients with low-risk basal cell carcinoma treated with nonsurgical techniques &#40;electrodessication and curettage&#44; cryosurgery&#44; CO<span class="elsevierStyleInf">2</span> laser&#44; imiquimod&#44; photodynamic therapy&#44; and 5-fluorouracil&#41;&#44; does follow-up by protocol facilitate early diagnosis in the case of recurrence compared with consultation as needed by the patient&#63;</p><span id="sec0160" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0220">Summary of Evidence</span><p id="par0205" class="elsevierStylePara elsevierViewall">There are no studies comparing follow-up by protocol with consultation as needed by the patient with respect to early diagnosis in the case of recurrence&#46; It is important to remember that nonsurgical approaches are to be used mainly in low-risk basal cell carcinomas&#44; although these therapeutic modalities are associated with greater recurrence rates than standard surgery &#40;Level of evidence&#44; 5&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0715"><span class="elsevierStyleSup">64&#44;65</span></a></p></span><span id="sec0165" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0225">Recommendations</span><p id="par0210" class="elsevierStylePara elsevierViewall">Given the lack of sufficient evidence to support a follow-up protocol in these cases&#44; we would extrapolate the follow-up recommendations for low-risk basal cell carcinoma &#40;Grade of recommendation&#44; D&#41;&#46;</p></span></span><span id="sec0170" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0230">Section 11&#46; Patient Follow-up for Detection of New Carcinomas</span><p id="par0215" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Question 11&#46;</span> In patients previously diagnosed with basal cell carcinoma&#44; does follow-up by protocol facilitate early diagnosis of new basal cell carcinomas compared with consultation requested by the patient&#63;</p><span id="sec0175" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0235">Summary of Evidence</span><p id="par0220" class="elsevierStylePara elsevierViewall">All patients with basal cell carcinoma have a greater risk of developing new basal cell carcinomas&#44; squamous cell carcinoma&#44; and melanoma&#44; and this risk is greater during the first 3&#8211;5 years &#40;Level of evidence&#44; 2a&#41;&#46; The number of previous basal cell carcinomas is the best predictor of new basal cell carcinomas &#40;Level of evidence&#44; 1b&#41;&#46; Therefore&#44; some experts recommend periodic follow-up of all patients with basal cell carcinoma at least once per year &#40;Level of evidence&#44; 5&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0710"><span class="elsevierStyleSup">63&#44;66&#8211;79</span></a></p></span><span id="sec0180" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0240">Recommendations</span><p id="par0225" class="elsevierStylePara elsevierViewall">At least 1 follow-up visit should be scheduled in order to advise the patient on photoprotective measures&#44; explain the risk of developing new lesions&#44; and highlight the importance of self-monitoring&#46; If the health system allows&#44; patients with basal cell carcinoma should be followed-up at least annually &#40;Grade of recommendation&#44; D&#41;&#46;</p></span></span></span><span id="sec0185" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0245">Discussion</span><p id="par0230" class="elsevierStylePara elsevierViewall">The CPG we adapted based on other recent guidelines can aid decision making in the field of dermatology-oncology&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">The main advantages of the present study were its rigorous and reproducible methodology&#44; the fact that the findings were applied to our setting&#44; and the external review by professionals from various disciplines before publication&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">A limitation to the approach adopted here could be the fact that the panelists were all dermatologists&#46; We followed this approach because the scope and objectives statement limited the CPGs to dermatology&#44; the original CPGs are multidisciplinary&#44; and the draft versions of the CPGs underwent multidisciplinary external review&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">The recommendations will remain in force but must be reviewed during the next 3 years&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">As with any guidelines&#44; these recommendations are not mandatory but should be applied with some flexibility depending on local availability of resources&#44; the physician&#39;s experience&#44; and the patient&#39;s preferences&#46;</p></span><span id="sec0190" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0250">Funding</span><p id="par0255" class="elsevierStylePara elsevierViewall">The AEDV White Paper on Skin Cancer was fully funded by <span class="elsevierStyleGrantSponsor" id="gs1">Fundaci&#243;n Piel Sana AEDV</span>&#46; Neither external companies nor the pharmaceutical industry played a role in its drafting &#40;except for possible external review &#91;Roche Pharma&#93;&#44; as with other interested parties&#41;&#46;</p></span><span id="sec0195" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0255">Conflicts of Interest</span><p id="par0260" class="elsevierStylePara elsevierViewall">A&#46; Ruiz-de-Casas and P&#46; Redondo-Bell&#243;n have given paid talks for Roche&#46; I&#46; Palacios-&#193;lvarez has given paid talks for Roche and IFC&#46; The remaining authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:3 [
          "identificador" => "xres1344882"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Background and objective"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Material and methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1237564"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1344881"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Antecedentes y objetivo"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Materiales y m&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1237563"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Material and Methods"
        ]
        6 => array:3 [
          "identificador" => "sec0015"
          "titulo" => "Results"
          "secciones" => array:11 [
            0 => array:3 [
              "identificador" => "sec0020"
              "titulo" => "Section 1&#46; Second Intervention vs Observation in Basal Cell Carcinoma With Positive Margins"
              "secciones" => array:2 [
                0 => array:2 [
                  "identificador" => "sec0025"
                  "titulo" => "Summary of Evidence"
                ]
                1 => array:2 [
                  "identificador" => "sec0030"
                  "titulo" => "Recommendations"
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "sec0035"
              "titulo" => "Section 2&#46; Radiotherapy vs Second Intervention in Basal Cell Carcinoma With Positive Margins"
              "secciones" => array:2 [
                0 => array:2 [
                  "identificador" => "sec0040"
                  "titulo" => "Summary of Evidence"
                ]
                1 => array:2 [
                  "identificador" => "sec0045"
                  "titulo" => "Recommendations"
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "sec0050"
              "titulo" => "Section 3&#46; Surgery vs Nonsurgical Treatment in Low-risk Basal Cell Carcinoma"
              "secciones" => array:2 [
                0 => array:2 [
                  "identificador" => "sec0055"
                  "titulo" => "Summary of Evidence"
                ]
                1 => array:2 [
                  "identificador" => "sec0060"
                  "titulo" => "Recommendations"
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "sec0065"
              "titulo" => "Section 4&#46; Effectiveness of Mohs Surgery"
              "secciones" => array:2 [
                0 => array:2 [
                  "identificador" => "sec0070"
                  "titulo" => "Summary of Evidence"
                ]
                1 => array:2 [
                  "identificador" => "sec0075"
                  "titulo" => "Recommendations"
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "sec0080"
