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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El lentigo maligno &#40;LM&#41; es un subtipo de melanoma <span class="elsevierStyleItalic">in situ</span> que aparece en personas de edad avanzada&#44; en zonas fotoexpuestas y con da&#241;o act&#237;nico cr&#243;nico<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; El tratamiento est&#225;ndar es la escisi&#243;n quir&#250;rgica con m&#225;rgenes de 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm&#46; Sin embargo&#44; dada la mala delimitaci&#243;n de muchos tumores es frecuente que esta ex&#233;resis sea incompleta<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;5</span></a>&#46; Entre un 6 y el 20&#37; de las lesiones recidivan&#44; lo que se atribuye a una extensi&#243;n de c&#233;lulas tumorales m&#225;s a all&#225; de los l&#237;mites cl&#237;nicos de la pieza de ex&#233;resis&#44; y a que el procesamiento convencional para un estudio histol&#243;gico solo eval&#250;a un 5&#37; de los m&#225;rgenes<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;8</span></a>&#46; La extensi&#243;n subcl&#237;nica parece estar relacionada con el tama&#241;o del tumor&#44; por lo que se ha sugerido que el margen requerido para garantizar una extirpaci&#243;n completa deber&#237;a ser mayor cuanto mayor sea el di&#225;metro del tumor<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; De hecho&#44; las &#250;ltimas recomendaciones de la <span class="elsevierStyleItalic">National Comprehensive Cancer Network</span> apuntan que para los LM de gran tama&#241;o podr&#237;an ser necesarios m&#225;rgenes superiores a 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm para obtener una extirpaci&#243;n completa&#44; y que ser&#237;a recomendable el uso de t&#233;cnicas que garanticen el control de todos los m&#225;rgenes de la pieza quir&#250;rgica&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Existen diversas t&#233;cnicas quir&#250;rgicas &#8212;cirug&#237;a de Mohs y sus variantes&#8212; que permiten el an&#225;lisis del 100&#37; de m&#225;rgenes de la pieza de ex&#233;resis&#44; y adem&#225;s contribuyen a minimizar la eliminaci&#243;n innecesaria de tejidos sanos circundantes<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;10</span></a>&#46; Diversos estudios retrospectivos han puesto de manifiesto que con estas t&#233;cnicas las recurrencias del LM se reducen al 0&#44;5-3&#37;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;11&#8211;15</span></a>&#46; Dada la dificultad que conlleva la identificaci&#243;n de los melanocitos en las secciones congeladas&#44; incluso con la ayuda de tinciones inmunohistoqu&#237;micas&#44; la mayor&#237;a de autores prefieren las variantes de Mohs en las que el estudio histol&#243;gico se realiza de forma diferida a partir del tejido procesado en parafina<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;16&#8211;19</span></a>&#46; En nuestra experiencia&#44; desde la introducci&#243;n de la cirug&#237;a de Mohs para el tratamiento del LM tambi&#233;n hemos observado un menor n&#250;mero de reca&#237;das&#46; En la mayor&#237;a de casos el tumor puede ser extirpado en un solo estadio&#44; pero nos llama la atenci&#243;n que en algunos pacientes son necesarios m&#225;s de dos estadios&#46; El tama&#241;o del LM y&#47;o sus caracter&#237;sticas cl&#237;nicas podr&#237;an condicionar la medida de los m&#225;rgenes adecuados para su ex&#233;resis curativa&#46; Pensamos que puede haber alguna correlaci&#243;n entre ciertos par&#225;metros cl&#237;nicos del LM y su posible extensi&#243;n subcl&#237;nica&#44; de modo que su identificaci&#243;n nos permitir&#237;a escoger <span class="elsevierStyleItalic">a priori</span> el tratamiento m&#225;s apropiado&#58; la ex&#233;resis quir&#250;rgica convencional con unos m&#225;rgenes preestablecidos o la cirug&#237;a de Mohs diferida&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El objetivo principal del presente estudio es identificar par&#225;metros cl&#237;nicos que puedan predecir qu&#233; LM localizados en la cabeza&#44; extirpados de forma primaria o tras la recidiva&#44; se extienden m&#225;s all&#225; de los l&#237;mites visibles y&#44; por tanto&#44; puedan requerir unos m&#225;rgenes quir&#250;rgicos m&#225;s amplios&#46; El segundo objetivo es definir cu&#225;l deber&#237;a ser el margen quir&#250;rgico para obtener la curaci&#243;n del tumor en funci&#243;n de dichas variables cl&#237;nicas&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Metodolog&#237;a</span><p id="par0020" class="elsevierStylePara elsevierViewall">Se seleccionaron los pacientes con LM localizado en la cabeza&#44; cuyo tratamiento quir&#250;rgico definitivo&#44; mediante cirug&#237;a convencional o cirug&#237;a de Mohs diferida&#44; fue realizado en el Servicio de Dermatolog&#237;a del Instituto Valenciano de Oncolog&#237;a &#40;IVO&#41; entre enero de 1993 y abril de 2011&#44; e incluidos en la base de datos de melanoma del centro<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#46; Se revis&#243; retrospectivamente toda la informaci&#243;n y la iconograf&#237;a incluida en las historias cl&#237;nicas acerca de las caracter&#237;sticas del paciente y de la lesi&#243;n&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">La cirug&#237;a convencional consisti&#243; en la ex&#233;resis con 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm de margen m&#225;s all&#225; de la lesi&#243;n cl&#237;nicamente visible y su procesamiento histol&#243;gico convencional&#46; En nuestro centro la cirug&#237;a convencional de los tumores incluye un fileteado de los m&#225;rgenes quir&#250;rgicos&#44; con evaluaci&#243;n por separado de los m&#225;rgenes laterales y los m&#225;rgenes profundos&#46; Con cirug&#237;a de Mohs diferida se estudi&#243; la pieza quir&#250;rgica incluida en parafina tras su procesamiento y corte&#44; seg&#250;n las pautas del Mohs convencional&#44; es decir&#44; con el an&#225;lisis del 100&#37; de sus m&#225;rgenes&#44; el mapeado de la pieza extirpada ayudado por im&#225;genes impresas aportadas al pat&#243;logo y la ayuda de tinciones inmunohistoqu&#237;micas &#40;Melan-A y HMB-45&#41; en los casos que la pudieran requerir&#46; Los m&#225;rgenes de cada estadio de Mohs tambi&#233;n son de 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm aproximadamente&#44; aunque a partir de la segunda etapa solo incluye la zona en la que hab&#237;a afectaci&#243;n del margen