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            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Autor para correspondencia&#46;"
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    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Characterization of Surgical Procedures in the Spanish Mohs Surgery Registry &#40;REGESMOHS&#41; for 2013-2015"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La cirug&#237;a microgr&#225;fica de Mohs es una t&#233;cnica para el tratamiento quir&#250;rgico de las neoplasias malignas cut&#225;neas localmente invasivas que proporciona tasas de curaci&#243;n superiores a otras opciones terap&#233;uticas y minimiza la eliminaci&#243;n de tejido sano peritumoral<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La t&#233;cnica descrita inicialmente por el Dr&#46; Mohs fue la t&#233;cnica del tejido fijado&#44; en la cual se aplicaba una pasta de cloruro de cinc sobre la lesi&#243;n que fijaba el tejido tumoral <span class="elsevierStyleItalic">in situ</span> y&#44; tras un periodo de varias horas&#44; se extirpaba la misma sin necesidad de anestesia y sin apenas sangrado&#46; Posteriormente se realizaban cortes horizontales de la pieza quir&#250;rgica en congelaci&#243;n y se examinaban al microscopio<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">2</span></a>&#46; Esta t&#233;cnica se repet&#237;a en d&#237;as sucesivos hasta asegurar la ausencia de tumor en los m&#225;rgenes&#46; Posteriormente&#44; el propio Mohs describi&#243; la denominada cirug&#237;a microgr&#225;fica de Mohs con tejido fresco&#44; en la cual se obvia la aplicaci&#243;n del cloruro de cinc&#44; extirpando directamente el tumor en capas bajo anestesia local&#46; De esta forma pod&#237;an realizarse varias secuencias&#44; e incluso la reconstrucci&#243;n en un mismo d&#237;a&#44; y pas&#243; a ser el m&#233;todo utilizado por la pr&#225;ctica totalidad de los cirujanos de Mohs<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">3&#44;4</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La dificultad para visualizar algunos tumores en congelaci&#243;n&#44; como el lentigo maligno o el dermatofibrosarcoma protuberans&#44; la posibilidad de recurrir a t&#233;cnicas de inmunohistoqu&#237;mica en determinados casos o&#44; simplemente&#44; no disponer de un laboratorio con criostato&#44; ha generado adaptaciones de la t&#233;cnica de Mohs caracterizadas por la inclusi&#243;n de las muestras en parafina&#44; en lugar de la congelaci&#243;n&#46; Es lo que se ha denominado Mohs en diferido o <span class="elsevierStyleItalic">slow</span>-Mohs&#44; y que con algunas modificaciones&#44; sobre todo en Europa&#44; ha recibido diversos nombres como histolog&#237;a en 3 dimensiones&#44; t&#233;cnica del per&#237;metro&#44; t&#233;cnica de Tubingen o m&#233;todo del cuadrante&#46; Todos estos m&#233;todos comparten entre ellos y con la cirug&#237;a de Mohs en congelaci&#243;n el concepto del estudio histopatol&#243;gico en cortes tangenciales que determina la valoraci&#243;n del 100&#37; de los m&#225;rgenes tumorales frente al m&#233;todo de cortes verticales habitual de las piezas quir&#250;rgicas<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Desde su descripci&#243;n inicial por el Dr&#46; Mohs&#44; la t&#233;cnica se implant&#243; en Estados Unidos y posteriormente en Europa&#46; En Espa&#241;a se ha desarrollado en las &#250;ltimas d&#233;cadas en un n&#250;mero creciente de centros&#44; tanto de la medicina p&#250;blica como de la privada&#46; Fruto de ello son los numerosos trabajos publicados sobre la t&#233;cnica en revistas nacionales e internacionales por autores espa&#241;oles<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">6&#8211;11</span></a>&#46; Con el objeto de describir los resultados de esta t&#233;cnica en Espa&#241;a en 2012 se plante&#243; por parte de la Fundaci&#243;n Academia Espa&#241;ola de Dermatolog&#237;a y Venereolog&#237;a &#40;FAEDV&#41;&#44; junto con el Grupo de trabajo de la AEDV de Dermatolog&#237;a Quir&#250;rgica&#44; L&#225;ser y Oncolog&#237;a Cut&#225;nea la puesta en marcha del Registro Espa&#241;ol de Cirug&#237;a de Mohs &#40;REGESMOHS&#41; en colaboraci&#243;n con la FAEDV&#46; En julio de 2013 se inici&#243; la recogida de datos&#46; Se han descrito previamente los centros en los que se realiza la t&#233;cnica y las caracter&#237;sticas de los pacientes y los tumores incluidos<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">12&#44;13</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">En el presente art&#237;culo se analiza la intervenci&#243;n quir&#250;rgica de los pacientes incluidos hasta la fecha en el registro&#44; valorando aspectos perioperatorios como el manejo de anticoagulantes y antiagregantes&#44; la t&#233;cnica quir&#250;rgica utilizada&#44; el n&#250;mero de estadios&#44; el tama&#241;o del defecto&#44; las complicaciones intraopreratorias&#44; el tipo de reconstrucci&#243;n y el consumo de recursos&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">El REGESMOHS es un estudio de cohortes prospectivo en el que participan un total de 18 centros dentro del &#225;mbito nacional &#40;sanidad p&#250;blica y privada&#41;&#44; en los que se practica al menos una intervenci&#243;n semanal de CMM&#46; Se incluyen en el registro todos aquellos pacientes sucesivos en los que se realice valoraci&#243;n previa para realizar cirug&#237;a de Mohs&#46; &#218;nicamente se excluyen pacientes menores de edad y los declarados judicialmente incapaces&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El estudio ha sido aprobado por el Comit&#233; &#201;tico de Investigaci&#243;n de Navarra&#44; la AEMPS y por parte de todos los centros participantes&#44; cumpliendo con la declaraci&#243;n de Helsinki y la legislaci&#243;n vigente&#46; Todos los pacientes han dado por escrito su consentimiento para participar en el estudio&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Las variables a medir se agrupan en las visitas del paciente&#46; En la primera visita se recogen los datos demogr&#225;ficos del paciente&#44; enfermedades asociadas como inmunosupresi&#243;n y diabetes mellitus y datos cl&#237;nicos e histopatol&#243;gicos del tumor&#44; as&#237; como los tratamientos previos&#46; En la segunda visita se