              "titulo" => "Section 5&#46; Risk Associated With Immunosuppression"
              "secciones" => array:2 [
                0 => array:2 [
                  "identificador" => "sec0085"
                  "titulo" => "Summary of Evidence"
                ]
                1 => array:2 [
                  "identificador" => "sec0090"
                  "titulo" => "Recommendations"
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "sec0095"
              "titulo" => "Section 6&#46; Vismodegib vs Radiotherapy in Locally Advanced Basal Cell Carcinoma"
              "secciones" => array:2 [
                0 => array:2 [
                  "identificador" => "sec0100"
                  "titulo" => "Summary of Evidence"
                ]
                1 => array:2 [
                  "identificador" => "sec0105"
                  "titulo" => "Recommendations"
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "sec0110"
              "titulo" => "Section 7&#46; Vismodegib in Neoadjuvant Therapy"
              "secciones" => array:2 [
                0 => array:2 [
                  "identificador" => "sec0115"
                  "titulo" => "Summary of Evidence"
                ]
                1 => array:2 [
                  "identificador" => "sec0120"
                  "titulo" => "Recommendations"
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "sec0125"
              "titulo" => "Section 8&#46; Follow-up by Protocol or as Needed for Early Diagnosis of Recurrence"
              "secciones" => array:2 [
                0 => array:2 [
                  "identificador" => "sec0130"
                  "titulo" => "Summary of Evidence"
                ]
                1 => array:2 [
                  "identificador" => "sec0135"
                  "titulo" => "Recommendations"
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "sec0140"
              "titulo" => "Section 9&#46; Follow-up by Protocol vs Discharge and Follow-up as Needed in Low-risk Basal Cell Carcinoma"
              "secciones" => array:2 [
                0 => array:2 [
                  "identificador" => "sec0145"
                  "titulo" => "Summary of Evidence"
                ]
                1 => array:2 [
                  "identificador" => "sec0150"
                  "titulo" => "Recommendations"
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "sec0155"
              "titulo" => "Section 10&#46; Follow-up After Nonsurgical Techniques in Low-risk Basal Cell Carcinoma"
              "secciones" => array:2 [
                0 => array:2 [
                  "identificador" => "sec0160"
                  "titulo" => "Summary of Evidence"
                ]
                1 => array:2 [
                  "identificador" => "sec0165"
                  "titulo" => "Recommendations"
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "sec0170"
              "titulo" => "Section 11&#46; Patient Follow-up for Detection of New Carcinomas"
              "secciones" => array:2 [
                0 => array:2 [
                  "identificador" => "sec0175"
                  "titulo" => "Summary of Evidence"
                ]
                1 => array:2 [
                  "identificador" => "sec0180"
                  "titulo" => "Recommendations"
                ]
              ]
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0185"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0190"
          "titulo" => "Funding"
        ]
        9 => array:2 [
          "identificador" => "sec0195"
          "titulo" => "Conflicts of Interest"
        ]
        10 => array:2 [
          "identificador" => "xack465617"
          "titulo" => "Acknowledgments"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-10-14"
    "fechaAceptado" => "2019-07-13"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1237564"
          "palabras" => array:5 [
            0 => "Basal cell carcinoma"
            1 => "Clinical practice guidelines"
            2 => "Neoplasms of skin"
            3 => "Therapy"
            4 => "Evidence-based medicine"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1237563"
          "palabras" => array:5 [
            0 => "Carcinoma basocelular"
            1 => "Gu&#237;a de pr&#225;ctica cl&#237;nica"
            2 => "Neoplasias de piel"
            3 => "Terapia"
            4 => "Medicina basada en la evidencia"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Basal cell carcinoma &#40;BCC&#41; is the most common skin cancer in the general population&#46; BCC is managed in a variety of ways&#44; and available international guidelines are difficult to put into practice in Spain&#46; This guideline aims to improve the management of BCC based on current evidence and provide a point of reference for Spanish dermatologists&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Members of the Spanish Oncologic Dermatology and Surgery Group &#40;GEDOC&#41; with experience treating BCC were invited to participate in drafting this guideline&#46; The drafters used the ADAPTE collaboration process to develop the new guideline based on existing ones&#44; first summarizing the care pathway and posing relevant clinical questions&#46; They then searched for guidelines&#44; assessed them with the AGREE II &#40;Appraisal of Guidelines for Research and Evaluation&#41; tool&#44; and searched the selected guidelines for answers to the clinical questions&#46; Finally&#44; the recommendations were drafted and submitted for external review&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The highest-scoring guidelines were from the Association of Dermatologists&#44; the National Comprehensive Cancer Network&#44; the European Dermatology Forum&#44; and the European Academy of Dermatology and Venereology&#46; A total of 11 clinical questions were answered&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This new guideline answers the working group&#39;s clinical questions about the routine management of BCC in Spain&#46; It provides dermatologists with a tool they can use for decision-making while taking into consideration the resources available and patient preferences&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background and objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El carcinoma basocelular supone el c&#225;ncer de piel m&#225;s frecuente en la poblaci&#243;n&#46; Hay una gran variabilidad en su manejo y las diferentes gu&#237;as extranjeras que existen son dif&#237;cilmente aplicables en nuestro medio&#46; El objetivo de la presente gu&#237;a es servir de referencia a los dermat&#243;logos espa&#241;oles para mejorar el manejo de este tumor bas&#225;ndose en la evidencia actual&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se escogi&#243; a miembros del Grupo Espa&#241;ol de Dermato-Oncolog&#237;a y Cirug&#237;a &#40;GEDOC&#41; con experiencia en el tratamiento de estos tumores y con inter&#233;s en participar en la elaboraci&#243;n de la gu&#237;a&#46; Se hizo una adaptaci&#243;n de las gu&#237;as de pr&#225;ctica cl&#237;nica existentes mediante el m&#233;todo ADAPTE&#44; se resumi&#243; el proceso de atenci&#243;n&#44; y se elaboraron las preguntas cl&#237;nicas relevantes&#46; Se seleccionaron las gu&#237;as mejor puntuadas mediante el instrumento AGREE II&#44; realizando la b&#250;squeda de las respuestas en dichas gu&#237;as y elaborando posteriormente las recomendaciones&#46; Finalmente se someti&#243; la gu&#237;a a revisi&#243;n externa&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Las gu&#237;as con mejor puntuaci&#243;n fueron las de la <span class="elsevierStyleItalic">British Association of Dermatologits</span> &#40;BAD&#41;&#44; del <span class="elsevierStyleItalic">National Comprehensive Cancer Network</span> &#40;NCCN&#41;&#44; del <span class="elsevierStyleItalic">European Dermatology Forum</span> &#40;EDF&#41; y de la <span class="elsevierStyleItalic">European Academy of Dermatology and Venereology</span> &#40;EADV&#41;&#46; Se obtuvieron en total 11 preguntas cl&#237;nicas&#44; contestadas a partir de estas gu&#237;as&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Esta gu&#237;a responde a preguntas habituales sobre el manejo del carcinoma basocelular en la pr&#225;ctica cl&#237;nica diaria y sirve a los dermat&#243;logos como referencia en la toma de decisiones&#44; siempre teniendo en cuenta los recursos y las preferencias del paciente&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Antecedentes y objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Materiales y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; V&#237;lchez-M&#225;rquez F&#44; Borreg&#243;n-Nofuentes P&#44; Barchino-Ortiz L&#44; Ru&#237;z-de-Casas A&#44; Palacios-&#193;lvarez I&#44; Soria-Rivas A&#44; et al&#46; Carcinoma basocelular cut&#225;neo&#58; diagn&#243;stico y tratamiento en atenci&#243;n especializada dermatol&#243;gica&#46; Gu&#237;a de Pr&#225;ctica Cl&#237;nica de la AEDV&#46; Actas Dermosifiliogr&#46; 2020&#59;111&#58;291&#8211;299&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0275" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary Data"