lateral en la etapa anterior y parte de las &#225;reas adyacentes&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En primer lugar se incluyeron LM primarios confirmados histol&#243;gicamente mediante biopsia incisional o excisional&#46; Entendemos como tumores primarios aquellos que no hab&#237;an recibido tratamiento curativo previo&#46; Se consideran tratamientos curativos la cirug&#237;a convencional con m&#225;rgenes de 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm libres de tumor &#40;o seguida de ampliaci&#243;n en los casos con m&#225;rgenes afectos&#41;&#44; la cirug&#237;a de Mohs o el imiquimod t&#243;pico seguido de la desaparici&#243;n cl&#237;nica de la lesi&#243;n&#46; Dentro de los tratamientos considerados no curativos se incluyeron aquellos procedimientos realizados antes del diagn&#243;stico histol&#243;gico y&#47;o de la sospecha cl&#237;nica de malignidad&#44; por lo tanto realizados con un diagn&#243;stico de lesi&#243;n benigna y que no segu&#237;an la aplicaci&#243;n recomendada en caso de que se hubieran aplicado con el diagn&#243;stico de LM&#46; Aqu&#237; se incluyen las ex&#233;resis por afeitado&#44; la cirug&#237;a convencional con menos de 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm de margen y otros procedimientos realizados con intenci&#243;n terap&#233;utica b&#225;sicamente est&#233;tica&#44; implicando que la lesi&#243;n pigmentada hab&#237;a sido considerada cl&#237;nicamente benigna&#46; La crioterapia&#44; la electrocoagulaci&#243;n&#44; diferentes tipos de l&#225;ser y las cremas despigmentantes forman parte de este grupo de t&#233;cnicas&#44; que a partir de ahora denominamos &#171;artefactuales&#187;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Por otro lado&#44; se incluyeron los LM que fueron operados en nuestro servicio tras presentar una reca&#237;da tumoral&#44; es decir&#44; que hab&#237;an reaparecido despu&#233;s de un tratamiento considerado curativo &#40;en nuestro centro o en otros centros&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Teniendo en cuenta que el margen de ex&#233;resis recomendado en la cirug&#237;a convencional del LM es de 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm&#44; y que en nuestro centro se analiza histol&#243;gicamente el 100&#37; de los m&#225;rgenes quir&#250;rgicos&#44; y asumiendo que en cada estadio de cirug&#237;a de Mohs diferida extraemos el mismo tama&#241;o de piel&#44; se consider&#243; que ambos procedimientos pueden englobarse bajo el concepto de etapa quir&#250;rgica&#44; con car&#225;cter aditivo para aquellos casos en que se requiri&#243; m&#225;s de una intervenci&#243;n para obtener m&#225;rgenes libres&#46; As&#237;&#44; se estableci&#243; que la variable respuesta principal a analizar en cada lesi&#243;n fue el n&#250;mero de etapas quir&#250;rgicas de 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm requeridas para obtener m&#225;rgenes libres de tumor&#59; esta variable fue dicotomizada en una o m&#225;s de una etapa&#46; La ex&#233;resis convencional con menos de 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm y las ex&#233;resis por afeitado no se consideran tratamientos curativos&#44; por lo tanto no se contabilizaron como etapas quir&#250;rgicas&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Como factores demogr&#225;ficos se incluyeron la edad del paciente en el momento de la cirug&#237;a definitiva&#44; el sexo y el fototipo de piel&#46; Con respecto al tumor se anot&#243; el tiempo de evoluci&#243;n desde la percepci&#243;n del paciente hasta su diagn&#243;stico&#44; la localizaci&#243;n&#44; su tama&#241;o aproximado en cent&#237;metros&#44; su color predominante y la delimitaci&#243;n de los m&#225;rgenes&#44; pudiendo estar bien o mal delimitados&#46; Por su car&#225;cter subjetivo la variable color de los LM fue categorizada como de predominio claro &#40;marr&#243;n claro y eritematoso&#41; u oscuro &#40;marr&#243;n oscuro o negro&#41;&#46; Se detallaron los tratamientos previos realizados en el grupo de LM que hab&#237;an presentado reca&#237;da tumoral y&#44; por &#250;ltimo&#44; se recogi&#243; la informaci&#243;n referente a las t&#233;cnicas artefactuales utilizadas en cada caso&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Se excluyeron los pacientes que presentaban focos de melanoma invasor en alguna de las biopsias o ex&#233;resis&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A efectos del estudio todas las variables cuantitativas fueron categorizadas y solo se incluyeron aquellos tumores con informaci&#243;n disponible en cada apartado&#46; Se realiz&#243; un an&#225;lisis descriptivo de las variables demogr&#225;ficas y los par&#225;metros cl&#237;nicos de las lesiones&#44; y se evaluaron las diferencias en la distribuci&#243;n de cada variable en funci&#243;n del n&#250;mero de etapas quir&#250;rgicas requeridas&#46; Se emple&#243; la prueba de la Ji cuadrado de Pearson&#44; excepto en aquellas situaciones en que la frecuencia m&#237;nima esperada era menor a 5&#44; en cuyo caso se emple&#243; el estad&#237;stico exacto de Fisher&#46; Se estableci&#243; la significaci&#243;n estad&#237;stica en 0&#44;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0060" class="elsevierStylePara elsevierViewall">Se incluyeron 62 LM &#40;49 primarios y 13 reca&#237;das&#41; que correspond&#237;an a 57 pacientes &#40;30 varones y 27 mujeres&#41;&#46; Un var&#243;n tuvo 2 LM en diferentes localizaciones y 4 pacientes fueron tratados en el IVO por la lesi&#243;n primaria y posteriormente por la reca&#237;da tumoral&#46; La edad mediana de los pacientes fue de 67&#44;5 a&#241;os &#40;intervalo intercuart&#237;lico de 60-76 a&#241;os&#41;&#46; Se observ&#243; que 20&#47;55 &#40;36&#44;4&#37;&#41; pacientes ten&#237;an un fototipo claro &#40;Fitzpatrick I-II&#41; y 35&#47;55 oscuro &#40;Fitzpatrick III-V&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Casi la mitad &#40;48&#44;4&#37;&#41; de LM estaban en la mejilla y&#44; por orden de frecuencia decreciente&#44; los dem&#225;s tumores se localizaban en la nariz &#40;22&#44;6&#37;&#41;&#44; el cuero cabelludo &#40;14&#44;5&#37;&#41;&#44; la frente y la sien &#40;4&#44;8&#37; cada una&#41;&#44; el pabell&#243;n auricular &#40;3&#44;2&#37;&#41; y la zona perioral &#40;1&#44;6&#37;&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">El tiempo de evoluci&#243;n de las lesiones oscilaba entre unos pocos meses y a&#241;os&#44; y fue superior a 10 a&#241;os en 11 