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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0005">Introducci&#243;n</span><p id="p0005" class="elsevierStylePara elsevierViewall">El carcinoma anexial microqu&#237;stico &#40;CAM&#41; &#40;carcinoma siringomatoso&#44; siringoma maligno&#44; carcinoma de los ductos sudor&#237;paros desmopl&#225;sico&#41;<a class="elsevierStyleCrossRefs" href="#bb0005"><span class="elsevierStyleSup">1-3</span></a> es una tumoraci&#243;n cut&#225;nea poco frecuente&#44; de diferenciaci&#243;n dual folicular y glandular&#44; que fue descrita por primera vez por Goldstein et al<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a> en 1982&#46;</p><p id="p0010" class="elsevierStylePara elsevierViewall">Se caracteriza por su naturaleza local agresiva&#44; una elevada capacidad infiltrante&#44; as&#237; como por un marcado neurotropismo&#46; Todas estas caracter&#237;sticas justifican una elevada tasa de recidiva a pesar de la aplicaci&#243;n de tratamientos agresivos&#46;</p><p id="p0015" class="elsevierStylePara elsevierViewall">Actualmente existe controversia en la elecci&#243;n de la mejor opci&#243;n terap&#233;utica para alcanzar la erradicaci&#243;n completa del CAM&#46; La cirug&#237;a microgr&#225;fica de Mohs &#40;CMM&#41;&#44; por las ventajas terap&#233;uticas y est&#233;ticas que posee&#44; podr&#237;a ser un tratamiento de elecci&#243;n en esta neoplasia&#46; No obstante&#44; la experiencia de uso de esta t&#233;cnica en esta tumoraci&#243;n anexial es muy limitada&#46;</p><p id="p0020" class="elsevierStylePara elsevierViewall">Se aporta una serie de 6 casos de pacientes con CAM tratados mediante CMM realizados en el mismo centro dermatol&#243;gico&#46; Se analizar&#225;n los diversos par&#225;metros cl&#237;nicos y quir&#250;rgicos de todos los pacientes&#44; as&#237; como la existencia de recidiva en el seguimiento a largo plazo&#46;</p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0010">Material y m&#233;todos</span><p id="p0025" class="elsevierStylePara elsevierViewall">Se revis&#243; la historia cl&#237;nica y quir&#250;rgica de 6 pacientes diagnosticados en el Servicio de Dermatolog&#237;a del Instituto Valenciano de Oncolog&#237;a entre 1995 y 2007&#46; En cada caso el diagn&#243;stico histopatol&#243;gico fue confirmado por un anatomopat&#243;logo mediante biopsias te&#241;idas con hematoxilina-eosina&#46;</p><p id="p0030" class="elsevierStylePara elsevierViewall">Se obtuvieron las piezas quir&#250;rgicas y se procesaron siguiendo la t&#233;cnica microgr&#225;fica de Mohs&#44; realiz&#225;ndose estadios de 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm hasta que se obtuvo ausencia de afectaci&#243;n de los bordes quir&#250;rgicos&#46; La t&#233;cnica se realiz&#243; de forma diferida en 4 de los casos y en fresco en los dos restantes&#46; En aquellos realizados en fresco se procedi&#243; a la toma de un estadio adicional una vez se alcanzaron los bordes libres de enfermedad&#46;</p><p id="p0035" class="elsevierStylePara elsevierViewall">Se recogieron los siguientes datos de cada paciente&#58; edad&#44; sexo&#44; localizaci&#243;n&#44; duraci&#243;n de la lesi&#243;n&#44; exposici&#243;n a radiaciones ionizantes&#44; lesi&#243;n primaria o recurrente&#44; dimensiones de la lesi&#243;n en la exploraci&#243;n cl&#237;nica preoperatoria&#44; n&#250;mero de estadios de CMM que se precisaron para alcanzar bordes libres de enfermedad&#44; defecto postoperatorio&#44; periodo de seguimiento y existencia o no de recidiva durante el mismo&#46;</p><p id="p0040" class="elsevierStylePara elsevierViewall">Posteriormente se realiz&#243; una revisi&#243;n de todos los casos de CAM tratados mediante CMM descritos en la literatura desde 1982 a 2007 utilizando el sistema de b&#250;squeda</p><p id="p0045" class="elsevierStylePara elsevierViewall">PubMed&#46; De ellos se recogieron los siguientes par&#225;metros&#58; n&#250;mero de CAM tratados&#44; dividi&#233;ndolos en casos primarios y recurrentes&#44; porcentaje de recidiva&#44; n&#250;mero medio de estadios quir&#250;rgicos realizados y&#44; por &#250;ltimo&#44; la media de seguimiento de los pacientes tratados&#46;</p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">Resultados</span><p id="p0050" class="elsevierStylePara elsevierViewall">Los diversos par&#225;metros cl&#237;nico-quir&#250;rgicos de los 6 pacientes se recogen en la <a class="elsevierStyleCrossRef" href="#t0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="t0005"></elsevierMultimedia><p id="p0055" class="elsevierStylePara elsevierViewall">El grupo tratado estaba formado por 5 mujeres y un hombre&#44; con edades comprendidas entre 48 y 90 a&#241;os&#44; con una media de edad de 69 a&#241;os&#46; Todas las tumoraciones analizadas fueron primarias&#44; y ninguno de los pacientes hab&#237;a sido sometido previamente a radioterapia en la zona de la lesi&#243;n&#46; Hasta un 50 &#37; de los casos hab&#237;a presentado previamente uno o m&#225;s carcinomas basocelulares en la regi&#243;n facial&#46; En todos los pacientes la tumoraci&#243;n asentaba en la cara &#40;tres en mejilla&#44; dos en surco nasogeniano y uno en ment&#243;n&#41;&#44; localiz&#225;ndose en el hemilado derecho en un total de 4 casos&#46; El tama&#241;o de la lesi&#243;n cl&#237;nica oscil&#243; entre 0&#44;5 &#215; 0&#44;6<span class="elsevierStyleHsp" style=""></span>cm y 2 &#215; 2<span class="elsevierStyleHsp" style=""></span>cm&#46;</p><p id="p0060" class="elsevierStylePara elsevierViewall">El n&#250;mero medio de estadios requeridos para alcanzar m&#225;rgenes libres de enfermedad fue de 1&#44;4 y el tama&#241;o del defecto quir&#250;rgico resultante oscil&#243; entre 1 &#215; 