            "identificador" => "sec0205"
          ]
        ]
      ]
    ]
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Area H&#58; center of the face&#44; eyelids&#44; eyebrows&#44; periorbital skin&#44; nose&#44; lips&#44; chin&#44; mandible&#44; preauricular area&#44; retroauricular area&#44; pinna&#44; temple&#44; genitals&#44; hands&#44; and feet&#46; Area L&#58; trunk and extremities&#46; Area M&#58; cheeks&#44; forehead&#44; neck&#44; scalp&#44; and neck&#46;</p>"
          "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"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Low Risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">High Risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></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  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Clinical criteria</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Location&#47;Size&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Area L&#60;20<span class="elsevierStyleHsp" style=""></span>mmArea M&#60;10<span class="elsevierStyleHsp" style=""></span>mmArea H&#60;6<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Area L&#62;20<span class="elsevierStyleHsp" style=""></span>mmArea M&#62;10<span class="elsevierStyleHsp" style=""></span>mmArea H&#62;6<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Borders&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Well defined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poorly defined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Primary vs recurrent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Recurrent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Immunosuppression&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Previous radiotherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Histopathologic criteria</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Subtype&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nodular&#47;Superficial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sclerodermiform&#44; basosquamous&#44; sclerosing&#44; infiltrative&#44; micronodular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Perineural invasion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2307215.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Risk Factors&#46;</p>"
        ]
      ]
      1 => array:5 [
        "identificador" => "upi0005"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Ecomponente" => array:2 [
          "fichero" => "mmc1.pdf"
          "ficheroTamanyo" => 543840
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:79 [
            0 => array:3 [
              "identificador" => "bib0400"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skin cancer incidence and mortality in Spain&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Tejera-Vaquerizo"
                            1 => "M&#46;A&#46; Descalzo-Gallego"
                            2 => "M&#46;M&#46; Otero-Rivas"
                            3 => "C&#46; Posada-Garc&#237;a"
                            4 => "L&#46; Rodr&#237;guez-Pazos"
                            5 => "I&#46; Pastushenko"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ad.2015.12.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2016"
                        "volumen" => "107"
                        "paginaInicial" => "318"
                        "paginaFinal" => "328"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26852370"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0405"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outpatient dermatological diagnoses in Spain&#58; results from the National DIADERM Random Sampling Project"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Buend&#237;a-Eisman"
                            1 => "S&#46; Arias-Santiago"
                            2 => "A&#46; Molina-Leyva"
                            3 => "Y&#46; Gilaberte"
                            4 => "P&#46; Fern&#225;ndez-Crehuet"
                             …1
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ad.2018.02.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2018"
                        "volumen" => "109"
                        "paginaInicial" => "416"
                        "paginaFinal" => "423"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0410"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Grupo de trabajo sobre actualizaci&#243;n de GPC&#46; Actualizaci&#243;n de Gu&#237;as de Pr&#225;ctica Cl&#237;nica en el Sistema Nacional de Salud&#46; Manual Metodol&#243;gico&#46; Plan de Calidad para el Sistema Nacional de Salud del Ministerio de Sanidad y Pol&#237;tica Social&#46; Instituto Aragon&#233;s de Ciencias de la Salud-I&#43;CS&#59; 2009&#46; Gu&#237;as de Pr&#225;ctica Cl&#237;nica en el SNS&#58; I&#43;CS N&#46;&#176; 2007&#47;02-01&#46;"
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0415"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guideline adaptation&#58; an approach to enhance efficiency in guideline development and improve utilisation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmjqs.2010.043257"
                      "Revista" => array:7 [
                        "tituloSerie" => "BMJ Qual Saf"
                        "fecha" => "2011"
                        "volumen" => "20"
                        "paginaInicial" => "228"
                        "paginaFinal" => "236"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0264410X1630264X"
                          "estado" => "S300"
                          "issn" => "0264410X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0420"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "AGREEII&#58; advancing guideline development&#44; reporting and evaluation in health care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jclinepi.2010.07.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Epidemiol"
                        "fecha" => "2010"
                        "volumen" => "63"
                        "paginaInicial" => "1308"
                        "paginaFinal" => "1311"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0425"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Oxford Centre for Evidence-based Medicine &#8212; Levels of Evidence &#40;March 2009&#41;&#46; Available at&#58; <a target="_blank" href="https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/">https&#58;&#47;&#47;www&#46;cebm&#46;net&#47;2009&#47;06&#47;oxford-centre-evidence-based-medicine-levels-evidence-march-2009&#47;</a> &#91;Accessed 21 Jun 2018&#93;"
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0430"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Positive margins in basal cell carcinoma&#58; relationship to clinical features and recurrence risk&#46; A retrospective study of 248 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1046/j.1468-3083.2003.00535.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
                        "fecha" => "2003"
                        "volumen" => "17"
                        "paginaInicial" => "167"
                        "paginaFinal" => "170"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0435"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recurrence rate of positive margin basal cell carcinoma&#58; results of a five-year prospective study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/jso.2930280117"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Surg Oncol"
                        "fecha" => "1985"
                        "volumen" => "28"
                        "paginaInicial" => "72"