de los casos&#46; La mayor&#237;a &#40;59&#44;6&#37;&#41; fueron observados por los pacientes por primera vez en los 5 a&#241;os anteriores&#46; Con respecto a las reca&#237;das el tiempo transcurrido desde el tratamiento curativo previo hasta el tratamiento practicado en nuestro centro oscilaba entre unos pocos meses y 6 a&#241;os&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">En relaci&#243;n con el tama&#241;o de la lesi&#243;n en 38 de 54 pacientes &#40;70&#44;4&#37;&#41; los tumores med&#237;an 2<span class="elsevierStyleHsp" style=""></span>cm o menos&#44; justo antes de recibir el tratamiento curativo y en 16 de 54 &#40;29&#44;6&#37;&#41; las lesiones eran mayores de 2<span class="elsevierStyleHsp" style=""></span>cm&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Treinta &#40;30&#47;48&#59; 62&#44;5&#37;&#41; lesiones se catalogaron como oscuras&#44; 18 de 48 &#40;37&#44;5&#37;&#41; claras y en 14 casos faltaba esta informaci&#243;n&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La gran mayor&#237;a de las lesiones &#40;47&#47;54&#59; 87&#37;&#41; estaban cl&#237;nicamente mal delimitadas y ten&#237;an m&#225;rgenes irregulares&#44; y solo 7 &#40;13&#37;&#41; &#8212;todos ellos LM primarios&#8212; fueron calificadas como bien definidas&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En 14 de 62 &#40;22&#44;6&#37;&#41; tumores se hab&#237;an utilizado una o m&#225;s de las &#171;t&#233;cnicas artefactuales&#187; durante la evoluci&#243;n de la lesi&#243;n&#44; empleadas siempre bajo el diagn&#243;stico cl&#237;nico de lesi&#243;n benigna&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Con respecto al tratamiento realizado en nuestro Servicio&#44; aproximadamente una cuarta parte &#40;13&#47;49&#59; 26&#44;5&#37;&#41; de LM primarios&#44; y casi un tercio &#40;4&#47;13&#59; 30&#44;7&#37;&#41; de las reca&#237;das fueron tratados mediante cirug&#237;a convencional con m&#225;rgenes de 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm en una o m&#225;s etapas&#44; en funci&#243;n de la afectaci&#243;n de los m&#225;rgenes quir&#250;rgicos&#46; De estos&#44; solo 4 LM &#40;3 recidivas y un primario&#41; fueron intervenidos en 2 etapas de 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm debido a la afectaci&#243;n de los m&#225;rgenes quir&#250;rgicos por el tumor&#46; En 33 de 49 &#40;67&#44;3&#37;&#41; LM primarios y en 8 de 13 &#40;61&#44;5&#37;&#41; recidivas se utiliz&#243; una cirug&#237;a de Mohs diferida&#44; que requiri&#243; de uno a 4 estadios para obtener m&#225;rgenes libres&#58; 29 lesiones se extirparon en una sola etapa&#44; 10 en 2 etapas&#44; una lesi&#243;n en 3 etapas y otra en 4 etapas&#46; Por &#250;ltimo se emple&#243; la cirug&#237;a de Mohs despu&#233;s de la ex&#233;resis convencional con m&#225;rgenes afectos &#40;en una o m&#225;s etapas&#41; en 3 de 49 LM primarios y en una de 13 reca&#237;das&#46; En los 3 casos fue suficiente una &#250;nica etapa de cirug&#237;a de Mohs&#46; Las ex&#233;resis convencionales de 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm con m&#225;rgenes afectos&#44; realizadas a pacientes que proven&#237;an de otros centros&#44; tambi&#233;n contabilizaron como etapa quir&#250;rgica&#46; La delimitaci&#243;n de la lesi&#243;n&#44; su tama&#241;o&#44; su localizaci&#243;n o algunas caracter&#237;sticas del paciente fueron par&#225;metros que determinaron la elecci&#243;n individualizada de una t&#233;cnica u otra&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Nueve de los 13 LM que intervenimos tras la reca&#237;da tumoral hab&#237;an sido tratados en otros centros&#44; y 4 hab&#237;an sido operados previamente en el IVO&#46; Con respecto a los tratamientos curativos que se hab&#237;an realizado 2 de 13 lesiones hab&#237;an sido tratadas con imiquimod&#44; obteni&#233;ndose la curaci&#243;n cl&#237;nica&#44; en 10 de 13 se hab&#237;a realizado una ex&#233;resis quir&#250;rgica con m&#225;rgenes informados como libres&#44; y un LM recay&#243; en 2 ocasiones&#44; primero despu&#233;s del tratamiento con imiquimod y posteriormente a los 2 a&#241;os de la ex&#233;resis quir&#250;rgica&#46; De los 11 tumores que hab&#237;an sido tratados quir&#250;rgicamente&#44; en 9 se hab&#237;a hecho cirug&#237;a convencional y en los otros 2 cirug&#237;a de Mohs&#46; Uno de estos &#250;ltimos casos correspond&#237;a a un LM con una larga historia de tratamientos con l&#225;seres ablativos y varios ciclos de imiquimod&#46; En 7 de 13 reca&#237;das de LM se hab&#237;an empleado &#171;t&#233;cnicas artefactuales&#187; una o m&#225;s veces durante su evoluci&#243;n&#46; Tambi&#233;n se hab&#237;an utilizado dichas t&#233;cnicas en 3 de los 4 tumores que hab&#237;an presentado reca&#237;da tumoral en m&#225;s de una ocasi&#243;n&#46; Respecto a los 3 LM tratados con imiquimod&#44; en todos ellos fueron necesarios varios ciclos de tratamiento para alcanzar la curaci&#243;n cl&#237;nica&#44; y cabe destacar que en los 3 casos tambi&#233;n se hab&#237;an empleado una o m&#225;s &#171;t&#233;cnicas artefactuales&#187; en alg&#250;n momento de su evoluci&#243;n&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Al analizar las diferentes variables explicativas en funci&#243;n del margen quir&#250;rgico requerido para su ex&#233;resis se obtuvieron los siguientes resultados&#58; el n&#250;mero medio de etapas requeridas fue de 1&#44;31 para los LM primarios y de 1&#44;92 para los LM recidivados&#46; Un 73&#44;5&#37; de los LM primarios fueron extirpados en una sola etapa quir&#250;rgica de 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm&#44; porcentaje que se elevaba a un 95&#44;5&#37; de los casos si se inclu&#237;an tambi&#233;n aquellos que precisaron de 1<span class="elsevierStyleHsp" style=""></span>cm de margen &#40;2 etapas&#41; para extirpar completamente la lesi&#243;n &#40;<a class="elsevierStyleCrossRefs" href="#tbl0005">tablas 1 y 2</a>&#41;&#46; A diferencia de los LM primarios&#44; solo el 30&#44;8&#37; de LM que presentaron reca&#237;da se extirparon completamente con m&#225;rgenes de 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm&#44; el 84&#44;6&#37; al incluir los que necesitaron 1<span class="elsevierStyleHsp" style=""></span>cm y el 92&#44;3&#37; si se inclu&#237;an los extirpados con 1&#44;5<span class="elsevierStyleHsp" style=""></span>cm de margen &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#41; &#40;<a class="elsevierStyleCrossRefs" href="#tbl0005">tablas 1 y 