1<span class="elsevierStyleHsp" style=""></span>cm y 4 &#215; 3<span class="elsevierStyleHsp" style=""></span>cm&#46;</p><p id="p0065" class="elsevierStylePara elsevierViewall">Las pruebas complementarias realizadas en todos los pacientes&#44; que incluyeron una anal&#237;tica &#40;hemograma&#44; perfil hep&#225;tico y renal y estado de coagulaci&#243;n&#41; y una radiograf&#237;a de t&#243;rax&#44; se encontraron dentro de los l&#237;mites de la normalidad&#46;</p><p id="p0070" class="elsevierStylePara elsevierViewall">El periodo de seguimiento oscil&#243; entre 1 y 12 a&#241;os&#44; con una media de 5 a&#241;os&#44; con ausencia de recidiva en la totalidad de los casos&#46;</p></span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">Discusi&#243;n</span><p id="p0075" class="elsevierStylePara elsevierViewall">El CAM es una tumoraci&#243;n anexial maligna que aparece con mayor frecuencia en mujeres de edades que oscilan entre los 50 y los 69 a&#241;os<a class="elsevierStyleCrossRefs" href="#bb0015"><span class="elsevierStyleSup">3&#44;5-10</span></a>&#46; Existe una mayor predisposici&#243;n al desarrollo de este tumor en las razas cauc&#225;sica y asi&#225;tica<a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a>&#44; con raros casos descritos en la poblaci&#243;n afroamericana<a class="elsevierStyleCrossRefs" href="#bb0010"><span class="elsevierStyleSup">2&#44;6&#44;12&#44;13</span></a>&#46;</p><p id="p0080" class="elsevierStylePara elsevierViewall">Se consideran varios factores de riesgo para el desarrollo de esta neoplasia&#44; que incluyen la exposici&#243;n a la radiaci&#243;n ultravioleta y&#47;o ionizante&#44; as&#237; como la existencia de una inmunosupresi&#243;n de base<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="p0085" class="elsevierStylePara elsevierViewall">El CAM se manifiesta cl&#237;nicamente como una placa&#44; n&#243;dulo o pseudoquiste de consistencia p&#233;trea&#44; asintom&#225;tico&#44; de crecimiento lento y progresivo&#44; que se presenta con un tama&#241;o medio de 2<span class="elsevierStyleHsp" style=""></span>cm en el momento del diagn&#243;stico &#40;<a class="elsevierStyleCrossRef" href="#f0005">fig&#46; 1</a>&#41;<a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a>&#46; La presencia de escozor&#44; parestesia o dolor en la zona de la tumoraci&#243;n orienta a la posible existencia de afectaci&#243;n perineural&#44; que en este tipo de tumoraci&#243;n var&#237;a entre un 18<a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a> y un 59 &#37; de los casos<a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a>&#46;</p><elsevierMultimedia ident="f0005"></elsevierMultimedia><p id="p0090" class="elsevierStylePara elsevierViewall">El CAM se localiza en la cabeza y el cuello hasta en un 83 &#37; de los casos<a class="elsevierStyleCrossRefs" href="#bb0055"><span class="elsevierStyleSup">11&#44;15</span></a>&#46; De ellos&#44; un 73 &#37; se localiza en la cara&#44; fundamentalmente afectando al &#225;rea palpebral<a class="elsevierStyleCrossRefs" href="#bb0080"><span class="elsevierStyleSup">16&#44;17</span></a> y al surco nasogeniano&#46;</p><p id="p0095" class="elsevierStylePara elsevierViewall">El retraso medio entre la aparici&#243;n de la lesi&#243;n y el establecimiento del diagn&#243;stico histopatol&#243;gico es variable seg&#250;n el sexo del paciente&#46; As&#237;&#44; mientras en el sexo femenino el retraso medio del diagn&#243;stico es de un a&#241;o&#44; en el sexo masculino alcanza hasta 5 a&#241;os<a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a>&#46; En nuestro estudio el retraso oscil&#243; entre 6 meses y 14 a&#241;os&#44; no pudiendo precisarse alguna relaci&#243;n seg&#250;n el sexo ya que la poblaci&#243;n era mayoritariamente femenina&#46;</p><p id="p0100" class="elsevierStylePara elsevierViewall">Se trata de una tumoraci&#243;n con una alta capacidad de penetraci&#243;n en profundidad<a class="elsevierStyleCrossRef" href="#bb0090"><span class="elsevierStyleSup">18</span></a>&#44; que frecuentemente invade el tejido celular subcut&#225;neo y el m&#250;sculo esquel&#233;tico subyacente&#44; habi&#233;ndose descrito afectaci&#243;n del pericondrio&#44; del periostio&#44; de la adventicia de los vasos sangu&#237;neos&#44; e incluso afectaci&#243;n &#243;sea<a class="elsevierStyleCrossRef" href="#bb0095"><span class="elsevierStyleSup">19</span></a>&#46; Histol&#243;gicamente se caracteriza por una epidermis respetada asociada a una dermis papilar y reticular superficial ocupadas por peque&#241;os quistes con queratinizaci&#243;n &#237;tsmica y del infund&#237;bulo folicular &#40;<a class="elsevierStyleCrossRef" href="#f0010">fig&#46; 2</a>&#41;&#46; En la dermis reticular media y profunda destaca la existencia de m&#250;ltiples islotes de c&#233;lulas basaloides&#44; que muestran vacuolizaci&#243;n intracitoplasm&#225;tica y en determinadas &#225;reas conforman ductos con l&#250;menes bien definidos&#44; tapizados por c&#233;lulas aplanadas organizadas en una o dos capas &#40;<a class="elsevierStyleCrossRef" href="#f0015">fig&#46; 3</a>&#41;<a class="elsevierStyleCrossRefs" href="#bb0100"><span class="elsevierStyleSup">20&#44;21</span></a>&#46;</p><elsevierMultimedia ident="f0010"></elsevierMultimedia><elsevierMultimedia ident="f0015"></elsevierMultimedia><p id="p0105" class="elsevierStylePara elsevierViewall">La infiltraci&#243;n perineural&#44; fen&#243;meno descrito en menos del 5 &#37; de los tumores de cabeza y cuello<a class="elsevierStyleCrossRefs" href="#bb0110"><span class="elsevierStyleSup">22-24</span></a>&#44; supone un fen&#243;meno relativamente frecuente en el CAM&#44; detect&#225;ndose en el an&#225;lisis histol&#243;gico de entre