                        "paginaFinal" => "74"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0440"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Basal cell carcinomas&#58; do they need to be followed up&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J R Coll Surg Edinb"
                        "fecha" => "1994"
                        "volumen" => "39"
                        "paginaInicial" => "109"
                        "paginaFinal" => "111"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0445"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Excision limits and reoperation in cutaneous carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Dermatol Venereol"
                        "fecha" => "1997"
                        "volumen" => "124"
                        "paginaInicial" => "421"
                        "paginaFinal" => "426"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0264410X14012547"
                          "estado" => "S300"
                          "issn" => "0264410X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0450"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical management of incompletely excised basal cell carcinomas of the head and neck"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bjoms.2004.02.030"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Oral Maxillofac Surg"
                        "fecha" => "2004"
                        "volumen" => "42"
                        "paginaInicial" => "311"
                        "paginaFinal" => "314"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0455"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Histological evolution of recurrent basal cell carcinoma and therapeutic implications for incompletely excised lesions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2004.06135.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2004"
                        "volumen" => "151"
                        "paginaInicial" => "623"
                        "paginaFinal" => "626"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0460"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recurrent basal cell carcinoma after incomplete resection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archderm.136.1.24"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "2000"
                        "volumen" => "136"
                        "paginaInicial" => "24"
                        "paginaFinal" => "1318"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0465"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The use of Mohs micrographic surgery for determination of residual tumor in incompletely excised basal cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/0190-9622(92)70106-p"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "1992"
                        "volumen" => "26"
                        "numero" => "Pt 1"
                        "paginaInicial" => "754"
                        "paginaFinal" => "756"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0470"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A management approach to incompletely excised basal cell carcinomas of skin"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/0360-3016(91)90052-6"
                      "Revista" => array:7 [
                        "tituloSerie" => "Int J Radiat Oncol Biol Phys"
                        "fecha" => "1991"
                        "volumen" => "20"
                        "paginaInicial" => "423"
                        "paginaFinal" => "428"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0002937811004558"
                          "estado" => "S300"
                          "issn" => "00029378"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0475"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Radiotherapy of recurrent basal and squamous cell skin carcinomas&#58; a study of 249 retreated carcinomas in 229 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Dermatol"
                        "fecha" => "2001"
                        "volumen" => "11"
                        "paginaInicial" => "25"
                        "paginaFinal" => "28"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0480"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Update of the European guidelines for basal cell carcinoma management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1684/ejd.2014.2271"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Dermatol"
                        "fecha" => "2014"
                        "volumen" => "24"
                        "paginaInicial" => "312"
                        "paginaFinal" => "329"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0485"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Radiotherapy for perineural invasion in cutaneous head and neck carcinomas&#58; toward a risk-adapted treatment approach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hed.20991"
                      "Revista" => array:6 [
                        "tituloSerie" => "Head Neck"
                        "fecha" => "2009"
                        "volumen" => "31"
                        "paginaInicial" => "604"
                        "paginaFinal" => "610"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0490"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical treatment of basal cell carcinomas using standard postoperative histological assessment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1440-0960.2006.00216.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Australas J Dermatol"
                        "fecha" => "2006"
                        "volumen" => "47"
                        "paginaInicial" => "1"
                        "paginaFinal" => "12"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0022347617313112"
                          "estado" => "S300"
                          "issn" => "00223476"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0495"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Curative and aesthetic results of surgical treatment of 138 basal-cell carcinomas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.1982.tb00302.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Dermatol Surg Oncol"
                        "fecha" => "1982"
                        "volumen" => "8"
                        "paginaInicial" => "379"
                        "paginaFinal" => "387"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0500"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Do basal cell carcinomas recur after complete conventional surgical excision&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bjps.2005.02.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Plast Surg"
                        "fecha" => "2005"
                        "volumen" => "58"
                        "paginaInicial" => "795"
                        "paginaFinal" => "805"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0505"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of basal cell carcinoma with curettage alone"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2006.01.041"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2006"
                        "volumen" => "54"
                        "paginaInicial" => "1039"
                        "paginaFinal" => "1045"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0510"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of basal cell epithelioma by curettage and electrodesiccation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0190-9622(84)80457-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "1984"
                        "volumen" => "11"
                        "paginaInicial" => "808"
                        "paginaFinal" => "814"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0515"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Curettage-electrodesiccation treatment of basal cell carcinomas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "1977"
                        "volumen" => "113"
                        "paginaInicial" => "439"
                        "paginaFinal" => "443"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0264410X12015253"
                          "estado" => "S300"