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Aquellas lesiones que fueron tratadas con &#171;t&#233;cnicas artefactuales&#187; previas al tratamiento definitivo requirieron en su mayor&#237;a 2 etapas quir&#250;rgicas&#44; y solo un 35&#44;7&#37; de los casos fueron extirpados adecuadamente con 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm de margen&#44; a diferencia de las que no recibieron dichos tratamientos &#40;72&#44;9&#37; de curaci&#243;n con 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">En los LM primarios de pacientes de fototipos claros se consigui&#243; un 92&#44;9&#37; de curaci&#243;n con una sola etapa&#44; mientras que en aquellos de fototipos oscuros fue necesario 1<span class="elsevierStyleHsp" style=""></span>cm de margen quir&#250;rgico para extirpar completamente el 93&#44;1&#37; de las lesiones &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46; Estos datos difieren de los observados en el grupo de recidivas de LM&#44; en el que la tendencia se invierte&#44; requiri&#233;ndose m&#225;s etapas quir&#250;rgicas en los LM de pacientes de fototipo claro &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Tambi&#233;n observaron diferencias significativas en el n&#250;mero de etapas quir&#250;rgicas requeridas en los LM recidivados en funci&#243;n del sexo de los pacientes&#58; las mujeres requirieron m&#225;s estadios para curarse que los hombres&#59; con 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm de margen se extirparon el 11&#44;1&#37; de LM en mujeres frente al 75&#37; en hombres&#44; porcentajes de curaci&#243;n que sub&#237;an al 77&#44;8 y el 100&#37; respectivamente cuando se inclu&#237;an los casos que precisaban de 1<span class="elsevierStyleHsp" style=""></span>cm &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;052&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46; El an&#225;lisis conjunto de todos los LM estudiados &#40;primarios m&#225;s recidivas&#41; mostr&#243; una tendencia a favor de lo mismo &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Pese a no alcanzar significaci&#243;n estad&#237;stica se observaron algunas tendencias que merece la pena destacar &#40;<a class="elsevierStyleCrossRefs" href="#tbl0015">tablas 3-5</a>&#41;&#46; Se requirieron m&#225;s etapas quir&#250;rgicas en los pacientes menores de 65 a&#241;os y en aquellas lesiones localizadas en la zona centrofacial &#40;mejilla&#44; nariz y zona perioral&#41;&#44; en comparaci&#243;n con la periferia de la cara &#40;frente&#44; cuero cabelludo&#44; sien y oreja&#41;&#46; Los LM de color claro y aquellos que hab&#237;an sido calificados como bien delimitados se extirparon completamente con menos cent&#237;metros de margen que los oscuros y los mal delimitados&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">No se encontraron diferencias significativas en el n&#250;mero de etapas requeridas en funci&#243;n del tama&#241;o de la lesi&#243;n y el tiempo de evoluci&#243;n&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En el grupo de las reca&#237;das tumorales ni el n&#250;mero de tratamientos previos realizados ni el tipo de tratamiento&#44; ya fuera ex&#233;resis quir&#250;rgica convencional&#44; cirug&#237;a de Mohs o imiquimod t&#243;pico&#44; mostr&#243; diferencias en el n&#250;mero de estadios requeridos &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0140" class="elsevierStylePara elsevierViewall">El tratamiento del LM sigue siendo un tema controvertido&#46; Existen diferentes opciones terap&#233;uticas&#44; pero las t&#233;cnicas quir&#250;rgicas ofrecen ciertas ventajas frente a las no quir&#250;rgicas&#46; La primera y principal es que permite asegurar que no existe componente invasor del melanoma y&#44; si est&#225; presente&#44; medir el &#237;ndice de Breslow&#44; crucial para el manejo y el pron&#243;stico de este tumor&#46; En segundo lugar se trata el componente profundo perianexial que se observa con frecuencia cuando hay extensi&#243;n subcl&#237;nica del tumor<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;21</span></a>&#44; y por &#250;ltimo&#44; a diferencia de otras t&#233;cnicas ablativas&#44; se evitan alteraciones de la pigmentaci&#243;n que dificulten o impidan la identificaci&#243;n de una posible reca&#237;da del LM&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">En cuanto al imiquimod&#44; Rajpar et al&#46;&#44; en una revisi&#243;n de LM tratados con este f&#225;rmaco&#44; comenta que pese a algunos datos llamativos de curaci&#243;n&#44; el tiempo de seguimiento de todos los estudios no es lo suficientemente largo como para probar la eficacia de este tratamiento para el c&#225;ncer<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;23</span></a>&#46; Adem&#225;s&#44; se ha demostrado que tras una biopsia incisional con diagn&#243;stico inicial de LM existe una probabilidad del 22&#37; de hallar un componente invasivo en el estudio histol&#243;gico de la pieza de ex&#233;resis&#44; dato que apoya el tratamiento quir&#250;rgico del tumor<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#46; Por todo ello&#44; no es un tratamiento recomendado con los datos actuales<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#46; Los resultados de nuestra serie&#44; a pesar del escaso n&#250;mero de pacientes&#44; tampoco apoyan su uso y pensamos que su utilizaci&#243;n podr&#237;a conllevar un &#171;efecto artefactual&#187; sobre las caracter&#237;sticas del LM&#46; Creemos que deber&#237;a restringirse su uso a aquellos casos en los que la cirug&#237;a est&#225; contraindicada y no se puedan administrar m&#233;todos alternativos&#44; tales como la radioterapia&#46; La cirug&#237;a convencional con 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm de margen y la cirug&#237;a de Mohs constituyen los tratamientos quir&#250;rgicos m&#225;s empleados&#46; En este estudio por primera vez hemos determinado el margen quir&#250;rgico requerido para extirpar completamente el LM en funci&#243;n de diferentes caracter&#237;sticas cl&#237;nicas y demogr&#225;ficas&#44; englobando a pacientes tratados con cirug&#237;a convencional y cirug&#237;a de Mohs diferida&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Adem&#225;s&#44; es el primer estudio en que se registran los tratamientos realizados sobre los LM antes de ser diagnosticados o sospechados como patolog&#237;a maligna&#44; que hemos denominado &#171;t&#233;cnicas artefactuales&#187;&#46; A pesar de que estos tratamientos se han