un 17&#44;5<a class="elsevierStyleCrossRef" href="#bb0115"><span class="elsevierStyleSup">23</span></a> a un 59 &#37; de los pacientes seg&#250;n las series<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a>&#46; Dicho fen&#243;meno aparece fundamentalmente en carcinomas anexiales recidivados &#40;hasta el 87&#44;5 &#37; de los casos&#41;<a class="elsevierStyleCrossRef" href="#bb0090"><span class="elsevierStyleSup">18</span></a>&#44; siendo poco frecuente en el carcinoma anexial primario&#59; este dato resalta la importancia de un tratamiento inicial &#243;ptimo como m&#233;todo para reducir el porcentaje global de CAM con infiltraci&#243;n perineural&#46; En nuestro estudio ninguno de los casos mostr&#243; infiltraci&#243;n perineural&#44; lo que puede ser debido a que todas las neoplasias tratadas en nuestra serie fueron primarias&#46;</p><p id="p0110" class="elsevierStylePara elsevierViewall">El CAM se trata de una tumoraci&#243;n de dif&#237;cil diagn&#243;stico tanto desde el punto de vista cl&#237;nico como histol&#243;gico<a class="elsevierStyleCrossRef" href="#bb0130"><span class="elsevierStyleSup">26</span></a>&#46; De hecho&#44; entre un 25 y un 53 &#37; de los casos&#44; seg&#250;n diferentes series&#44; fueron mal diagnosticados cl&#237;nicamente&#44; de manera que el diagn&#243;stico inicial m&#225;s com&#250;n fue el de carcinoma basocelular esclerodermiforme<a class="elsevierStyleCrossRefs" href="#bb0025"><span class="elsevierStyleSup">5&#44;11</span></a>&#46; A la dificultad del diagn&#243;stico cl&#237;nico se suman en muchos casos tambi&#233;n errores en el diagn&#243;stico histopatol&#243;gico&#44; lo que se debe a que las biopsias tomadas por rebanado imposibilitan estudiar el patr&#243;n estratificado caracter&#237;stico del CAM<a class="elsevierStyleCrossRef" href="#bb0135"><span class="elsevierStyleSup">27</span></a>&#46; En nuestro estudio&#44; 4 de los 6 casos fueron cl&#237;nicamente diagnosticados de carcinoma basocelular&#44; y en uno de ellos el estudio histopatol&#243;gico apoy&#243; este diagn&#243;stico&#46; Sin embargo&#44; en este caso se hab&#237;a realizado una biopsia por rebanado y la posterior biopsia mediante un <span class="elsevierStyleItalic">punch</span> confirm&#243; el diagn&#243;stico de CAM&#46; As&#237; pues&#44; ante una lesi&#243;n esclerodermiforme localizada en un &#225;rea fotoexpuesta&#44; resulta imprescindible la obtenci&#243;n de una muestra de tejido que alcance el tejido celular subcut&#225;neo&#46;</p><p id="p0115" class="elsevierStylePara elsevierViewall">El principal problema del CAM es su comportamiento local agresivo&#44; que se manifiesta por su gran capacidad infiltrativa y su alta frecuencia de afectaci&#243;n perineural<a class="elsevierStyleCrossRef" href="#bb0140"><span class="elsevierStyleSup">28</span></a>&#44; lo que conlleva una alta frecuencia de recidiva local tras una ex&#233;resis quir&#250;rgica convencional&#44; que alcanza el 40-60 &#37; de los casos<a class="elsevierStyleCrossRefs" href="#bb0140"><span class="elsevierStyleSup">28-30</span></a>&#46; La afectaci&#243;n a distancia es excepcional en esta tumoraci&#243;n anexial&#46; Unicamente se han descrito 5 casos con afectaci&#243;n en la cadena linf&#225;tica locorregional ipsilateral &#40;4 casos&#41;<a class="elsevierStyleCrossRef" href="#bb0155"><span class="elsevierStyleSup">31</span></a> o contralateral &#40;un caso&#41;<a class="elsevierStyleCrossRef" href="#bb0160"><span class="elsevierStyleSup">32</span></a>&#46; Por otro lado&#44; la afectaci&#243;n sist&#233;mica es excepcional&#44; habi&#233;ndose comunicado casos aislados en pulm&#243;n<a class="elsevierStyleCrossRef" href="#bb0165"><span class="elsevierStyleSup">33</span></a>&#44; hueso<a class="elsevierStyleCrossRef" href="#bb0150"><span class="elsevierStyleSup">30</span></a> e h&#237;gado<a class="elsevierStyleCrossRef" href="#bb0170"><span class="elsevierStyleSup">34</span></a>&#46;</p><p id="p0120" class="elsevierStylePara elsevierViewall">Las opciones terap&#233;uticas aplicadas en esta tumoraci&#243;n incluyen la radioterapia y la cirug&#237;a&#44; tanto en forma de ex&#233;resis simple como en forma de cirug&#237;a de control de m&#225;rgenes&#46; La radioterapia ha sido utilizada en el tratamiento del CAM tanto de forma aislada como de manera coadyuvante al acto quir&#250;rgico<a class="elsevierStyleCrossRefs" href="#bb0170"><span class="elsevierStyleSup">34&#44;35</span></a>&#46; A partir de los diversos resultados obtenidos se pueden establecer las siguientes conclusiones&#58;<ul class="elsevierStyleList" id="l0005"><li class="elsevierStyleListItem" id="o0005"><span class="elsevierStyleLabel">1&#46;</span><p id="p0125" class="elsevierStylePara elsevierViewall">La radioterapia no debe utilizarse como una opci&#243;n terap&#233;utica aislada de un CAM primario&#44; ya que se ha demostrado que en este caso no solo resulta ineficaz&#44; sino que es capaz de inducir la conversi&#243;n en una variante tumoral de mayor agresividad cl&#237;nica e histol&#243;gica<a class="elsevierStyleCrossRefs" href="#bb0175"><span class="elsevierStyleSup">35&#44;36</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="o0010"><span class="elsevierStyleLabel">2&#46;</span><p id="p0130" class="elsevierStylePara elsevierViewall">La aplicaci&#243;n de radiaci&#243;n ionizante se puede plantear como tratamiento coadyuvante a la ex&#233;resis quir&#250;rgica de un CAM con m&#225;rgenes libres de enfermedad en determinadas situaciones&#44; que incluyen&#58; casos recidivados&#44; casos con infiltraci&#243;n perineural&#44; vascular o linf&#225;tica&#44; as&#237; como aquellos que infiltren m&#250;sculo o hueso<a class="elsevierStyleCrossRefs" href="#bb0075"><span