                          "issn" => "0264410X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0520"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Basal cell carcinoma on the lower extremity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.1994.tb01621.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Dermatol Surg Oncol"
                        "fecha" => "1994"
                        "volumen" => "20"
                        "paginaInicial" => "258"
                        "paginaFinal" => "259"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0525"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Failure of curettage and electrodesiccation for removal of basal cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "1984"
                        "volumen" => "120"
                        "paginaInicial" => "1456"
                        "paginaFinal" => "1460"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0530"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evidence-based review of the use of cryosurgery in treatment of basal cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2003"
                        "volumen" => "29"
                        "paginaInicial" => "566"
                        "paginaFinal" => "571"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0535"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cryosurgery of basal cell carcinoma&#58; a study of 358 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Dermatol Venereol"
                        "fecha" => "2000"
                        "volumen" => "127"
                        "paginaInicial" => "175"
                        "paginaFinal" => "179"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0540"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The five-year cure rate achieved by cryosurgery for skin cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/0190-9622(91)70160-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "1991"
                        "volumen" => "24"
                        "paginaInicial" => "1002"
                        "paginaFinal" => "1004"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0545"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cryosurgery for skin cancer&#58; 30-year experience and cure rates"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2004.30090.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2004"
                        "volumen" => "30"
                        "paginaInicial" => "297"
                        "paginaFinal" => "300"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0550"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of basal-cell carcinoma&#58; comparison of radiotherapy and cryotherapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0009-9260(86)80161-1"
                      "Revista" => array:7 [
                        "tituloSerie" => "Clin Radiol"
                        "fecha" => "1986"
                        "volumen" => "37"
                        "paginaInicial" => "33"
                        "paginaFinal" => "34"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0264410X13003654"
                          "estado" => "S300"
                          "issn" => "0264410X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0555"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cryosurgery in difficult to treat basal cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Dermatol"
                        "fecha" => "2000"
                        "volumen" => "39"
                        "paginaInicial" => "223"
                        "paginaFinal" => "229"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0560"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cryotherapy for eyelid and periocular basal cell carcinomas&#58; outcome in 166 cases over an 8-year period"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/BF00183593"
                      "Revista" => array:6 [
                        "tituloSerie" => "Graefes Arch Clin Exp Ophthalmol"
                        "fecha" => "1995"
                        "volumen" => "233"
                        "paginaInicial" => "205"
                        "paginaFinal" => "208"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0565"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrapulse CO<span class="elsevierStyleInf">2</span> used for the successful treatment of basal cell carcinomas found in patients with basal cell nevus syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1046/j.1524-4725.2002.01080.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2002"
                        "volumen" => "28"
                        "paginaInicial" => "287"
                        "paginaFinal" => "290"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0570"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Imiquimod 5&#37; cream for the treatment of superficial basal cell carcinoma&#58; results from two phase III&#44; randomized&#44; vehicle-controlled studies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2003.11.066"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2004"
                        "volumen" => "50"
                        "paginaInicial" => "722"
                        "paginaFinal" => "733"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0575"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cost-effectiveness of treatment of superficial basal cell carcinoma&#58; surgical excision vs&#46; imiquimod 5&#37; cream"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2006.07726.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2007"
                        "volumen" => "156"
                        "paginaInicial" => "769"
                        "paginaFinal" => "771"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0580"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Photodynamic therapy using topical methyl aminolevulinate vs surgery for nodular basal cell carcinoma&#46; Results of a multicenter randomized prospective trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archderm.140.1.17"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "2004"
                        "volumen" => "140"
                        "paginaInicial" => "17"
                        "paginaFinal" => "23"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0585"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Five year follow-up of a randomized&#44; prospective trial of methyl aminolevulinate photodynamic therapy vs surgery for nodular basal cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archderm.143.9.1131"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "2007"
                        "volumen" => "143"
                        "paginaInicial" => "1131"
                        "paginaFinal" => "1136"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0590"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fractionated aminolevulinic acid-photodynamic therapy provides additional evidence for the use of PDT for non-melanoma skin cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1468-3083.2007.02445.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
                        "fecha" => "2008"
                        "volumen" => "22"
                        "paginaInicial" => "426"
                        "paginaFinal" => "430"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0264410X14010743"
                          "estado" => "S300"
                          "issn" => "0264410X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0595"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fractionated 5-aminolaevulinic acid-photodynamic therapy vs&#46; surgical excision in the treatment of nodular basal cell carcinoma&#58; results of a randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2008.08787.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2008"
                        "volumen" => "159"
                        "paginaInicial" => "864"
                        "paginaFinal" => "870"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0600"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A clinical study comparing methyl aminolevulinate photodynamic therapy and surgery in small superficial basal cell carcinoma &#40;8&#8211;20<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; with a 12-month followup"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1468-3083.2008.02803.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