aplicado con &#233;xito en algunas series de LM&#44; creemos que es fundamental conocer la intenci&#243;n con la que se realizan&#46; Collins en 1991&#44; y posteriormente Kuflick en 1994 aplicando crioterapia en LM con intenci&#243;n curativa&#44; atribuyeron su alta tasa de recurrencias al hecho de no alcanzar la temperatura o profundidad adecuadas<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#8211;29</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Es importante tener en cuenta que al tratarse de un estudio retrospectivo y observacional conlleva una serie de limitaciones&#58; algunos par&#225;metros no fueron registrados de forma estandarizada y prospectiva en el momento del diagn&#243;stico&#44; o no se han podido recuperar &#40;color&#44; tama&#241;o&#44; fototipo&#44; etc&#46;&#41;&#46; Tambi&#233;n habr&#237;a que remarcar el car&#225;cter subjetivo de algunas de las caracter&#237;sticas cl&#237;nicas&#44; como el color o la delimitaci&#243;n de las lesiones&#46; Por otro lado&#44; creemos importante mencionar que no se utiliz&#243; la dermatoscopia ni la luz de Wood<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> para optimizar la delimitaci&#243;n de las lesiones antes de la intervenci&#243;n quir&#250;rgica&#46; Es especialmente importante recordar que&#44; como centro de referencia para la cirug&#237;a de Mohs&#44; existe un inevitable sesgo de selecci&#243;n que hace que la poblaci&#243;n estudiada no sea necesariamente representativa de la poblaci&#243;n de pacientes que presentan un LM&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Somos conscientes de que existen notables diferencias entre la cirug&#237;a convencional y la cirug&#237;a de Mohs&#44; tanto en la t&#233;cnica de escisi&#243;n &#40;&#225;ngulo de incisi&#243;n&#44; profundidad&#44; exactitud del tama&#241;o de margen&#44; etc&#46;&#41; y en el procesamiento de la muestra&#44; como en el defecto final obtenido &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; No obstante&#44; a efectos pr&#225;cticos&#44; consideramos que cada intervenci&#243;n de cirug&#237;a convencional o cada estadio de cirug&#237;a de Mohs forma parte del mismo concepto de &#171;etapa quir&#250;rgica&#187;&#44; que ser&#237;a el equivalente al tama&#241;o del margen quir&#250;rgico desde el l&#237;mite visible de la lesi&#243;n&#46; En particular&#44; en nuestro centro se analizan todos los m&#225;rgenes laterales en las cirug&#237;as convencionales mediante el fileteado de los mismos&#44; y la gran diferencia con la cirug&#237;a de Mohs diferida consiste en el mapeo de la lesi&#243;n&#44; que permite identificar exactamente la zona donde el margen quir&#250;rgico ha sido insuficiente&#46; De forma arbitraria&#44; y posiblemente sujeto a variaciones potencialmente significativas&#44; especialmente en localizaciones donde el cirujano se propone ahorrar el m&#225;ximo tejido sano posible &#40;por ejemplo&#44; la zona periocular&#41;&#44; hemos considerado que cada etapa quir&#250;rgica&#44; tanto en cirug&#237;a convencional como en cirug&#237;a de Mohs&#44; corresponder&#237;a a 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm&#46; Esta asunci&#243;n debe considerarse tambi&#233;n como una limitaci&#243;n del estudio&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">Por otra parte&#44; es importante resaltar que todos los pacientes fueron tratados en el mismo centro&#44; especializado en oncolog&#237;a cut&#225;nea&#44; y que probablemente muchos de ellos fueron derivados a este por presentar lesiones complejas&#44; con m&#250;tiples recidivas o previamente tratadas sin &#233;xito&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">En nuestra serie hemos observado que las reca&#237;das de LM requieren un margen quir&#250;rgico m&#225;s amplio que los LM primarios&#46; Tambi&#233;n que aquellos LM&#44; tanto primarios como recidivados&#44; que han sido tratados con t&#233;cnicas &#171;artefactuales&#187; requieren m&#225;s etapas quir&#250;rgicas para su curaci&#243;n&#46; Estos resultados podr&#237;an indicar que los LM que presenten reca&#237;da fueran lesiones mal delimitadas desde su inicio o con una extensi&#243;n subcl&#237;nica amplia&#44; y que por tanto fueran extirpadas incorrectamente o que el proceso de cicatrizaci&#243;n dificulte el diagn&#243;stico precoz de la reca&#237;da y permita un mayor crecimiento de la lesi&#243;n&#46; Por otro lado&#44; los tratamientos est&#233;ticos empleados err&#243;neamente durante la evoluci&#243;n de la lesi&#243;n parecen haber interferido notablemente en el aspecto cl&#237;nico del LM&#44; lo que da lugar a una mala delimitaci&#243;n cl&#237;nica al recaer&#46; Varios estudios han mencionado con anterioridad que hay tasas altas de recurrencias tras tratamientos con crioterapia&#44; l&#225;ser de arg&#243;n o electrocoagulaci&#243;n&#44; destacando la dificultad para identificar cl&#237;nicamente estas recurrencias<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;30</span></a>&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">En relaci&#243;n con las tasas de curaci&#243;n con la cirug&#237;a se han descrito resultados parecidos en otras publicaciones&#46; En la serie de Huilgol et al&#46; un 20&#37; de LM primarios y un 56&#37; de las reca&#237;das requirieron m&#225;s de un estadio de 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm&#59; los resultados en nuestra serie fueron del 26&#44;5 y del 69&#44;2&#37;&#44; respectivamente&#46; Sin embargo&#44; Huilgol utiliz&#243; una t&#233;cnica quir&#250;rgica seriada con control de m&#225;rgenes y procesamiento de la pieza igual a la cirug&#237;a convencional&#44; por tanto analizando un porcentaje del margen perif&#233;rico que dista del 100&#37; que se obtiene con la t&#233;cnica de Mohs<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46; Aagarwal-Antal obten&#237;a solo un 42&#37; de curaci&#243;n con 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm de margen en LM de zonas fotoexpuestas<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; En otro trabajo de 46 LM tratados con cirug&#237;a de Mohs convencional con tinciones inmunohistoqu&#237;micas&#44; Zalla et al&#46; obten&#237;an curaciones del 50&#37; con 0&#44;6<span class="elsevierStyleHsp" style=""></span>cm de margen<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">El hecho de que los LM primarios de pacientes de fototipos de piel m&#225;s oscuros requieran m&#225;s etapas quir&#250;rgicas para ser completamente