registran datos de la cirug&#237;a&#58; tipo de cirug&#237;a de Mohs&#44; anestesia&#44; ingreso hospitalario&#44; manejo de los anticoagulantes y antiagregantes en la cirug&#237;a&#44; tama&#241;os del defecto quir&#250;rgico reconstrucci&#243;n&#44; tratamientos complementarios y tiempo de quir&#243;fano empleado en la cirug&#237;a&#44; as&#237; como las complicaciones y morbilidad intraquir&#250;rgica&#46; En la tercera visita se registran los resultados y complicaciones de la cirug&#237;a a corto plazo&#46; En las visitas de seguimiento sucesivas&#44; al menos una al a&#241;o&#44; se valoran los resultados de la cirug&#237;a&#44; recurrencias y aparici&#243;n de nuevos tumores&#46; Aquellos pacientes que desarrollen m&#225;s de un tumor tratado con cirug&#237;a de Mohs a lo largo del registro ser&#225;n descritos&#44; pero &#250;nicamente se realiza el seguimiento del primero de los tumores&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">La informaci&#243;n se recoge de forma protocolizada mediante un sistema <span class="elsevierStyleItalic">online</span> &#40;OpenClinica Open Source softvare&#44; versi&#243;n 3&#46;1&#44; Waltham&#44; EE&#46; UU&#46;&#41; de la Unidad de Investigaci&#243;n de la Fundaci&#243;n AEDV&#46; Se realiza una monitorizaci&#243;n continua <span class="elsevierStyleItalic">online</span> y monitorizaci&#243;n <span class="elsevierStyleItalic">in situ</span> anual de los centros participantes para comprobar el cumplimiento del protocolo y la congruencia de los datos con los documentos fuente&#46; El an&#225;lisis estad&#237;stico de los datos se realiza mediante el programa Stata &#40;versi&#243;n 14&#46;1&#44; Statacorp&#44; Texas&#44; EE&#46; UU&#46;&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Datos de los pacientes</span><p id="par0050" class="elsevierStylePara elsevierViewall">Entre julio de 2013 y enero de 2016 se han registrado 1&#46;796 pacientes a los que se ha realizado al menos una cirug&#237;a de Mohs en 18 centros &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; La descripci&#243;n de la poblaci&#243;n es similar a la publicada previamente<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a>&#44; si bien ha aumentado el tama&#241;o muestral&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> muestra las caracter&#237;sticas de los pacientes&#46; El 51&#44;2&#37; son varones y la media de edad es de 68&#44;5 &#40;DE 14&#44;4&#41; a&#241;os&#46; El 77&#44;7&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1391&#41; proced&#237;an del &#225;rea sanitaria de referencia del centro donde se realiza la cirug&#237;a y el 22&#44;4&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>405&#41; eran derivados de otras &#225;reas distintas&#46; El 3&#44;8&#37; de los pacientes ten&#237;a historia de m&#250;ltiples tumores cut&#225;neos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>68&#41;&#44; 6 de ellos diagnosticados de s&#237;ndrome de Gorlin&#46; Tambi&#233;n hab&#237;a un 3&#44;8&#37; de pacientes con alg&#250;n tipo de inmunosupresi&#243;n &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>68&#41;&#44; siendo el trasplante de &#243;rgano s&#243;lido la causa m&#225;s frecuente de la misma &#40;38 pacientes&#44; 2&#44;8&#37;&#41;&#46; Adem&#225;s&#44; el 10&#44;2&#37; de los pacientes eran diab&#233;ticos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>179&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Datos relacionados con los tumores y tratamientos previos</span><p id="par0060" class="elsevierStylePara elsevierViewall">En cuanto a las caracter&#237;sticas de los tumores y tratamientos previos no hay cambios relevantes con respecto a la descripci&#243;n previa<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a> ni en el tipo de tumores &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#44; ni en su localizaci&#243;n&#44; suponiendo la pir&#225;mide nasal&#44; la mejilla&#44; la frente&#44; el canto interno y la zona auricular las localizaciones m&#225;s frecuentes &#40;82&#37;&#41;&#46; La mediana de tama&#241;o del eje mayor del tumor fue de 10<span class="elsevierStyleHsp" style=""></span>mm &#40;rango intercuart&#237;lico<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; Solo uno de los pacientes intervenidos ten&#237;a signos de afectaci&#243;n ganglionar y 2 ten&#237;an met&#225;stasis&#46; La mediana del tiempo de evoluci&#243;n del tumor hasta el momento de su inclusi&#243;n en el registro en la primera visita fue de 11&#44;4 meses &#40;rango intercuart&#237;lico<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#44;4 meses&#41;&#46; El tiempo transcurrido desde el momento de inclusi&#243;n en el registro en la primera visita hasta la intervenci&#243;n quir&#250;rgica fue de 1&#44;6 meses &#40;rango intercuart&#237;lico<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;9 meses&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">El 66&#44;9&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1200&#41; de los tumores eran primarios&#44; es decir&#44; no hab&#237;an recibido ning&#250;n tratamiento previo&#44; mientras que el 19&#44;2&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>345&#41; eran recurrentes tras un tratamiento previo m&#233;dico o quir&#250;rgico y el 13&#44;9&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>250&#41; eran persistencias tumorales en los m&#225;rgenes quir&#250;rgicos de una extirpaci&#243;n previa o que no hab&#237;an respondido a un tratamiento no quir&#250;rgico&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> se detallan los tratamientos previos y el tiempo transcurrido desde los mismos hasta su inclusi&#243;n en el registro&#46; El n&#250;mero de tratamientos quir&#250;rgicos previamente recibidos por cada paciente en el caso de tumores persistentes y recidivantes vari&#243; de uno &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>358&#41; a 15 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46; Los 3 casos que recibieron tratamiento previo con inhibidores hedgehog eran tumores gigantes en los que se utiliz&#243; como tratamiento adyuvante previo a la cirug&#237;a de Mohs&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Datos relacionados con las intervenciones quir&#250;rgicas</span><p id="par0075" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a> se