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Los datos fueron introducidos en una base de datos anonimizada y analizados con el paquete estad&#237;stico SPSS&#174; &#40;versi&#243;n 20&#46;0&#59; SPSS Inc&#46;&#44; Chicago&#44; IL&#44; EE&#46; UU&#46;&#41;&#46; El estudio cuenta con la aprobaci&#243;n del Comit&#233; &#201;tico de Investigaci&#243;n con Medicamentos del Hospital Universitario Fundaci&#243;n Alcorc&#243;n&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En 14 a&#241;os &#40;2006-2019&#41; hemos diagnosticado y tratado a 9 pacientes &#40;11 tumores&#41; con CEU mediante CMM &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#58; 6 varones &#40;66&#37;&#41; y 3 mujeres &#40;33&#37;&#41;&#44; con una mediana de edad de 62 a&#241;os &#40;rango 40-81&#41;&#46; El 45&#37; de los tumores afectaron al primer dedo de la mano &#40;5&#47;11&#41;&#44; un 36&#37; a otros dedos de la mano &#40;4&#47;11&#41; y un 18&#37; al primer dedo del pie &#40;2&#47;11&#41;&#46; Dos pacientes presentaban inmunosupresi&#243;n &#40;infecci&#243;n por VIH y neoplasia mieloproliferativa&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Cl&#237;nicamente las lesiones se presentaron como placas eritematodescamativas &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>A y B&#41;&#44; n&#243;dulos querat&#243;sicos o tejido similar a granulaci&#243;n periungueal &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>C&#41;&#46; El 50&#37; de los pacientes asociaba alteraciones de la tabla ungueal &#40;onic&#243;lisis&#44; hiperqueratosis&#44; xantoniquia o destrucci&#243;n de los bordes laterales&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; En 4&#47;9 pacientes &#40;44&#44;4&#37;&#41; realizamos una radiograf&#237;a simple del dedo afecto antes de la cirug&#237;a&#44; que descart&#243; afectaci&#243;n &#243;sea&#44; en concreto en tumores de gran tama&#241;o o cuando exist&#237;a dolor asociado&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Todos los pacientes fueron tratados mediante CMM con una mediana de 3 estadios &#40;rango 1-6&#41;&#46; En un paciente no se complet&#243; la CMM y tras un primer estadio con m&#225;rgenes tumorales afectos&#44; el paciente prefiri&#243; ser sometido a una amputaci&#243;n de la falange&#46; De los 10 tumores restantes y tras obtener m&#225;rgenes libres de tumor&#44; en 9&#47;10 se realiz&#243; un cierre del defecto por segunda intenci&#243;n y en 1 caso se coloc&#243; un injerto cut&#225;neo&#46; No hubo ninguna complicaci&#243;n durante ni tras la cirug&#237;a&#46; El estudio histol&#243;gico confirm&#243; carcinoma espinocelular infiltrativo en 8&#47;11 tumores &#40;72&#37;&#41; y su forma <span class="elsevierStyleItalic">in situ</span> en 3&#47;11 tumores &#40;27&#37;&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Tras una mediana de seguimiento de 9 a&#241;os &#40;108 meses&#44; rango 9-254 meses&#41;&#44; 2 pacientes experimentaron recidiva local del tumor tras 2 y 10 a&#241;os&#44; respectivamente&#46; El primer paciente acudi&#243; de manera imprevista por dolor y aumento de volumen en el pulpejo del dedo afecto&#46; Una resonancia magn&#233;tica evidenci&#243; una masa heterog&#233;nea en la dermis y tejido celular subcut&#225;neo con destrucci&#243;n de la falange &#243;sea distal&#46; Tras confirmar histol&#243;gicamente la recidiva&#44; se amput&#243; la falange distal del dedo afecto&#46; La segunda paciente&#44; positiva para VIH &#40;estadio C3&#41;&#44; present&#243; recidiva tras m&#225;s de 10 a&#241;os de seguimiento en forma de una placa eritematoescamosa periungueal mal delimitada&#46; Una RS descart&#243; afectaci&#243;n &#243;sea&#46; Sin embargo&#44; tras confirmaci&#243;n histol&#243;gica de la recidiva&#44; la paciente ha rechazado cualquier intervenci&#243;n quir&#250;rgica y est&#225; en seguimiento cl&#237;nico estrecho&#46; Hasta el momento ning&#250;n paciente ha fallecido ni ha experimentado met&#225;stasis ganglionares o a distancia&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El CEU es un tumor ungueal muy infrecuente&#46; Asienta principalmente sobre el primer y segundo dedos de la mano<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; La cl&#237;nica es variada y poco espec&#237;fica&#44; diagnostic&#225;ndose a menudo como un proceso benigno &#40;verrugas periungueales&#44; perionixis&#44; eccema cr&#243;nico y onicomicosis&#41;&#44; lo que puede retrasar su diagn&#243;stico<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#8211;5</span></a>&#46; En nuestra serie&#44; el 63&#44;6&#37; de los tumores &#40;7&#47;11&#41; estaban localizados en el primer o segundo dedos de la mano&#44; con una mediana de tiempo de evoluci&#243;n desde el inicio de la lesi&#243;n hasta el diagn&#243;stico histopatol&#243;gico de 2 a&#241;os &#40;rango 2-8 a&#241;os&#41;&#46; En general&#44; el CEU tiene un comportamiento poco agresivo comparado con el carcinoma espinocelular de otras &#225;reas anat&#243;micas como el labio o el pabell&#243;n auricular<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>&#46; En el 30-40&#37; de los casos existe afectaci&#243;n &#243;sea al diagn&#243;stico al realizar una prueba de imagen<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4&#44;7</span></a>&#46; Sin embargo&#44; el diagn&#243;stico de afectaci&#243;n &#243;sea no siempre es fiable y en un n&#250;mero elevado de pacientes puede corresponder a un falso positivo por la reacci&#243;n inflamatoria o compresiva que ejerce el tumor<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;8</span></a>&#46; En nuestra serie realizamos una RS preoperatoria al 44&#44;4&#37; de los pacientes&#44; descartando afectaci&#243;n &#243;sea en todos los casos&#46; La mayor&#237;a de los autores coincide en la necesidad de realizar una prueba de imagen preoperatoria a todos los pacientes diagnosticados de CEU&#44; independientemente del tama&#241;o tumoral o la sintomatolog&#237;a&#46; Este cribado preoperatorio suele realizarse con una RS&#44; una prueba accesible y fiable para evaluar la afectaci&#243;n &#243;sea prequir&#250;rgica&#46; Sin embargo&#44; la RS no ofrece una elevada especificidad&#44; sobre todo en tumores de crecimiento exof&#237;tico&#44; donde puede dar muchos falsos positivos&#46; Por