extirpados&#44; podr&#237;a tener su explicaci&#243;n en la dificultad que confiere delimitar una lesi&#243;n melanoc&#237;tica sobre un fondo pigmentado&#46; Adem&#225;s cabe destacar que la delimitaci&#243;n histol&#243;gica de estas lesiones tambi&#233;n puede verse afectada por la elevada frecuencia en que se observan alteraciones en la densidad y distribuci&#243;n de melanocitos en la piel fotoexpuesta&#44; incluso con presencia de atipia leve-moderada en alg&#250;n caso&#44; en ausencia de tumor<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">32&#44;33</span></a>&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">La tendencia a requerir m&#225;s etapas quir&#250;rgicas en los LM centrofaciales podr&#237;a ser debido a que en zonas periorificiales el cirujano tiende a ser m&#225;s conservador&#44; con el objetivo de preservar las unidades est&#233;ticas de la cara&#46; Este motivo podr&#237;a justificar que tambi&#233;n se necesiten m&#225;s etapas en mujeres y en pacientes menores de 65 a&#241;os&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">El n&#250;mero medio de etapas quir&#250;rgicas de 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm en nuestro estudio es de 1&#44;31 en los LM primarios y de 1&#44;91 en los LM recidivados&#46; Clayton et al&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">34</span></a> obtuvieron una media de 1&#44;65 etapas quir&#250;rgicas para un total de 77 LM extirpados mediante cirug&#237;a de Mohs diferida&#46; En un estudio prospectivo de 116 pacientes con LM tratados mediante cirug&#237;a de Mohs convencional obten&#237;an una media de 1&#44;97 etapas quir&#250;rgicas<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; En este trabajo Bene demostr&#243; la necesidad del procesamiento diferido al encontrar c&#243;mo un nuevo corte parafinado tras el procesamiento con secciones congeladas revelaba persistencia de tumor en 8 de 167 casos de melanoma <span class="elsevierStyleItalic">in situ</span>&#46; Siew-Yin et al&#46; obtuvieron una media de 1&#44;64 etapas de 0&#44;2-0&#44;5<span class="elsevierStyleHsp" style=""></span>cm en un estudio retrospectivo de cirug&#237;a de Mohs diferida en 14 melanomas perioculares&#44; 8 de ellos LM<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">35</span></a>&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">De los 45 LM que tratamos con cirug&#237;a de Mohs diferida solo hubo 2 casos de reca&#237;da&#44; confirmando las altas tasas de curaci&#243;n descritas en la literatura<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;11&#8211;15</span></a>&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Creemos que la decisi&#243;n de emplear una t&#233;cnica quir&#250;rgica u otra debe individualizarse en funci&#243;n de las variables previamente descritas&#59; la escisi&#243;n quir&#250;rgica convencional es una excelente opci&#243;n para los LM primarios bien delimitados&#44; de peque&#241;o tama&#241;o&#44; en la periferia de la cara de pacientes de fototipo claro&#46; En caso contrario deber&#225;n plantearse intervenciones con m&#225;rgenes quir&#250;rgicos m&#225;s amplios &#40;0&#44;5-1<span class="elsevierStyleHsp" style=""></span>cm&#41;&#44; o t&#233;cnicas con control de m&#225;rgenes como la cirug&#237;a de Mohs&#44; que adem&#225;s de ofrecer mejores tasas de curaci&#243;n permite minimizar la p&#233;rdida de tejido sano en localizaciones est&#233;ticamente comprometidas&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; como ya se ha comentado en la literatura&#44; los datos de nuestra serie apoyan que una ex&#233;resis con m&#225;rgenes de 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm es insuficiente para algunos casos de LM&#46; Los tumores que han presentado reca&#237;da&#44; los que han recibido diversos tratamientos no curativos que puedan interferir en su delimitaci&#243;n cl&#237;nica&#44; las lesiones que aparecen en personas de fototipos oscuros y los LM localizados en la zona centrofacial pueden requerir un margen quir&#250;rgico inicial m&#225;s amplio&#46; Seg&#250;n nuestra serie caracter&#237;sticas como el tama&#241;o&#44; el color de la lesi&#243;n o el tiempo de evoluci&#243;n no ayudar&#237;an a predecir si la lesi&#243;n puede extenderse m&#225;s all&#225; de los l&#237;mites visibles&#46; No obstante&#44; otros trabajos s&#237; han demostrado la influencia del tama&#241;o de la lesi&#243;n en la probabilidad de extensi&#243;n subcl&#237;nica<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#46; Ser&#237;an necesarios estudios prospectivos aleatorizados con un n&#250;mero mayor de pacientes para alcanzar mayor evidencia cient&#237;fica&#46; Por otra parte&#44; el empleo de la microscop&#237;a confocal para delimitar adecuadamente el tumor&#44; monitorizar tratamientos no invasivos o detectar recidivas precozmente&#44; as&#237; como el uso de tratamientos adyuvantes&#44; como el imiquimod t&#243;pico al 0&#44;1&#37; en el periodo postquir&#250;rgico en el &#225;rea pericicatricial para disminuir las recurrencias podr&#237;an modificar sustancialmente las perspectivas terap&#233;uticas para el LM<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">36&#8211;38</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0210" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El tratamiento est&#225;ndar del lentigo maligno &#40;LM&#41; es la escisi&#243;n quir&#250;rgica con m&#225;rgenes de 0&#44;5 cm&#46; Sin embargo&#44; dada la mala delimitaci&#243;n de muchos tumores&#44; es frecuente que esta ex&#233;resis sea incompleta&#46;</p> <span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">identificar par&#225;metros cl&#237;nicos que puedan predecir qu&#233; LM localizados en la cabeza&#44; extirpados de forma primaria o tras recidivar&#44; se extienden m&#225;s all&#225; de los l&#237;mites visibles y por tanto&#44; puedan requerir m&#225;rgenes quir&#250;rgicos m&#225;s amplios&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">se revis&#243; retrospectivamente la informaci&#243;n cl&#237;nica de los pacientes con LM localizado en la cabeza cuyo tratamiento quir&#250;rgico definitivo&#44; mediante cirug&#237;a convencional o cirug&#237;a de Mohs diferida&#44; fue realizado en el Servicio de Dermatolog&#237;a del Instituto Valenciano de Oncolog&#237;a &#40;IVO&#41; entre enero de 1993 y abril de 2011&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">un 69&#44;2&#37; de los LM recidivados y un 26&#44;5&#37; de los tumores