class="elsevierStyleSup">15&#44;37&#44;38</span></a>&#46;</p></li></ul></p><p id="p0135" class="elsevierStylePara elsevierViewall">La cirug&#237;a convencional precisa la obtenci&#243;n de un amplio margen de seguridad tanto en superficie como en profundidad para que el riesgo de una ex&#233;resis incompleta sea m&#237;nimo&#46; Sin embargo&#44; la definici&#243;n de &#171;un amplio margen&#187; es bastante imprecisa&#44; por lo que la evaluaci&#243;n de los resultados obtenidos mediante cirug&#237;a convencional en diversos trabajos resulta imposible de realizar&#46; Por otra parte&#44; el an&#225;lisis de la pieza quir&#250;rgica obtenida mediante esta t&#233;cnica quir&#250;rgica s&#243;lo permite la valoraci&#243;n de un 0&#44;2 &#37; de los m&#225;rgenes&#44; lo que conlleva una recurrencia de hasta un 40-60 &#37;<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a> de casos en los primeros tres a&#241;os tras el tratamiento&#46;</p><p id="p0140" class="elsevierStylePara elsevierViewall">La CMM permite conseguir una mayor selectividad en el volumen de tejido extirpado&#44; reduciendo al m&#225;ximo la ex&#233;resis de piel sana&#44; con lo que se alcanza un mejor resultado est&#233;tico&#44; un dato importante teniendo en cuenta la tendencia de este tipo de tumoraci&#243;n a aparecer en la regi&#243;n facial<a class="elsevierStyleCrossRef" href="#bb0195"><span class="elsevierStyleSup">39</span></a>&#46; A su vez&#44; la forma de obtenci&#243;n de la pieza y su an&#225;lisis permite valorar casi el 100 &#37; de los m&#225;rgenes tanto laterales como profundo de la lesi&#243;n<a class="elsevierStyleCrossRef" href="#bb0100"><span class="elsevierStyleSup">20</span></a>&#44; con lo que el riesgo de recurrencia mediante esta t&#233;cnica var&#237;a entre un 0<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a> y un 12 &#37;<a class="elsevierStyleCrossRefs" href="#bb0010"><span class="elsevierStyleSup">2&#44;6&#44;40-43</span></a>&#44; dejando un defecto posquir&#250;rgico que alcanza hasta 4 veces el tama&#241;o de la lesi&#243;n cl&#237;nica inicial<a class="elsevierStyleCrossRefs" href="#bb0025"><span class="elsevierStyleSup">5&#44;44-46</span></a>&#46;</p><p id="p0145" class="elsevierStylePara elsevierViewall">En la literatura existe un n&#250;mero escaso de series de pocos pacientes tratados mediante cirug&#237;a de Mohs &#40;<a class="elsevierStyleCrossRef" href="#t0010">tabla 2</a>&#41;&#46; En nuestra serie ning&#250;n paciente present&#243; signos de recidiva en el control peri&#243;dico postex&#233;resis&#44; que oscil&#243; entre 12 meses y 12 a&#241;os&#44; con una media de seguimiento de 5 a&#241;os&#46; El defecto quir&#250;rgico alcanz&#243; de dos a cuatro veces el tama&#241;o de la lesi&#243;n cl&#237;nica inicial&#46;</p><elsevierMultimedia ident="t0010"></elsevierMultimedia><p id="p0150" class="elsevierStylePara elsevierViewall">La recurrencia tumoral adquiere un valor importante en el CAM&#44; ya que&#44; comparado con el CAM primario&#44; las recidivas se presentan con mayores dimensiones&#44; lo que supone la necesidad de un n&#250;mero superior de estadios y un mayor defecto quir&#250;rgico secundario&#44; e histol&#243;gicamente muestran una mayor atipia celular con una tasa de infiltraci&#243;n perineural superior &#40;hasta el 80 &#37; de casos&#41;&#46; En nuestra serie&#44; los 6 casos presentaron una tumoraci&#243;n anexial primaria que histol&#243;gicamente mostraba una leve atipia celular y ausencia de infiltraci&#243;n perineural&#46;</p><p id="p0155" class="elsevierStylePara elsevierViewall">Con todo ello se concluye que la CMM deber&#237;a considerarse como el tratamiento de elecci&#243;n para este tipo de tumores&#46;</p><p id="p0160" class="elsevierStylePara elsevierViewall">Actualmente no est&#225; establecido el intervalo de seguimiento ni las pruebas complementarias necesarias en el control de este tipo de pacientes&#46; Dado el mayor riesgo de recidiva tumoral en los primeros tres a&#241;os posresecci&#243;n de la lesi&#243;n&#44; se aconseja un seguimiento cada 3-6 meses&#46; Tras estos tres primeros a&#241;os se deber&#237;a realizar un control anual de por vida&#44; ya que se han descrito recidivas tumorales hasta 30 a&#241;os tras la ex&#233;resis inicial de la lesi&#243;n&#46;</p><p id="p0170" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Conflicto de intereses</span></p><p id="p0165" class="elsevierStylePara elsevierViewall">Declaramos no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n y objetivos</span><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall">El carcinoma anexial microqu&#237;stico &#40;CAM&#41; es un tumor raro y agresivo que cl&#237;nicamente se manifiesta como un n&#243;dulo subcut&#225;neo localizado en las regiones de cabeza y cuello&#46; Esta tumoraci&#243;n puede ser cl&#237;nica e histol&#243;gicamente confundida con otras lesiones cut&#225;neas benignas o malignas&#44; lo que con frecuencia conduce a un tratamiento inicial err&#243;neo&#46; La principal complicaci&#243;n del CAM es la alta morbilidad y la elevada tasa de recurrencia tras escisi&#243;n local amplia&#46; Estudios preliminares recientes han mostrado unas mayores tasas de curaci&#243;n mediante cirug&#237;a microgr&#225;fica de Mohs &#40;CMM&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall">Se revisaron las historias cl&#237;nicas de 6 pacientes consecutivos con CAM tratados mediante CMM en nuestro Servicio de Dermatolog&#237;a entre 1995 y 2007&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall">Todos los casos se localizaron en la cabeza y el 100 &#37; fue tumor primario&#46; En el 70 &#37; de los casos el tumor fue inicialmente mal diagnosticado