describe la frecuencia de los tratamientos antiagregantes y anticoagulantes y su retirada preoperatoria&#44; as&#237; como la comedicaci&#243;n con esteroides y la presencia de diabetes mellitus&#44; como factores prequir&#250;rgicos que pueden alterar la cicatrizaci&#243;n&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">El r&#233;gimen de tratamiento fue ambulatorio o con ingreso inferior a 24<span class="elsevierStyleHsp" style=""></span>horas en el 71&#44;8&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1420&#41; de los casos&#44; mientras que el 21&#44;9&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>376&#41; requiri&#243; ingreso hospitalario&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La intervenci&#243;n quir&#250;rgica se realiz&#243; bajo anestesia local en el 86&#44;7&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1554&#41; de los pacientes&#44; local con premedicaci&#243;n oral en el 3&#44;7&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>67&#41; y sedaci&#243;n o anestesia general en el 9&#44;5&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>171&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">La t&#233;cnica quir&#250;rgica fue con mayor frecuencia cirug&#237;a de Mohs convencional en congelaci&#243;n &#40;89&#44;5&#37;&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1603&#41;&#44; seguido por cirug&#237;a de Mohs en diferido &#40;10&#37;&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>180&#41; y cirug&#237;a con control tridimensional de m&#225;rgenes &#40;0&#44;5&#37;&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#41;&#46; &#218;nicamente se realiz&#243; inmunohistoqu&#237;mica intraoperatoria&#44; inmunomohs&#44; en el 0&#44;4&#37; de las intervenciones &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Previamente a la intervenci&#243;n quir&#250;rgica se realiz&#243; curetaje del tumor en funci&#243;n de las preferencias del dermat&#243;logo&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a> se refleja el n&#250;mero de etapas requeridas para alcanzar m&#225;rgenes libres de tumor en cada caso&#46; En 56 pacientes &#40;3&#44;2&#37;&#41; la intervenci&#243;n quir&#250;rgica no se complet&#243; con m&#225;rgenes libres de afectaci&#243;n tumoral por causas del tumor o del estado general del paciente o decisi&#243;n del mismo&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">La mediana y rango intercuart&#237;lico del tama&#241;o del defecto quir&#250;rgico final y del tumor inicial se describen en la <a class="elsevierStyleCrossRef" href="#tbl0035">tabla 7</a>&#46; La profundidad del defecto quir&#250;rgico llegaba a la dermis en el 61&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;059&#41; seguido de la hipodermis &#40;25&#44;7&#37;&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>445&#41;&#44; m&#250;sculo &#40;7&#44;3&#37;&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>127&#41; y en 15 casos &#40;0&#44;9&#37;&#41; se detect&#243; afectaci&#243;n &#243;sea&#46;</p><elsevierMultimedia ident="tbl0035"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0040">tabla 8</a> se describen tanto el especialista que reconstruye el defecto quir&#250;rgico creado como la t&#233;cnica empleada para ello&#46;</p><elsevierMultimedia ident="tbl0040"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Las complicaciones quir&#250;rgicas intraoperatorias fueron poco frecuentes&#46; El 98&#44;4&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;760&#41; no present&#243; ninguna complicaci&#243;n&#46; Entre los 29 pacientes que presentaron morbilidad intraquir&#250;rgica destacable&#44; considerada como aquella que obliga a una intervenci&#243;n inmediata o modifica el curso de la intervenci&#243;n quir&#250;rgica&#44; la m&#225;s frecuente fue el s&#237;ncope vasovagal en 10 pacientes &#40;0&#44;6&#37;&#41;&#44; seguida de hipertensi&#243;n arterial que requiri&#243; tratamiento en 8 pacientes &#40;0&#44;5&#37;&#41;&#44; hemorragia que requiri&#243; tratamiento intravenoso u oblig&#243; a suspender la intervenci&#243;n quir&#250;rgica en 5 pacientes &#40;0&#44;3&#37;&#41;&#44; 2 episodios de hiperglucemia que precisaron tratamiento y arritmia no especificada en un paciente &#40;0&#44;06&#37;&#41;&#46; Todas las complicaciones se resolvieron de forma inmediata&#44; permitiendo continuar la intervenci&#243;n quir&#250;rgica&#44; excepto en un caso en que motivaron su finalizaci&#243;n&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">La mediana de la duraci&#243;n de la intervenci&#243;n quir&#250;rgica en fue de 75<span class="elsevierStyleHsp" style=""></span>minutos &#40;rango intercuart&#237;lico<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41; con un rango de 15-438&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Como tratamiento adyuvante tras la cirug&#237;a 3 pacientes &#40;0&#44;17&#37;&#41; recibieron radioterapia&#44; uno terapia fotodin&#225;mica&#44; uno imiquimod&#44; uno cirug&#237;a radical de la zona y un &#250;ltimo fresado &#243;seo y radioterapia&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n</span><p id="par0125" class="elsevierStylePara elsevierViewall">Nuestro estudio describe la cirug&#237;a de Mohs realizada en Espa&#241;a en la actualidad&#46; Entre julio de 2013 y enero de 2016 REGESMOHS ha recogido datos de las intervenciones de 1&#46;796 pacientes a los que se ha realizado al menos una cirug&#237;a de Mohs en los 18 centros participantes&#46; El presente estudio nos aporta datos sobre la t&#233;cnica quir&#250;rgica&#44; el grado de complejidad de la t&#233;cnica&#44; los recursos empleados y los resultados inmediatos&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Entre las ventajas del estudio destacamos que se trata de un estudio prospectivo y altamente representativo de la cirug&#237;a de Mohs en nuestro medio&#44; pues en &#233;l participan buena parte de los centros que hacen cirug&#237;a de Mohs en Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Una limitaci&#243;n es que&#44; siendo progresiva la inclusi&#243;n de los pacientes y la entrada de los datos en el registro&#44; algunos centros aparentan tener menos pacientes en este estudio que en el previo &#40;no han operado a los pacientes o no han incluido los datos en el sistema <span class="elsevierStyleItalic">online</span>&#41;&#46; Adem&#225;s&#44; es de esperar que en publicaciones sucesivas se produzcan peque&#241;as variaciones en los resultados&#44; fruto de la variaci&#243;n aleatoria&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">La incidencia de c&#225;ncer cut&#225;neo no melanomaha aumentado de forma exponencial en las &#250;ltimas d&#233;cadas&#46; En Europa&#44; EE&#46; UU&#46;&#44; Canad&#225; y Australia se ha registrado un incremento anual del 3-8&#37; desde 1960<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">14&#8211;16</span></a>&#46; Actualmente la cirug&#237;a de Mohs se considera el <span class="elsevierStyleItalic">gold standard</span> en el tratamiento del carcinoma basocelular y epidermoide de alto riesgo y ha mostrado tambi&#233;n resultados superiores a otras t&#233;cnicas en otros tumores cut&#225;neos&#46; Sin embargo&#44; los requerimientos de infraestructura&#44; personal entrenado y tiempo hacen pueda parecer <span class="elsevierStyleItalic">a priori</span> poco rentable&#46; Estos datos pueden ser diferentes en distintos pa&#237;ses&#44; por eso es necesario describirlos adecuadamente en nuestro entorno&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Entre los estudios prospectivos publicados podemos destacar los del registro australiano de cirug&#237;a de Mohs que recoge un gran n&#250;mero de pacientes tratados con esta t&#233;cnica entre los a&#241;os 1993 a 2002<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">17&#8211;19</span></a>&#44; o las publicaciones holandesas&#44; tanto prospectivas como de ensayos aleatorizados comparando cirug&#237;a de Mohs y cirug&#237;a convencional<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;22</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Los resultados obtenidos en cuanto a distribuci&#243;n por sexos y localizaci&#243;n del tumor son similares a los del grupo inicial ya publicado y a otras series<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a>&#46; &#218;nicamente encontramos en el tipo histol&#243;gico de tumores tratados un aumento en el n&#250;mero y porcentaje de lentigo maligno &#40;LM&#41; y dermatofibrosarcoma protuberans &#40;DFSP&#41; respecto a otras series en las que se especifican otros tumores distintos a carcinoma basocelular &#40;CB&#41; y epidermoide &#40;CE&#41;&#44; como la publicada recientemente en Reino Unido<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">22</span></a>&#44; en la que el LM representa el 0&#37; frente a nuestro 2&#44;81&#37; y el DFSP es el 0&#44;5&#37; frente al 1&#44;97&#37; de nuestra serie&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Los pacientes que hab&#237;an recibido un trasplante de &#243;rgano s&#243;lido &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>28&#41; fueron el grupo m&#225;s numeroso de todos los que presentaban alg&#250;n tipo de inmunosupresi&#243;n&#46; Los pacientes trasplantados tienen una incidencia aumentada de c&#225;ncer cut&#225;neo no melanoma&#44; especialmente de carcinoma epidermoide&#44; y el antecedente de transplante puede llevar a la indicaci&#243;n de cirug&#237;a de Mohs<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">23&#44;24</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">El porcentaje de pacientes que recib&#237;an alg&#250;n tipo de antiagregante o anticoagulante &#40;18&#37;&#41; es inferior al de otras series de pacientes a los que se hab&#237;a practicado alg&#250;n tipo de cirug&#237;a dermatol&#243;gica&#58; habi&#233;ndose descrito en el 29&#37; de los pacientes de cirug&#237;a de Mohs<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">25</span></a> y en el 35&#37; en pacientes de cirug&#237;a dermatol&#243;gica en general<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">26</span></a>&#46; El manejo perioperatorio de estos tratamientos durante la cirug&#237;a&#44; sin embargo&#44; fue similar a lo descrito previamente<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">27&#44;28</span></a>&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">El 33&#44;1&#37; de los tumores eran recurrentes o persistentes intervenidos&#44; cifra id&#233;ntica a la del registro australiano &#40;33&#44;1&#37;&#41; en CB<span class="elsevierStyleSup">17</span>&#44; y al 29&#44;3&#37; de la serie m&#225;s reciente de Hoorens<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">29</span></a>&#46; Al igual que en dichas series el tratamiento previo m&#225;s frecuente realizado fue la cirug&#237;a&#46; Entre los tratamientos no quir&#250;rgicos previos llama la atenci&#243;n que&#44; salvo en el caso de la crioterapia&#44; el n&#250;mero de pacientes es peque&#241;o&#44; no superando ninguna el 3&#37; de los pacientes totales&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">El n&#250;mero medio de etapas fue de 1&#44;6 &#40;mediana 1&#44; rango 1-12&#41;&#44; ligeramente inferior a la del registro australiano en la serie de los CB 1&#44;7 &#40;mediana 2&#44; rango 1-9&#41;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">17</span></a>&#44; y superior en la serie de los CE 1&#44;6 &#40;mediana 1&#44; rango 1-7&#41;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">19</span></a>&#46; Comparando con las series europeas Flohil et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#44; encuentran un 43&#44;5&#37; de casos que requirieron una etapa frente al 56&#44;5&#37; que necesitaron 2 o m&#225;s etapas&#46; Smeets et al&#46;&#44; en una serie de 737 CB tratados con cirug&#237;a de Mohs&#44; refieren que el 25&#37; de pacientes requiri&#243; una etapa y 2 el 46&#37;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#46; En la serie brit&#225;nica el 58&#37; de los casos requiri&#243; una etapa&#44; el 34&#37; 2 etapas&#44; el 6&#37; 3 etapas&#44; el 1&#37; 4 etapas y el 0&#44;5&#37; 5 o m&#225;s etapas<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">22</span></a>&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">La reconstrucci&#243;n se llev&#243; a cabo por el propio dermat&#243;logo en un porcentaje muy elevado de los casos &#40;98&#44;4&#37;&#41;&#44; y en general superior al resto de los estudios publicados&#46; En la serie de 12&#46;344 cirug&#237;as de Mohs de EE&#46; UU&#46; del periodo 2005-2012 &#40;Brown University&#44; Rhode Island&#41; en el 17&#37; de las mujeres y el 8&#37; de los varones la reconstrucci&#243;n la realiz&#243; cirug&#237;a pl&#225;stica<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">30</span></a>&#46; En una la serie de Horens et al&#46; el 84&#37; el dermat&#243;logo&#44; el 8&#44;5&#37; de los casos el cirujano de cabeza y cuello&#44; el 6&#44;2&#37; el cirujano pl&#225;stico y en el 1-3&#37; otros especialistas como el cirujano oculopl&#225;stico<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">29</span></a>&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">La elecci&#243;n del colgajo o plastia en el 47&#44;2&#37; como m&#233;todo de reconstrucci&#243;n coincide con lo reflejado por otros autores<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">31&#44;32</span></a>&#46; Hace d&#233;cadas se consideraba el injerto la t&#233;cnica m&#225;s &#250;til en cirug&#237;a de Mohs porque permit&#237;a una detecci&#243;n m&#225;s precoz de las posibles recidivas&#46; Actualmente el aumento en la confianza en los resultados de la t&#233;cnica&#44; de la destreza del cirujano y el hecho de que los defectos posquir&#250;rgicos sean menores y los pacientes en ocasiones m&#225;s j&#243;venes han hecho que aumente en las series publicadas el porcentaje de reconstrucciones mediante colgajos frente a los injertos o cierres por segunda intenci&#243;n&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Las complicaciones registradas durante las cirug&#237;as o morbilidad intraquir&#250;rgica estuvieron relacionadas en todos los casos con episodios de hipertensi&#243;n arterial y&#47;o sangrado intraoperatorio&#46; En un solo caso el paciente requiri&#243; hospitalizaci&#243;n por el sangrado intra y postoperatorio&#44; consider&#225;ndose una complicaci&#243;n mayor de la cirug&#237;a<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">33&#44;34</span></a>&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">La mediana del tiempo de ocupaci&#243;n de quir&#243;fano de cada paciente&#44; 75<span class="elsevierStyleHsp" style=""></span>minutos&#44; sugiere que el tiempo empleado en la mayor&#237;a de las cirug&#237;as de Mohs no es mucho mayor que el empleado en una cirug&#237;a convencional de un tumor cut&#225;neo localizado en la cara&#44; y que requiera una t&#233;cnica reconstructiva asociada como injerto o colgajo&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusi&#243;n</span><p id="par0195" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas de los pacientes y tumores tratados mediante cirug&#237;a de Mohs son similares las descritas en estudios de las mismas caracter&#237;sticas en otras &#225;reas geogr&#225;ficas&#46; Los resultados inmediatos de la cirug&#237;a son tambi&#233;n superponibles&#46; Las principales diferencias son un mayor porcentaje de DFSP y LM tratados&#44; y que la reconstrucci&#243;n en nuestro medio la realiza el dermat&#243;logo con mayor frecuencia que en otros pa&#237;ses&#46; La tasa de complicaciones intraoperatorias mayores es muy reducida&#44; y el tiempo de ocupaci&#243;n de quir&#243;fano discretamente superior al de la cirug&#237;a convencional&#46; Estos datos son &#250;tiles para valorar si datos de estudios en otro medio pueden aplicarse a Espa&#241;a para la planificaci&#243;n de la actividad en los centros que se planteen iniciar la aplicaci&#243;n de cirug&#237;a de Mohs y como comparaci&#243;n <span class="elsevierStyleItalic">&#40;benchmarking&#41;</span> para los que ya la est&#225;n realizando&#46; Adem&#225;s&#44; pueden ser &#250;tiles para estudios de efectividad de la t&#233;cnica&#44; teniendo inter&#233;s tanto para los dermat&#243;logos como para otros especialistas o gestores&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Responsabilidades &#233;ticas</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Protecci&#243;n de personas y animales</span><p id="par0200" class="elsevierStylePara elsevierViewall">Los autores declaran que para esta investigaci&#243;n no se han realizado experimentos en seres humanos ni en animales&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Confidencialidad de los datos</span><p id="par0205" class="elsevierStylePara elsevierViewall">Los autores declaran que han seguido los protocolos de su centro de trabajo sobre la publicaci&#243;n de datos de pacientes&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Derecho a la privacidad y consentimiento informado</span><p id="par0210" class="elsevierStylePara elsevierViewall">Los autores han obtenido el consentimiento informado de los pacientes y&#47;o sujetos referidos en el art&#237;culo&#46; Este documento obra en poder del autor de correspondencia&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Financiaci&#243;n</span><p id="par0215" class="elsevierStylePara elsevierViewall">El registro es financiado por la Fundaci&#243;n Academia Espa&#241;ola de Dermatolog&#237;a y Venereolog&#237;a&#44; con la colaboraci&#243;n de Roche Farma&#46; El laboratorio financiador no ha participado en la elaboraci&#243;n del art&#237;culo&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicto de intereses</span><p id="par0220" class="elsevierStylePara elsevierViewall">Los autores declaran no tener conflicto de intereses con respecto a lo reflejado en el art&#237;culo&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El Registro Espa&#241;ol de Cirug&#237;a de Mohs recoge los datos de aplicaci&#243;n y resultados de esta t&#233;cnica en Espa&#241;a&#46; Se describen los datos de las intervenciones realizadas desde el inicio del Registro en julio de 2013 a enero de 2016&#46; Se analizan los datos de las cirug&#237;as tanto perioperatorios como intraoperatorios&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohortes prospectivo en el que participan 18 centros&#46; Se recogen los datos de las intervenciones quir&#250;rgicas como tipo de anestesia&#44; t&#233;cnica quir&#250;rgica&#44; ingreso hospitalario&#44; n&#250;mero de estadios&#44; manejo de factores de riesgo preoperatorios&#44; tratamientos complementarios&#44; tratamientos previos&#44; tipo de tumor&#44; tiempo empleado en la cirug&#237;a y complicaciones&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se analizan 1&#46;796 intervenciones quir&#250;rgicas&#46; El