primarios requirieron m&#225;rgenes de m&#225;s de 0&#44;5 cm&#46; La administraci&#243;n previa de tratamientos que puedan interferir en la delimitaci&#243;n cl&#237;nica&#44; la localizaci&#243;n centrofacial y las lesiones que se presentan en pacientes con fototipos altos &#40;III-V&#41; fueron los factores asociados a la necesidad de m&#225;rgenes quir&#250;rgicos m&#225;s amplios&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">la utilizaci&#243;n de m&#225;rgenes de 0&#44;5 cm para el tratamiento del LM es insuficiente para un n&#250;mero importante de casos localizados en la cabeza&#44; especialmente los recidivados&#46; La cirug&#237;a de Mohs diferida&#44; con el estudio de todos los m&#225;rgenes en parafina&#44; parece el tratamiento de elecci&#243;n en particular para los casos recidivados o en los que la delimitaci&#243;n cl&#237;nica pueda verse dificultada&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Surgical excision with margins of 0&#46;5<span class="elsevierStyleHsp" style=""></span>cm is the standard treatment for lentigo maligna &#40;LM&#41;&#46; Excision&#44; however&#44; is often incomplete as many of these tumors have indistinct borders&#46;</p> <span class="elsevierStyleSectionTitle">Objective</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To identify clinical predictors of subclinical extension in primary and recurrent LM of the head and thereby determine which lesions might require wider surgical margins&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">We reviewed the clinical records of patients with LM of the head treated definitively with conventional surgical excision or slow micrographic Mohs surgery &#40;MMS&#41; at the dermatology department of Instituto Valenciano de Oncolog&#237;a between January 1993 and April 2011&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Surgical margins larger than 0&#46;5<span class="elsevierStyleHsp" style=""></span>cm were required in 69&#46;2&#37; of recurrent LM and 26&#46;5&#37; of primary LM&#46; Factors associated with the need for wider margins were prior treatment that might have interfered with the clinical delineation of the border&#44; lesions in the center of the face&#44; and skin phototypes III to V&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Surgical margins of 0&#46;5<span class="elsevierStyleHsp" style=""></span>cm are inadequate for the treatment of a considerable number of LM lesions located on the head&#44; particularly if these are recurrent&#46; Slow MMS using paraffin-embedded sections appears to be the treatment of choice in such cases&#44; particularly for recurrent lesions or lesions with poorly defined borders or possible subclinical extension&#46;</p>"
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1092
            "Ancho" => 2333
            "Tamanyo" => 212118
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Esquema sobre las diferencias en el defecto final que se obtiene tras una cirug&#237;a convencional y una cirug&#237;a de Mohs&#46; La parte central oscura simboliza un lentigo maligno&#46; El &#225;rea gris&#225;cea corresponde al margen de ex&#233;resis est&#225;ndar de piel sana alrededor del lentigo maligno&#44; por ejemplo&#44; 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm&#46; Las l&#237;neas de puntos indicar&#237;an el margen requerido en una segunda etapa en caso de que los m&#225;rgenes de la primera intervenci&#243;n estuvieran invadidos&#46; En el caso de la cirug&#237;a convencional &#40;figura de la izquierda&#41; el defecto final ser&#237;a mayor que con una cirug&#237;a de Mohs diferida &#40;figura de la derecha&#41;&#44; en la que solo se extrae tejido de la zona en la que se ha observado afectaci&#243;n en la primera etapa&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">P&#58; significaci&#243;n estad&#237;stica cuando se compara el grupo que ha obtenido la curaci&#243;n con margen de 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm vs&#46; &#62;<span class="elsevierStyleHsp" style=""></span>0&#44;5<span class="elsevierStyleHsp" style=""></span>cm&#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  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Lentigo maligno</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="6" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Margen requerido de ex&#233;resis</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">0&#44;5<span class="elsevierStyleHsp" style=""></span>cm</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;5<span class="elsevierStyleHsp" style=""></span>cm</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&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-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&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">Primarios&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#44;5&#37;&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="char" 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><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;5&#37;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&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">0&#44;008&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">Recidivas&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="char" 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;8&#37;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#44;2&#37;&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="char" 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><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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">Total&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#44;5&#37;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;5&#37;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab182717.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Margen quir&#250;rgico requerido para extirpar completamente los lentigos malignos primarios y las recidivas&#44; en una o m&#225;s de una etapa de 0&#44;5<span class="elsevierStyleHsp" style=""></span>cm</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "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  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Lentigo maligno</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="9" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Margen requerido de ex&#233;resis</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">0&#44;5<span class="elsevierStyleHsp" style=""></span>cm</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">1<span class="elsevierStyleHsp" style=""></span>cm</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">1&#44;5<span class="elsevierStyleHsp" style=""></span>cm</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">2<span class="elsevierStyleHsp" style=""></span>cm</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total&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-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">95&#44;9&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">49&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">84&#44;6&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#44;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">100&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \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