de carcinoma basocelular&#46; No se detect&#243; invasi&#243;n perineural en ninguno de los casos y la recurrencia estuvo ausente en todos los pacientes tras un periodo de seguimiento comprendido entre 1 y 12 a&#241;os posteriores a la CMM&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="sp0055" class="elsevierStyleSimplePara elsevierViewall">La ausencia de afectaci&#243;n perineural y de una importante atipia celular puede deberse al car&#225;cter primario de la tumoraci&#243;n&#46; Ello justificar&#237;a la necesidad de un tratamiento definitivo radical inicial del tumor primario para evitar las complicaciones que implica una recidiva tumoral&#46; La localizaci&#243;n y la ausencia de recurrencia en todos nuestros casos tratados mediante CMM apoyan el uso de esta t&#233;cnica como el tratamiento de elecci&#243;n para el CAM&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction and objectives</span><p id="sp0060" class="elsevierStyleSimplePara elsevierViewall">Microcystic adnexal carcinoma is a rare and aggressive tumor that manifests clinically as a subcutaneous nodule located on the head or neck&#46; The tumor can be confused clinically and histologically with other benign and malignant skin lesions&#44; often leading to inappropriate initial treatment&#46; The chief concern with microcystic adnexal carcinoma is the elevated morbidity and the high rate of recurrence after wide local excision&#46; Recent preliminary studies point to higher cure rates with Mohs micrographic surgery&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="sp0065" class="elsevierStyleSimplePara elsevierViewall">We reviewed the medical histories of 6 consecutive patients with microcystic adnexal carcinoma who underwent Mohs micrographic surgery in our dermatology department between 1995 and 2007&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="sp0070" class="elsevierStyleSimplePara elsevierViewall">In all cases&#44; lesions were located on the head and were primary tumors&#46; Seventy percent of the tumors were wrongly diagnosed initially as basal cell carcinoma&#46; Perineural invasion was not detected in any patient&#44; and all were free of recurrence after between 1 and 12 years of postoperative follow-up&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="sp0075" class="elsevierStyleSimplePara elsevierViewall">The absence of perineural involvement and substantial cell atypia can be attributed to the lesions being primary tumors&#46; This would provide a rationale for definitive radical treatment of the primary tumor from the outset to avoid the complications associated with recurrence&#46; The site and the absence of recurrence in all our patients who underwent Mohs micrographic surgery support the use of this technique as the treatment of choice in microcystic adnexal carcinoma&#46;</p>"
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          "es" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Placa mal delimitada&#44; de coloraci&#243;n marfile&#241;a con telangiectasias&#44; localizada en la mejilla derecha&#46;</p>"
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          0 => array:4 [
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            "Tamanyo" => 200619
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          "es" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">En la dermis superficial se aprecian islotes epiteliales y algunos quistes c&#243;rneos &#40;hematoxilina-eosina&#44; &#215;<span class="elsevierStyleHsp" style=""></span>20&#41;&#46;</p>"
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        "identificador" => "f0015"
        "etiqueta" => "Figura 3"
        "tipo" => "MULTIMEDIAFIGURA"
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          0 => array:4 [
            "imagen" => "gr3.jpeg"
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          "es" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">La dermis media est&#225; infiltrada por peque&#241;os islotes epiteliales y en la dermis profunda aparecen algunas estructuras tubulares &#40;hematoxilina-eosina&#44; &#215;<span class="elsevierStyleHsp" style=""></span>20&#41;&#46;</p>"
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        "identificador" => "t0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
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        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">CBC&#58; carcinoma basocelular&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edad&#47;sexo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tiempo de evoluci&#243;n &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Motivo de consulta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&#225;ncer cut&#225;neo previo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Localizaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Exploraci&#243;n f&#237;sica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diagn&#243;stico de sospecha&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46;&#176; estadios&#40;defecto quir&#250;rgico&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Seguimiento &#40;a&#241;os&#41;&#47;reca&#237;da&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#47;Hombre&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="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&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">Placa asintom&#225;tica&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">Mejilla izquierda&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">Placa mal delimitada amarillenta p&#233;trea 1 &#215; 1&#44;5<span class="elsevierStyleHsp" style=""></span>cm&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">Tumor