                        "fecha" => "2008"
                        "volumen" => "22"
                        "paginaInicial" => "1302"
                        "paginaFinal" => "1311"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0605"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A randomized study of minimal curettage followed by topical photodynamic therapy compared with surgical excision for low risk nodular BCC"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2007.07996.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2007"
                        "volumen" => "157"
                        "paginaInicial" => "401"
                        "paginaFinal" => "403"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0264410X14013206"
                          "estado" => "S300"
                          "issn" => "0264410X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0610"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term recurrence rates in previously untreated &#40;primary&#41; basal cell carcinoma&#58; Implications for patient follow-up"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Dermatol Surg Oncol"
                        "fecha" => "1989"
                        "volumen" => "15"
                        "paginaInicial" => "315"
                        "paginaFinal" => "328"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0615"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Australian Mohs database&#44; part II&#58; periocular basal cell carcinoma outcome at 5-year follow-up"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ophtha.2003.11.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ophthalmology"
                        "fecha" => "2004"
                        "volumen" => "111"
                        "paginaInicial" => "631"
                        "paginaFinal" => "636"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0620"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Basal cell carcinoma treated with Mohs surgery in Australia II&#46; Outcome at 5-year follow-up"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2005.04.087"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2005"
                        "volumen" => "53"
                        "paginaInicial" => "452"
                        "paginaFinal" => "457"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0625"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mohs&#8217; micrographic surgery for treatment of basal cell carcinoma of the face&#58; results of a retrospective study and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2004.06047.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2004"
                        "volumen" => "151"
                        "paginaInicial" => "141"
                        "paginaFinal" => "147"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0630"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Five-year results of Mohs&#8217; micrographic surgery for aggressive facial basal cell carcinoma in Sweden"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/000155599750010292"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Derm Venereol"
                        "fecha" => "1999"
                        "volumen" => "79"
                        "paginaInicial" => "370"
                        "paginaFinal" => "372"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0635"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical excision versus Mohs&#8217; micrographic surgery for primary and recurrent basal-cell carcinoma of the face&#58; a prospective randomised controlled trial with 5-years&#8217; follow-up"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S1470-2045(08)70260-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Oncol"
                        "fecha" => "2008"
                        "volumen" => "9"
                        "paginaInicial" => "1149"
                        "paginaFinal" => "1156"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib0640"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical excision versus Mohs&#8217; micrographic surgery for basal cell carcinoma of the face&#58; a randomised clinical trial with 10 year follow-up"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejca.2014.08.018"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cancer"
                        "fecha" => "2014"
                        "volumen" => "50"
                        "paginaInicial" => "3011"
                        "paginaFinal" => "3020"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib0645"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Basal cell carcinomas developing in solid organ transplant recipients&#58; clinicopathologic study of 176 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archderm.139.9.1133"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "2003"
                        "volumen" => "139"
                        "paginaInicial" => "1133"
                        "paginaFinal" => "1137"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib0650"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinicopathologic features of skin cancer in organ transplant recipients&#58; a retrospective case-control series"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2005.10.049"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2006"
                        "volumen" => "54"
                        "paginaInicial" => "290"
                        "paginaFinal" => "300"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0264410X16302110"
                          "estado" => "S300"
                          "issn" => "0264410X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib0655"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aggressive behavior of nonmelanotic skin cancers in solid organ transplant recipients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/TP.0b013e3181ec7228"
                      "Revista" => array:7 [
                        "tituloSerie" => "Transplantation"
                        "fecha" => "2010"
                        "volumen" => "90"
                        "paginaInicial" => "683"
                        "paginaFinal" => "687"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0264410X15004739"
                          "estado" => "S300"
                          "issn" => "0264410X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib0660"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Ficha t&#233;cnica de vismodegib &#91;consultado 25 May 2017&#93;&#46; Available at&#58; <a target="_blank" href="http://www.ema.europa.eu/docs/es%20ES/document%20library/EPAR-Product%20Information/human/002602/WC500146817.pdf">http&#58;&#47;&#47;www&#46;ema&#46;europa&#46;eu&#47;docs&#47;es ES&#47;document library&#47;EPAR-Product Information&#47;human&#47;002602&#47;WC500146817&#46;pdf</a>"
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib0665"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy and safety of vismodegib in advanced basal-cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1113713"
                      "Revista" => array:7 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2012"
                        "volumen" => "366"
                        "paginaInicial" => "2171"
                        "paginaFinal" => "2179"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0264410X17303730"
                          "estado" => "S300"
                          "issn" => "0264410X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            54 => array:3 [
              "identificador" => "bib0670"
              "etiqueta" => "55"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pivotal ERIVANCE basal cell carcinoma &#40;BCC&#41; study&#58; 12-month update of efficacy and safety of vismodegib in advanced BCC"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2015.03.021"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2015"
                        "volumen" => "72"
                        "paginaInicial" => "1021"
                        "paginaFinal" => "1026"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib0675"