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                  \t\t\t\t">Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">93&#44;6&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">98&#44;4&#37;&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="char" 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " rowspan="3" align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Margen requerido de ex&#233;resis</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">0&#44;5<span class="elsevierStyleHsp" style=""></span>cm</td><td class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">1<span class="elsevierStyleHsp" style=""></span>cm</td><td class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">1&#44;5<span class="elsevierStyleHsp" style=""></span>cm</td><td class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mejilla&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Nariz&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Perioral&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Periferia&#46; Total</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Frente&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Cuero cabelludo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#62;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Nariz&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">66&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Perioral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Periferia&#46; Total</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Frente&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Cuero cabelludo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">87&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Sien&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">66&#44;7&nbsp;\t\t\t\t\t\t\n
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                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  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Lentigo maligno recidivas</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="11" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Margen requerido de ex&#233;resis</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">0&#44;5<span class="elsevierStyleHsp" style=""></span>cm</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">1<span class="elsevierStyleHsp" style=""></span>cm</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">1&#44;5<span class="elsevierStyleHsp" style=""></span>cm</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">2<span class="elsevierStyleHsp" style=""></span>cm</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&#40;a&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&#40;b&#41;&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-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&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  " colspan="12" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Sexo</span></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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hombre</span>&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="char" 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&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="char" 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&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="char" 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">0&#44;052&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="char" 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></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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mujer</span>&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="char" 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#44;8&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="char" 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#44;9&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="char" 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="12" 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="12" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Edad</span></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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#8804;<span class="elsevierStyleHsp" style=""></span>65 a&#241;os</span>&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="char" 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#44;7&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#44;7&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="char" 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&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">0&#44;26&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="char" 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></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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#62;<span class="elsevierStyleHsp" style=""></span>65 a&#241;os</span>&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="char" 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&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="char" 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " colspan="12" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="12" align="char" valign="\n
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                  \t\t\t\t  " colspan="12" align="char" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#62;<span class="elsevierStyleHsp" style=""></span>1</span>&nbsp;\t\t\t\t\t\t\n
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