anexial&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">2 &#40;7 &#215; 2<span class="elsevierStyleHsp" style=""></span>cm&#41;&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="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;No&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#47;Mujer&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="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&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">Placa indurada asintom&#225;tica&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">Ment&#243;n derecho&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">Placa p&#233;trea con depresi&#243;n central de 2 &#215; 2<span class="elsevierStyleHsp" style=""></span>cm&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">Tumor anexial&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">2 &#40;5 &#215; 5<span class="elsevierStyleHsp" style=""></span>cm&#41;&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="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;No&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#47;Mujer&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="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&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">P&#225;pula amarillenta indurada&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">CBC&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">Surco nasogeniano derecho&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">P&#225;pula marfile&#241;a con telangiectasia 1 &#215; 1<span class="elsevierStyleHsp" style=""></span>cm&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">CBC&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">2 &#40;3 &#215; 3<span class="elsevierStyleHsp" style=""></span>cm&#41;&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="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#47;No&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#47;Mujer&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="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&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">Lesi&#243;n cicatricial&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">Mejilla derecha&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">P&#225;pula amarillenta de 2 &#215; 1<span class="elsevierStyleHsp" style=""></span>cm&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">CBC&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">1 &#40;3 &#215; 3<span class="elsevierStyleHsp" style=""></span>cm&#41;&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="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#47;No&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#47;Mujer&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="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&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">N&#243;dulo semiduro&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">CBC&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">Mejilla izquierda&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">P&#225;pula indurada amarillenta de 0&#44;5 &#215; 0&#44;6<span class="elsevierStyleHsp" style=""></span>cm&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">CBC&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">1 &#40;1&#44;5 &#215; 1&#44;5<span class="elsevierStyleHsp" style=""></span>cm&#41;&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="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#47;No&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#47;Mujer&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="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&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">N&#243;dulo amarillento indurado&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">CBC&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">Ala nasal derecha&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">P&#225;pula indurada de 1 &#215; 1<span class="elsevierStyleHsp" style=""></span>cm&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">CBC&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">2 &#40;2 &#215; 2<span class="elsevierStyleHsp" style=""></span>cm&#41;&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="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#47;No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab183013.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas de los pacientes tratados mediante cirug&#237;a de Mohs en nuestro servicio</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "t0010"
        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="sp0035" class="elsevierStyleSimplePara elsevierViewall">NS&#58; dato no recogido en el informe quir&#250;rgico&#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"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Autor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46;&#176; de casos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Recurrencia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46;&#176; medio de estadios&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Media de seguimiento &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fleischmann et al<a class="elsevierStyleCrossRef" href="#bb0230"><span class="elsevierStyleSup">46</span></a>&#44; 1984&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">1&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">NS&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"><span class="elsevierStyleHsp" style=""></span>7&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cooper y Mills<a class="elsevierStyleCrossRef" href="#bb0010"><span