tumor intervenido con m&#225;s frecuencia es el carcinoma basocelular &#40;85&#44;96&#37;&#41;&#44; seguido del carcinoma epidermoide &#40;6&#44;18&#37;&#41;&#44; lentigo maligno &#40;2&#44;81&#37;&#41; y dermatofibrosarcoma protuberans &#40;1&#44;97&#37;&#41;&#46; El 66&#44;9&#37; de los tumores eran primarios&#44; el 19&#44;2&#37; recurrentes y el 13&#44;9&#37; persistentes&#46; El tratamiento previo m&#225;s frecuente fue quir&#250;rgico&#46; La cirug&#237;a de Mohs se realiz&#243; con m&#225;s frecuencia bajo anestesia local &#40;86&#44;7&#37;&#41; y de forma ambulatoria &#40;71&#44;8&#37;&#41;&#46; En el 89&#44;5&#37; de los casos se utiliz&#243; la t&#233;cnica de Mohs en congelaci&#243;n&#46; El n&#250;mero de etapas requerido para alcanzar m&#225;rgenes libres de tumor fue una en 56&#44;45&#37; de los pacientes&#44; 2 en 32&#44;1&#37;&#44; 3 en 7&#44;1&#37;&#44; 4 en 2&#44;7&#37; y 5 o m&#225;s en 1&#44;8&#37;&#46; El propio dermat&#243;logo reconstruy&#243; el defecto en el 98&#37; de los pacientes y la t&#233;cnica reconstructiva m&#225;s utilizada fue el colgajo &#40;47&#44;2&#37;&#41;&#46; Solo el 1&#44;62&#37; de los pacientes present&#243; alguna complicaci&#243;n intraoperatoria y la mediana de la duraci&#243;n de la cirug&#237;a fue 75 &#40;p25&#58;60-p75&#58;100&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Las caracter&#237;sticas de los pacientes y tumores tratados son similares a las descritas en estudios de las mismas caracter&#237;sticas en otras &#225;reas geogr&#225;ficas&#46; Existe un porcentaje mayor de lentigo maligno y dermatofibrosarcoma protuberans&#46; La reconstrucci&#243;n la realiza el dermat&#243;logo con m&#225;s frecuencia que en otras series&#46; El tiempo de utilizaci&#243;n de quir&#243;fano no es mucho mayor que para otras t&#233;cnicas y la tasa de complicaciones intraoperatorias es muy reducida&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The Spanish Mohs Surgery Registry is used to collect data on the use and outcomes of Mohs micrographic surgery &#40;MMS&#41; in Spain&#46; The aim of this study was to describe perioperative and intraoperative data recorded for MMS procedures performed between July 2013 &#40;when the registry started&#41; and January 2016&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Prospective cohort study of data from 18 hospitals&#46; The data collected included type of anesthesia&#44; surgical technique&#44; hospital admission&#44; number of Mohs stages&#44; management of preoperative risk factors&#44; additional treatments&#44; previous treatments&#44; type of tumor&#44; operating time&#44; and complications&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Data were available for 1796 operations&#46; The most common tumor treated by MMS was basal cell carcinoma &#40;85&#46;96&#37;&#41;&#44; followed by squamous cell carcinoma &#40;6&#46;18&#37;&#41;&#44; lentigo maligna &#40;2&#46;81&#37;&#41;&#44; and dermatofibrosarcoma protuberans &#40;1&#46;97&#37;&#41;&#46; Primary tumors accounted for 66&#46;9&#37; of all tumors operated on&#59; 19&#46;2&#37; of tumors were recurrent and 13&#46;9&#37; were persistent&#46; The most common previous treatment was surgical&#46; MMS was mostly performed under local anesthesia &#40;86&#46;7&#37; of cases&#41; and as an outpatient procedure &#40;71&#46;8&#37;&#41;&#46; The frozen section technique was used in 89&#46;5&#37; of cases&#46; One stage was needed to achieve tumor-free margins in 56&#46;45&#37; of patients&#59; 2 stages were required in 32&#46;1&#37; of patients&#44; 3 in 7&#46;1&#37;&#37;&#44; 4 in 2&#46;7&#37;&#44; and 5 or more in 1&#46;8&#37;&#46; The defect was reconstructed by the dermatologist in 98&#37; of patients and the most common technique was flap closure &#40;47&#46;2&#37;&#41;&#46; Intraoperative complications were recorded for just 1&#46;62&#37; of patients and the median &#40;interquartile range&#41; duration of surgery was 75 &#40;60-100&#41; minutes&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The characteristics of the patients and tumors treated by MMS are similar to those reported for similar studies in other geographic areas&#46; Lentigo maligna and dermatofibrosarcoma protuberans accounted for a higher proportion of cases in our series&#44; and repair of the surgical defect by a dermatologist was also more common&#46; Operating times in MMS are not much longer than those reported for other procedures and the rate of intraoperative complications is very low&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0025"
            "titulo" => "Introduction"
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            "identificador" => "abst0035"
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            "identificador" => "abst0040"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N&#250;mero de cirug&#237;as por centro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital Santa Creu i Sant Pau&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">345 &#40;19&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fundaci&#243;n H&#46; Alcorc&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">235 &#40;13&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Complejo H&#46; Universitario de Guadalajara&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">214 &#40;11&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Complejo Hospitalario de Le&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">197 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cl&#237;nica Universidad de Navarra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">109 &#40;6&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cl&#237;nica Teknon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Instituto Valenciano de Oncolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84 &#40;4&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cl&#237;nica Zarzuela&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82 &#40;4&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cl&#237;nica Quir&#243;n Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78 &#40;4&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital del Mar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69 &#40;3&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital La Princesa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68 &#40;3&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital Galdakao&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60 &#40;3&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital de Cruces&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56 &#40;3&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital de Manises&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41 &#40;2&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital Gregorio Mara&#241;&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Complexo Hospitalario Universitario de Santiago&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital San Roque&#44; Las Palmas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital La Paz&#44; Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;796&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Caracter&#237;sticas demogr&#225;ficas</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">N &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Distribuci&#243;n por sexos</span><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Hombre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">919 &#40;51&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">876 &#40;48&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Origen del paciente</span><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Del &#225;rea sanitaria del centro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">405 &#40;22&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>De otras &#225;reas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1391 &#40;77&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Edad&#44; media &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68&#44;5 &#40;14&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Caracter&#237;sticas cl&#237;nicas previas a la cirug&#237;a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">N &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Inmunodepresi&#243;n</span><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Trasplantado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 &#40;2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tratamiento inmunosupresor&#40;&#62;<span class="elsevierStyleHsp" style=""></span>3 meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tumor hematol&#243;gico<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>5 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>VIH positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">S&#237;ndromes de tumores m&#250;ltiples</span><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Historia de tumores m&#250;ltiples sin diagn&#243;stico de s&#237;ndrome de Gorlin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55 &#40;3&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;ndrome de Gorlin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;0&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Otros s&#237;ndromes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Diabetes mellitus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">179 &#40;10&#44;2&#41;&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
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tipo&#47;subtipo histol&#243;gico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Carcinoma basocelular</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;544&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85&#44;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Infiltrativo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">734&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41&#44;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Histol&#243;gicamente no agresivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">429&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#44;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Morfeiforme&#47;esclerosante&#47;fibrosante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">220&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Micronodular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">113&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Metat&#237;pico&#47;queratinizante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Perineural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Carcinoma epidermoide</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">111</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">6&#44;18</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Infiltrante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Histol&#243;gicamente no agresivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Basoescamoso &#40;excluyendo basocelular metat&#237;pico&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Indiferenciado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Esclerosante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Infiltraci&#243;n perineural&#47;perivascular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Epidermoide de c&#233;lulas fusiformes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Epidermoide clear cell&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Epidermoide de c&#233;lulas peque&#241;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Epidermoide tipo queratoacantoma centrofacial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Epidermoide Breslow<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Epidermoide Clark<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Lentigo maligno</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Dermatofibrosarcoma protuberans</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Carcinoma anexial microqu&#237;stico</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Tumor de Merkel</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Paget extramamario</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Fibroxantoma at&#237;pico&#47;histiocitoma fibroso maligno</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Angiosarcoma</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Melanoma lentiginoso acral</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Carcinoma seb&#225;ceo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Carcinoma ecrino&#47;mucinoso</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Tricoepitelioma desmopl&#225;sico</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tratamientos previos a la cirug&#237;a de Mohs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tiempo desde tratamiento previo Mediana &#40;p25-p75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cirug&#237;a cierre directo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">441 &#40;24&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#44;2 &#40;4&#44;4-60&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cirug&#237;a con plastia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">123 &#40;6&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;1 &#40;2&#44;6-59&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Crioterapia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95 &#40;5&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#44;1 &#40;8&#44;6-55&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cirug&#237;a con injerto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60 &#40;3&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#44;4 &#40;9&#44;5-81&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Curetaje&#47;electrocoagulaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#44;6 &#40;2&#44;4-70&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cirug&#237;a de Mohs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42 &#40;2&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#44;6 &#40;18&#44;9-69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Radioterapia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55&#44;8 &#40;12&#44;4-149&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Terapia fotodin&#225;mica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;8 &#40;8-19&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Imiquimod&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 &#40;2&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#44;1 &#40;8&#44;8-42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fluoropirimidinas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">197&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inhibidores hedgehog&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#44;3 &#40;8-25&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Datos relacionados con los tumores&#46; Tratamientos previos en los tumores recurrentes y tiempo transcurrido desde los mismos</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Factores de riesgo perioperatorio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Tratamiento antiagregante</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">No</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">133 &#40;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">S&#237;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Tratamiento anticoagulante</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Suspende anticoagulante</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46 &#40;35&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83 &#40;64&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Tratamiento corticoides &#62;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">3 meses</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Diabetes mellitus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">179 &#40;10&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Datos relacionados con las intervenciones quir&#250;rgicas&#46; Factores prequir&#250;rgicos que pueden alterar la cicatrizaci&#243;n</p>"
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        "etiqueta" => "Tabla 6"
        "tipo" => "MULTIMEDIATABLA"
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        "mostrarDisplay" => false
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        "tabla" => array:1 [
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                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N&#176;&#46; de etapas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N&#46;&#176; de pacientes &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1002 &#40;56&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">569 &#40;32&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">126 &#40;7&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5 o m&#225;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 &#40;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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        "etiqueta" => "Tabla 7"
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        "tabla" => array:1 [
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Di&#225;metro mayor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Di&#225;metro menor&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;5-12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tama&#241;o defecto poscirug&#237;a &#40;mm&#41; mediana &#40;p25-p75&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">T&#233;cnica de reconstrucci&#243;n</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Colgajo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cierre directo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">488 &#40;27&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">166 &#40;9&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63 &#40;3&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Datos relacionados con las intervenciones quir&#250;rgicas&#46; Reconstrucci&#243;n del defecto</p>"
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      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:34 [
            0 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mohs micrographic surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46;L&#46; Shriner"
                            1 => "D&#46;K&#46; McCoy"
                            2 => "M&#46;D&#46; Goldberg"
                            3 => "R&#46;F&#46; Wagner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "1998"
                        "volumen" => "39"
                        "paginaInicial" => "79"
                        "paginaFinal" => "97"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9674401"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "2"
              "referencia" => array:1 [
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