ello&#44; en casos dudosos&#44; la resonancia magn&#233;tica es la prueba m&#225;s espec&#237;fica para evaluar las partes blandas y la afectaci&#243;n &#243;sea&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Entre los factores desencadenantes descritos &#40;radiaci&#243;n&#44; ars&#233;nico&#44; pesticidas&#44; disqueratosis cong&#233;nita&#41;&#44; la infecci&#243;n por virus del papiloma humano &#40;VPH&#41; oncog&#233;nicos juega un papel principal&#46; El VPH se ha demostrado responsable del CEU hasta en un 60&#37; de los casos&#44; siendo el serotipo m&#225;s frecuente el 16 &#40;75&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&#46; Otros serotipos identificados incluyen el 2&#44; 6&#44; 11&#44; 18&#44; 26&#44; 31&#44; 34&#44; 35&#44; 56&#44; 58 y 73&#46; Hasta un tercio de los pacientes con CEU presentan historia de infecci&#243;n genital por VPH&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">La terapia fotodin&#225;mica&#44; el l&#225;ser de CO<span class="elsevierStyleInf">2</span>&#44; el tratamiento t&#243;pico con 5-fluorouracilo o imiquimod al 5&#37;&#44; el raspado o la electroquimioterapia son tratamientos eficaces para el CEU&#46; Sin embargo&#44; la cirug&#237;a es el tratamiento de elecci&#243;n&#44; sobre todo teniendo en cuenta la posibilidad de invasi&#243;n local y de afectaci&#243;n &#243;sea&#46; Aunque la CMM representa un reto por las peculiaridades anat&#243;micas e histol&#243;gicas de la unidad ungueal&#44; se considera la t&#233;cnica quir&#250;rgica m&#225;s efectiva para el tratamiento del CEU&#44; con tasas de curaci&#243;n de hasta el 96&#37; y de recurrencias de entre el 0-22&#37; respecto a un 28&#44;5-56&#37; de recurrencia descrita en cirug&#237;a ungueal convencional<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#44;7&#44;10</span></a>&#46; La CMM permite evaluar la invasi&#243;n peri&#243;stica en la zona profunda tumoral y distinguir de manera fiable la invasi&#243;n &#243;sea de la inflamaci&#243;n o la compresi&#243;n&#46; En nuestra serie&#44; tras una mediana de seguimiento de 9 a&#241;os&#44; un 18&#44;1&#37; &#40;2&#47;11&#41; de los tumores recurrieron localmente&#46; Se ha descrito mayor tasa de recurrencia local cuantos m&#225;s estadios sean necesarios para la obtenci&#243;n de m&#225;rgenes libres&#44; y en tumores positivos para el VPH&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; el CEU es una neoplasia maligna infrecuente&#46; En muchos casos el diagn&#243;stico es tard&#237;o&#44; confundi&#233;ndose con enfermedad ungueal benigna&#46; La CMM es la t&#233;cnica de elecci&#243;n para su tratamiento&#44; con una baja tasa de recurrencia local y permitiendo mantener una buena funcionalidad y calidad de vida del paciente&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicto de intereses</span><p id="par0055" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sexo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Edad &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Localizaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tiempo evoluci&#243;n hasta el diagn&#243;stico &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Histolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Inmunosupresi&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estadio CMM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cierre defecto quir&#250;rgico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">M&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
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                  \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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;<span class="elsevierStyleSup">er</span> dedo pie&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">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CE&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
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                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;&#170; intenci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V&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">76&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">5&#46;<span class="elsevierStyleSup">o</span> dedo mano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&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">EB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Amputaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-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-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V&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">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;<span class="elsevierStyleSup">er</span> dedo mano D&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">Desconocido&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
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                  \t\t\t\t">CE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;&#170; intenci&#243;n&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="" 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><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
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttop\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\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \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
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#46;&#170; intenci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas demogr&#225;ficas y cl&#237;nicas de los pacientes diagnosticados de carcinoma epidermoide ungueal</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nail tumors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "B&#46; Richert"
                            1 => "P&#46; Lecerf"
                            2 => "M&#46; Caucanas"
                            3 => "J&#46; Andr&#233;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clindermatol.2013.06.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Dermatol"
                        "fecha" => "2013"
                        "volumen" => "31"
                        "paginaInicial" => "602"
                        "paginaFinal" => "617"
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