class="elsevierStyleSup">2</span></a>&#44; 1984&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">1 &#40;recurrente&#41;&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">S&#237;&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">NS&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"><span class="elsevierStyleHsp" style=""></span>8&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nickoloff et al<a class="elsevierStyleCrossRef" href="#bb0040"><span class="elsevierStyleSup">8</span></a>&#44; 1986&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">1&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">4&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">13&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hamm et al<a class="elsevierStyleCrossRef" href="#bb0200"><span class="elsevierStyleSup">40</span></a>&#44; 1987&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">3 &#40;2 recurrentes&#41;&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">NS&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">19&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mayer et al<a class="elsevierStyleCrossRef" href="#bb0180"><span class="elsevierStyleSup">36</span></a>&#44; 1988&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">3 &#40;2 recurrentes&#41;&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">S&#237; &#40;1 caso&#41;&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">NS&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">NS&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chow et al<a class="elsevierStyleCrossRef" href="#bb0220"><span class="elsevierStyleSup">44</span></a>&#44; 1989&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">1&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">NS&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">NS&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Birkby et al<a class="elsevierStyleCrossRef" href="#bb0235"><span class="elsevierStyleSup">47</span></a>&#44; 1989&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">1 &#40;recurrente&#41;&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">NS&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">18&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wallace y Bernstein<a class="elsevierStyleCrossRef" href="#bb0240"><span class="elsevierStyleSup">48</span></a>&#44; 1991&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">1 caso&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">NS&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">18&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Futran et al<a class="elsevierStyleCrossRef" href="#bb0245"><span class="elsevierStyleSup">49</span></a>&#44; 1992&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">1 caso&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">NS&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"><span class="elsevierStyleHsp" style=""></span>1&#44;5&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sebastien et al<a class="elsevierStyleCrossRef" href="#bb0090"><span class="elsevierStyleSup">18</span></a>&#44; 1993&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">1 &#40;recurrente&#41;&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">NS&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">16&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Burns et al<a class="elsevierStyleCrossRef" href="#bb0250"><span class="elsevierStyleSup">50</span></a>&#44; 1994&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">10 &#40;4 recurrentes&#41;&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">NS&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">25&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">McAlvany et al<a class="elsevierStyleCrossRef" href="#bb0255"><span class="elsevierStyleSup">51</span></a>&#44; 1994&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">1&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">1&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">32&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hazen y Bass<a class="elsevierStyleCrossRef" href="#bb0260"><span class="elsevierStyleSup">52</span></a>&#44; 1994&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">1 &#40;recurrente&#41;&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">S&#237;&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">NS&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">42&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hesse et al<a class="elsevierStyleCrossRef" href="#bb0225"><span class="elsevierStyleSup">45</span></a>&#44; 1995&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">1&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">NS&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">24&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Barlow et al<a class="elsevierStyleCrossRef" href="#bb0135"><span class="elsevierStyleSup">27</span></a>&#44; 1996&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">2&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">1&#44;5&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">24&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Billingsley et al<a class="elsevierStyleCrossRef" href="#bb0035"><span class="elsevierStyleSup">7</span></a>&#44; 1996&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">4 &#40;3 recurrentes&#41;&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">NS&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">31&#44;4&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Park y Parry<a class="elsevierStyleCrossRef" href="#bb0060"><span class="elsevierStyleSup">12</span></a>&#44; 1998&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">1&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">3&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"><span class="elsevierStyleHsp" style=""></span>6&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Friedman et al<a class="elsevierStyleCrossRef" href="#bb0160"><span class="elsevierStyleSup">32</span></a>&#44; 1999&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">11 &#40;2 recurrentes&#41;&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">3&#44;5&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">60&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chiller et al<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a>&#44; 2000&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">25 &#40;3 recurrentes&#41;&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">S&#237; &#40;3 casos&#41;&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">NS&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">38&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Snow et al<a class="elsevierStyleCrossRef" href="#bb0265"><span class="elsevierStyleSup">53</span></a>&#44; 2001&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">13 &#40;3 recurrentes&#41;&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">NS&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">60&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abbate et al<a class="elsevierStyleCrossRef" href="#bb0270"><span class="elsevierStyleSup">54</span></a>&#44; 2003&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">6 &#40;2 recurrentes&#41;&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">NS&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">23&#44;3&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Khachemoune et al<a class="elsevierStyleCrossRef" href="#bb0275"><span class="elsevierStyleSup">55</span></a>&#44; 2005&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">4&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">4&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">12&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Leibovitch et al<a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a>&#44; 2005&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">20 &#40;4 recurrentes&#41;&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">2&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">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab183012.png"
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        ]
        "descripcion" => array:1 [
          "es" => "<p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">Pacientes con carcinoma anexial microqu&#237;stico tratados mediante cirug&#237;a de Mohs descritos en la literatura</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bs0005"
          "bibliografiaReferencia" => array:55 [
            0 => array:3 [
              "identificador" => "bb0005"
              "etiqueta" => "1&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sweat gland carcinoma with syringomatous features&#58; a light microscopic and ultrastructural study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Lipper"
                            1 => "S&#46;C&#46; Peiper"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "1979"
                        "volumen" => "44"
                        "paginaInicial" => "157"
                        "paginaFinal" => "163"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/455242"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bb0010"
              "etiqueta" => "2&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Microcystic adnexal carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46;H&#46; Cooper"
                            1 => "S&#46;E&#46; Mills"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "1984"
                        "volumen" => "10"
                        "paginaInicial" => "908"
                        "paginaFinal" => "914"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6725679"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bb0015"
              "etiqueta" => "3&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sclerosing sweat duct &#40;syringomatous&#41; carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;H&#46; Cooper"
                            1 => "S&#46;E&#46; Mills"
                            2 => "D&#46;D&#46; Leonard"
                            3 => "D&#46;J&#46; Santa Cruz"
                            4 => "J&#46;T&#46; Headington"
                            5 => "R&#46;J&#46; Barr"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Surg Pathol"
                        "fecha" => "1985"
                        "volumen" => "9"
                        "paginaInicial" => "422"
                        "paginaFinal" => "433"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4091180"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bb0020"
              "etiqueta" => "4&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Microcystic adnexal carcinoma&#58; a distinct clinicopathologic entity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;J&#46; Goldstein"
                            1 => "R&#46;J&#46; Barr"
                            2 => "D&#46;J&#46; Santacruz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "1982"
                        "volumen" => "50"
                        "paginaInicial" => "566"
                        "paginaFinal" => "572"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7093897"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bb0025"
              "etiqueta" => "5&#46;"
              "referencia" => array:1 [
                0 => array:2 [
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