              "etiqueta" => "56"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Expanded access study of patients with advanced basal cell carcinoma treated with the Hedgehog pathway inhibitor&#44; vismodegib"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2013.09.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2014"
                        "volumen" => "70"
                        "paginaInicial" => "60"
                        "paginaFinal" => "69"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            56 => array:3 [
              "identificador" => "bib0680"
              "etiqueta" => "57"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vismodegib in patients with advanced basal cell carcinoma &#40;STEVIE&#41;&#58; a pre-planned interim analysis of an international&#44; open-label trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S1470-2045(15)70198-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Oncol"
                        "fecha" => "2015"
                        "volumen" => "16"
                        "paginaInicial" => "729"
                        "paginaFinal" => "736"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            57 => array:3 [
              "identificador" => "bib0685"
              "etiqueta" => "58"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An investigator-initiated open-label clinical trial of vismodegib as a neoadjuvant to surgery for high-risk basal cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2014.05.020"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2014"
                        "volumen" => "71"
                        "paginaInicial" => "904"
                        "paginaFinal" => "911&#46;e1"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            58 => array:3 [
              "identificador" => "bib0690"
              "etiqueta" => "59"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Update to an open-label clinical trial of vismodegib as neoadjuvant before surgery for high-risk basal cell carcinoma &#40;BCC&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2016.02.1235"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2016"
                        "volumen" => "75"
                        "paginaInicial" => "213"
                        "paginaFinal" => "215"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            59 => array:3 [
              "identificador" => "bib0695"
              "etiqueta" => "60"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of neoadjuvant hedgehog inhibitor therapy on the surgical treatment of extensive basal cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/SAP.0000000000000452"
                      "Revista" => array:8 [
                        "tituloSerie" => "Ann Plast Surg"
                        "fecha" => "2015"
                        "volumen" => "74"
                        "numero" => "Suppl&#46; 4"
                        "paginaInicial" => "S193"
                        "paginaFinal" => "S197"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0264410X18315731"
                          "estado" => "S300"
                          "issn" => "0264410X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            60 => array:3 [
              "identificador" => "bib0700"
              "etiqueta" => "61"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recurrence rates of treated basal cell carcinomas part 2&#58; curettage-electrodesiccation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Dermatol Surg Oncol"
                        "fecha" => "1991"
                        "volumen" => "14"
                        "paginaInicial" => "720"
                        "paginaFinal" => "726"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            61 => array:3 [
              "identificador" => "bib0705"
              "etiqueta" => "62"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term recurrence rates in previously untreated &#40;primary&#41; basal cell carcinoma&#58; implications for patient follow up"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.1989.tb03166.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Dermatol Surg Oncol"
                        "fecha" => "1989"
                        "volumen" => "15"
                        "paginaInicial" => "315"
                        "paginaFinal" => "328"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            62 => array:3 [
              "identificador" => "bib0710"
              "etiqueta" => "63"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Occurrence of metachronous basal cell carcinomas&#58; a prognostic model"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/bjd.15771"
                      "Revista" => array:7 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2017"
                        "volumen" => "177"
                        "paginaInicial" => "1113"
                        "paginaFinal" => "1121"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0264410X15011688"
                          "estado" => "S300"
                          "issn" => "0264410X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            63 => array:3 [
              "identificador" => "bib0715"
              "etiqueta" => "64"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "National Comprehensive Cancer Network&#46; NCCN Guideline for Treatment of Basal Cell Skin Cancer &#91;consultado 16 May 2017&#93;&#46; Available at&#58; <a target="_blank" href="http://www.nccn.org/professionals/physician_gls/pdf/nmsc/pdf">http&#58;&#47;&#47;www&#46;nccn&#46;org&#47;professionals&#47;physician&#95;gls&#47;pdf&#47;nmsc&#47;pdf</a>"
                ]
              ]
            ]
            64 => array:3 [
              "identificador" => "bib0720"
              "etiqueta" => "65"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European guidelines for topical photodynamic therapy part 1&#58; Treatment delivery and current indications &#8212; actinic keratoses Bowen&#39;s disease&#44; basal cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jdv.12031"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
                        "fecha" => "2013"
                        "volumen" => "27"
                        "paginaInicial" => "536"
                        "paginaFinal" => "544"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            65 => array:3 [
              "identificador" => "bib0725"
              "etiqueta" => "66"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk of developing a subsequent nonmelanoma skin cancer in patients with a history of nonmelanoma skin cancer&#58; a critical review of the literature and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archderm.136.12.1524"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "2000"
                        "volumen" => "136"
                        "paginaInicial" => "1524"
                        "paginaFinal" => "1530"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            66 => array:3 [
              "identificador" => "bib0730"
              "etiqueta" => "67"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High incidence of second basal cell skin cancers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ijc.22000"
                      "Revista" => array:7 [
                        "tituloSerie" => "Int J Cancer"
                        "fecha" => "2006"
                        "volumen" => "119"
                        "paginaInicial" => "1505"
                        "paginaFinal" => "1507"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0264410X09005404"
                          "estado" => "S300"
                          "issn" => "0264410X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            67 => array:3 [
              "identificador" => "bib0735"
              "etiqueta" => "68"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors for single and multiple basal cell carcinomas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archdermatol.2010.155"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "2010"
                        "volumen" => "146"
                        "paginaInicial" => "848"
                        "paginaFinal" => "855"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            68 => array:3 [
              "identificador" => "bib0740"
              "etiqueta" => "69"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Risk of subsequent basal cell carcinoma and squamous cell carcinoma of the skin among patients with prior skin cancer&#46; Skin Cancer Prevention Study Group"
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "1992"
                        "volumen" => "267"
                        "paginaInicial" => "10"
                        "paginaFinal" => "3305"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            69 => array:3 [
              "identificador" => "bib0745"
              "etiqueta" => "70"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cumulative risks and rates of subsequent basal cell carcinomas in the Netherlands"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2011.10488.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2011"
                        "volumen" => "165"
                        "paginaInicial" => "874"
                        "paginaFinal" => "881"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            70 => array:3 [
              "identificador" => "bib0750"
              "etiqueta" => "71"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Follow-up and prevention &#40;basal cell carcinoma&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:5 [
                        "editores" => "S&#46;J&#46;Miller, M&#46;E&#46;Maloney"
                        "titulo" => "Cutaneous oncology pathophysiology&#44; diagnosis and management"
                        "paginaInicial" => "695"
                        "paginaFinal" => "698"
                        "serieFecha" => "1998"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            71 => array:3 [
              "identificador" => "bib0755"
              "etiqueta" => "72"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patients with both basal and squamous cell carcinomas are at a lower risk of further basal cell carcinomas than patients with only a basal cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2009.03.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2009"
                        "volumen" => "61"
                        "paginaInicial" => "247"
                        "paginaFinal" => "251"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            72 => array:3 [
              "identificador" => "bib0760"
              "etiqueta" => "73"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk of subsequent cutaneous malignancy in patients with prior keratinocyte carcinoma&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejca.2013.03.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cancer"
                        "fecha" => "2013"
                        "volumen" => "49"
                        "paginaInicial" => "2365"
                        "paginaFinal" => "2375"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            73 => array:3 [
              "identificador" => "bib0765"
              "etiqueta" => "74"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Basal cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/1097-0142(20000901)89:5<1012::aid-cncr10>3.0.co;2-o"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "2000"
                        "volumen" => "89"
                        "paginaInicial" => "1012"
                        "paginaFinal" => "1018"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            74 => array:3 [
              "identificador" => "bib0770"
              "etiqueta" => "75"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous basal cell carcinomas&#58; distinct host factors are associated with the development of tumors on the trunk and head and neck"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/1097-0142(20010715)92:2<354::aid-cncr1330>3.0.co;2-f"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "2001"
                        "volumen" => "92"
                        "paginaInicial" => "354"
                        "paginaFinal" => "358"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            75 => array:3 [
              "identificador" => "bib0775"
              "etiqueta" => "76"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Associations between ultraviolet radiation&#44; basal cell carcinoma site and histology&#44; host characteristics&#44; and rate of development of further tumors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2004.08.060"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2005"
                        "volumen" => "52"
                        "numero" => "Pt 1"
                        "paginaInicial" => "468"
                        "paginaFinal" => "473"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            76 => array:3 [
              "identificador" => "bib0780"
              "etiqueta" => "77"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predicting the risk of a second basal cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/jid.2015.244"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Invest Dermatol"
                        "fecha" => "2015"
                        "volumen" => "135"
                        "paginaInicial" => "2649"
                        "paginaFinal" => "2656"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            77 => array:3 [
              "identificador" => "bib0785"
              "etiqueta" => "78"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic factors for a subsequent basal cell carcinoma&#58; implications for follow up"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2005.06911.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2005"
                        "volumen" => "153"
                        "paginaInicial" => "1078"
                        "paginaFinal" => "1080"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            78 => array:3 [
              "identificador" => "bib0790"
              "etiqueta" => "79"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for the management of basal cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2008.08666.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2008"
                        "volumen" => "159"
                        "paginaInicial" => "35"
                        "paginaFinal" => "48"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack465617"
        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0265" class="elsevierStylePara elsevierViewall">The present guidelines form part of the White Paper on Skin Cancer of Fundaci&#243;n Piel Sana of the AEDV&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000011100000004/v1_202006060751/S1578219020300834/v1_202006060751/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "6228"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Consensus document"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011100000004/v1_202006060751/S1578219020300834/v1_202006060751/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219020300834?idApp=UINPBA000044"
]

Article information

ISSN: 15782190
Original language: English

DOI:10.1016/j.adengl.2020.04.009

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	14	7	21
2024 October	103	56	159
2024 September	106	44	150
2024 August	119	81	200
2024 July	106	47	153
2024 June	102	34	136
2024 May	83	48	131
2024 April	80	36	116
2024 March	93	40	133
2024 February	93	52	145
2024 January	81	58	139
2023 December	82	37	119
2023 November	122	66	188
2023 October	97	68	165
2023 September	99	54	153
2023 August	96	20	116
2023 July	91	59	150
2023 June	78	32	110
2023 May	82	45	127
2023 April	65	28	93
2023 March	84	38	122
2023 February	68	35	103
2023 January	57	32	89
2022 December	104	62	166
2022 November	49	45	94
2022 October	31	42	73
2022 September	35	59	94
2022 August	35	55	90
2022 July	30	75	105
2022 June	48	41	89
2022 May	44	52	96
2022 April	47	61	108
2022 March	67	76	143
2022 February	73	38	111
2022 January	53	52	105
2021 December	53	49	102
2021 November	58	41	99
2021 October	63	70	133
2021 September	59	41	100
2021 August	71	46	117
2021 July	45	22	67
2021 June	65	36	101
2021 May	65	61	126
2021 April	227	128	355
2021 March	91	41	132
2021 February	89	41	130
2021 January	91	21	112
2020 December	59	21	80
2020 November	49	26	75
2020 October	51	15	66
2020 September	63	36	99
2020 August	89	27	116
2020 July	92	31	123
2020 June	128	49	177
2020 May	118	48	166

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter