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las extremidades &#40;20-30&#37;&#41; y la cabeza &#40;10-15&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a>&#46; Su etiolog&#237;a permanece desconocida&#44; si bien se ha observado que existe un antecedente de un traumatismo local hasta en un 10-20&#37; de los casos&#44; sugiriendo que pudiera tratarse de un factor desencadenante<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>&#46; La histog&#233;nesis del DFSP es incierta&#44; aunque la teor&#237;a m&#225;s aceptada es que se origina una c&#233;lula neuromesenquimal pluripotencial<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El crecimiento asim&#233;trico y su mala delimitaci&#243;n cl&#237;nica justifica que se haya constatado que hasta el 21&#37; de los casos presentan una recidiva local &#40;RL&#41; durante los cinco a&#241;os siguientes al tratamiento<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>&#46; Existen m&#250;ltiples gu&#237;as terap&#233;uticas que recomiendan la cirug&#237;a microgr&#225;fica de Mohs &#40;CMM&#41; en diferido como la t&#233;cnica de elecci&#243;n en su tratamiento&#44; relegando la cirug&#237;a convencional &#40;<span class="elsevierStyleSmallCaps">C</span>V&#41; con m&#225;rgenes amplios para los casos en los que no sea posible su realizaci&#243;n y reservando la radioterapia &#40;RT&#41; y el tratamiento con imatinib para situaciones especiales<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>&#46; Se ha estimado una incidencia de RL de 3&#44;7&#37; tras CV vs&#46; 1&#44;7&#37; tras CMM&#44; encontrando diferencias significativas entre ambos<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El objetivo principal de nuestro estudio fue definir las caracter&#237;sticas de los pacientes con DFSP en nuestro centro y el secundario definir las diferencias en el manejo entre aquellos tratados por el Servicio de Dermatolog&#237;a de nuestro hospital frente a otras especialidades&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio descriptivo retrospectivo incluyendo consecutivamente a todos los pacientes con diagn&#243;stico histol&#243;gico de DFSP entre enero de 2010 y agosto de 2022 del Hospital Universitario Puerta del Mar&#44; C&#225;diz&#46; Se recogieron variables epidemiol&#243;gicas&#44; cl&#237;nicas y de tratamiento&#44; de manera que se analizaron los datos de forma global y&#44; posteriormente&#44; seg&#250;n si fue intervenido por el Servicio de Dermatolog&#237;a &#40;grupo 1&#41; frente a otras especialidades &#40;grupo 2&#41;&#46; Para ello&#44; se tomaron medidas de tendencia central y de dispersi&#243;n para las variables cuantitativas y medidas de distribuci&#243;n de frecuencias para las variables cualitativas&#44; seg&#250;n su distribuci&#243;n&#46; Para esto &#250;ltimo se realiz&#243; la prueba de Kolmogorov-Smirnov para comprobar si la variable cuantitativa segu&#237;a la distribuci&#243;n normal o no&#46; Se realizaron an&#225;lisis inferenciales utilizando la <span class="elsevierStyleItalic">t</span> de Student para las variables cuantitativas y la <span class="elsevierStyleItalic">X</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span> para las variables cualitativas&#46; Se estableci&#243; el nivel de significaci&#243;n estad&#237;stica en p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Se utiliz&#243; el programa IBM-<span class="elsevierStyleItalic">Statistical Package for the Social Sciences</span> &#40;SPSS&#41; versi&#243;n 27 &#40;IBM Company&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se identificaron 19 pacientes&#44; 12 &#40;63&#44;2&#37;&#41; hombres&#44; con una mediana de edad de 38 a&#241;os &#40;rango 16-77&#41;&#46; Las localizaciones m&#225;s frecuentes fueron 11 &#40;57&#44;9&#37;&#41; en el tronco&#44; cuatro &#40;21&#37;&#41; en las extremidades inferiores y cuatro &#40;21&#37;&#41; craneofacial&#46; La mediana de tiempo de evoluci&#243;n del DFSP fue de cuatro a&#241;os &#40;rango 1-30&#41; y 10 &#40;52&#44;6&#37;&#41; hab&#237;an recibido alg&#250;n tratamiento previo&#46; La mediana de tiempo de seguimiento tras el tratamiento fue de 32 meses &#40;3-141&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">El an&#225;lisis comparativo entre ambos grupos puede observarse en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; El grupo 1&#44; de forma estad&#237;sticamente significativa&#44; difer&#237;a con respecto al grupo 2 en que incluy&#243; pacientes que no hab&#237;an sido tratados previamente &#40;37&#44;5&#37; vs&#46; 63&#44;6&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;049&#41;&#44; fueron tratados mayoritariamente con CMM &#40;87&#44;5&#37; vs&#46; 18&#44;2&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41; y tuvo una menor tasa de RL durante el seguimiento &#40;0&#37; vs&#46; 45&#44;5&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;026&#41;&#46; No se observaron diferencias significativas en el sexo&#44; edad&#44; tiempo de evoluci&#243;n&#44; localizaci&#243;n&#44; tama&#241;o&#44; tiempo de seguimiento&#44; n&#250;mero de cirug&#237;as previas&#44; RT adyuvante ni progresi&#243;n&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">La cohorte analizada presenta caracter&#237;sticas epidemiol&#243;gicas &#40;edad&#44; localizaci&#243;n&#44; tama&#241;o y tiempo de evoluci&#243;n&#41; similares al resto de cohortes publicadas&#44; a excepci&#243;n de una mayor prevalencia de hombres<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;10</span></a>&#46; En el an&#225;lisis comparativo se observaron diferencias significativas en el n&#250;mero de pacientes tratados previamente&#44; en el n&#250;mero de RL y en el tipo de cirug&#237;a practicada&#44; destacando una mayor aplicaci&#243;n de CMM en el grupo 1 y traduci&#233;ndose en una menor tasa de RL&#46; Adem&#225;s&#44; en el an&#225;lisis comparativo tambi&#233;n destacaron diferencias llamativas entre ambos grupos en el tiempo de evoluci&#243;n&#44; en el n&#250;mero de cirug&#237;as previas realizadas y en la administraci&#243;n de RT adyuvante &#40;mayor en el grupo 2&#41;&#44; aunque sin alcanzar significaci&#243;n estad&#237;stica en ninguna de ellas&#46; El mayor n&#250;mero de intervenciones previas&#44; mayor n&#250;mero de RL durante el seguimiento y mayor necesidad de RT adyuvante observado en el grupo 2&#44; posiblemente debido principalmente a pacientes multiintervenidos y algunos con m&#225;rgenes quir&#250;rgicos afectos&#44; puede hacernos inferir quiz&#225;s una mayor complejidad en los pacientes tratados en dicho grupo&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Las limitaciones de este trabajo se derivan de su car&#225;cter retrospectivo&#44; incluyendo una p&#233;rdida de datos en variables como el n&#250;mero de cirug&#237;as previas y el tiempo de evoluci&#243;n que no permiti&#243; obtener diferencias significativas en el estudio comparativo&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Los resultados obtenidos concuerdan con la superioridad de la CMM con respecto a la CV en el tratamiento del DFSP observada en la literatura&#46; Mediante este estudio se puede concluir que la atenci&#243;n y tratamiento del DFSP mediante la CMM por parte del Servicio de Dermatolog&#237;a disminuye el n&#250;mero de recidivas y&#44; por consiguiente&#44; 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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Extremidades inferiores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;27&#44;3&#37;&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Craneofacial&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">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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="left" valign="\n
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                  \t\t\t\t">4 &#40;36&#44;3&#37;&#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="\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"><span class="elsevierStyleItalic">Tama&#241;o &#40;cm&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 x 2&#44;6&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">0&#44;243&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">5&#44;8 x 4&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tiempo medio seguimiento &#40;meses&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;084&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">58&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \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"><span class="elsevierStyleItalic">Tratados previamente</span>&nbsp;\t\t\t\t\t\t\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
                  \t\t\t\t">3 &#40;37&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;049&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">7 &#40;63&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">N&#250;mero cirug&#237;as previas &#40;media&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;529&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;3<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento realizado</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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
                  \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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CV m&#225;rgenes&nbsp;\t\t\t\t\t\t\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
                  \t\t\t\t">1 &#40;12&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;003&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">9 &#40;81&#44;8&#37;&#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="\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"><span class="elsevierStyleHsp" style=""></span>Cirug&#237;a de Mohs diferida&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">7 &#40;87&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;18&#44;2&#37;&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Recidivas</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;026&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">5 &#40;45&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">RT adyuvante</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;055&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;36&#44;3&#37;&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Progresi&#243;n</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\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
                  \t\t\t\t">0&#44;381&nbsp;\t\t\t\t\t\t\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
                  \t\t\t\t">1 &#40;9&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Resultados del an&#225;lisis comparativo entre ambos grupos&#58; grupo 1 &#40;atendidos en el servicio de Dermatolog&#237;a&#41; y grupo 2 &#40;atendidos en otros servicios del mismo centro&#41;</p>"
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                      "titulo" => "Dermatofibrosarcoma Protuberans&#58; Update on the Diagnosis and Treatment"
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                            2 => "F&#46; Wu"
                            3 => "T&#46;W&#46; Stultz"
                            4 => "G&#46;W&#46; Procop"
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                    0 => array:2 [
                      "doi" => "10.3390/jcm9061752"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32516921"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Incidence and Survival of Primary Dermatofibrosarcoma Protuberans in the United States"
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                          "etal" => false
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                            3 => "J&#46;S&#46; Barnholtz-Sloan"
                            4 => "J&#46;S&#46; Bordeaux"
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                    0 => array:2 [
                      "doi" => "10.1097/dss.0000000000000300"
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                        "tituloSerie" => "Dermatol Surg&#46;"
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                        "volumen" => "42"
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                    0 => array:2 [
                      "titulo" => "Descriptive epidemiology of dermatofibrosarcoma protuberans in the United States&#44; 1973 to 2002"
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                          "etal" => false
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                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2006.09.006"
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                        "tituloSerie" => "J Am Acad Dermatol&#46;"
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                        "volumen" => "56"
                        "paginaInicial" => "968"
                        "paginaFinal" => "973"
                        "link" => array:1 [
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                            2 => "S&#46; Sanpaphant"
                            3 => "K&#46; Kiranantawat"
                            4 => "C&#46; Wirojtananugoon"
                            5 => "V&#46; Sirikulchayanonta"
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CARTA CIENTÍFICO-CLÍNICA
Dermatofibrosarcoma protuberans: casuística hospitalaria y comparativa en el manejo entre Dermatología y otras especialidades
Dermatofibrosarcoma Protuberans: Hospital Casuistry and Comparative Analysis in the Management of This Entity by the Dermatology Unit Compared to Other Units
M. Viedma-Martíneza,
Autor para correspondencia
myriamdermatologiacadiz@gmail.com

Autor para correspondencia.
, J.F. Millán-Cayetanoa, C. Grassi-Garcíab, M. Linares-Barriosa
a Departamento de Dermatología, Hospital Universitario Puerta del Mar, Cádiz, España
b Departamento de Cirugía Plástica, Hospital Universitario Puerta del Mar, Cádiz, España
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las extremidades &#40;20-30&#37;&#41; y la cabeza &#40;10-15&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a>&#46; Su etiolog&#237;a permanece desconocida&#44; si bien se ha observado que existe un antecedente de un traumatismo local hasta en un 10-20&#37; de los casos&#44; sugiriendo que pudiera tratarse de un factor desencadenante<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>&#46; La histog&#233;nesis del DFSP es incierta&#44; aunque la teor&#237;a m&#225;s aceptada es que se origina una c&#233;lula neuromesenquimal pluripotencial<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El crecimiento asim&#233;trico y su mala delimitaci&#243;n cl&#237;nica justifica que se haya constatado que hasta el 21&#37; de los casos presentan una recidiva local &#40;RL&#41; durante los cinco a&#241;os siguientes al tratamiento<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>&#46; Existen m&#250;ltiples gu&#237;as terap&#233;uticas que recomiendan la cirug&#237;a microgr&#225;fica de Mohs &#40;CMM&#41; en diferido como la t&#233;cnica de elecci&#243;n en su tratamiento&#44; relegando la cirug&#237;a convencional &#40;<span class="elsevierStyleSmallCaps">C</span>V&#41; con m&#225;rgenes amplios para los casos en los que no sea posible su realizaci&#243;n y reservando la radioterapia &#40;RT&#41; y el tratamiento con imatinib para situaciones especiales<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>&#46; Se ha estimado una incidencia de RL de 3&#44;7&#37; tras CV vs&#46; 1&#44;7&#37; tras CMM&#44; encontrando diferencias significativas entre ambos<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El objetivo principal de nuestro estudio fue definir las caracter&#237;sticas de los pacientes con DFSP en nuestro centro y el secundario definir las diferencias en el manejo entre aquellos tratados por el Servicio de Dermatolog&#237;a de nuestro hospital frente a otras especialidades&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio descriptivo retrospectivo incluyendo consecutivamente a todos los pacientes con diagn&#243;stico histol&#243;gico de DFSP entre enero de 2010 y agosto de 2022 del Hospital Universitario Puerta del Mar&#44; C&#225;diz&#46; Se recogieron variables epidemiol&#243;gicas&#44; cl&#237;nicas y de tratamiento&#44; de manera que se analizaron los datos de forma global y&#44; posteriormente&#44; seg&#250;n si fue intervenido por el Servicio de Dermatolog&#237;a &#40;grupo 1&#41; frente a otras especialidades &#40;grupo 2&#41;&#46; Para ello&#44; se tomaron medidas de tendencia central y de dispersi&#243;n para las variables cuantitativas y medidas de distribuci&#243;n de frecuencias para las variables cualitativas&#44; seg&#250;n su distribuci&#243;n&#46; Para esto &#250;ltimo se realiz&#243; la prueba de Kolmogorov-Smirnov para comprobar si la variable cuantitativa segu&#237;a la distribuci&#243;n normal o no&#46; Se realizaron an&#225;lisis inferenciales utilizando la <span class="elsevierStyleItalic">t</span> de Student para las variables cuantitativas y la <span class="elsevierStyleItalic">X</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span> para las variables cualitativas&#46; Se estableci&#243; el nivel de significaci&#243;n estad&#237;stica en p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Se utiliz&#243; el programa IBM-<span class="elsevierStyleItalic">Statistical Package for the Social Sciences</span> &#40;SPSS&#41; versi&#243;n 27 &#40;IBM Company&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se identificaron 19 pacientes&#44; 12 &#40;63&#44;2&#37;&#41; hombres&#44; con una mediana de edad de 38 a&#241;os &#40;rango 16-77&#41;&#46; Las localizaciones m&#225;s frecuentes fueron 11 &#40;57&#44;9&#37;&#41; en el tronco&#44; cuatro &#40;21&#37;&#41; en las extremidades inferiores y cuatro &#40;21&#37;&#41; craneofacial&#46; La mediana de tiempo de evoluci&#243;n del DFSP fue de cuatro a&#241;os &#40;rango 1-30&#41; y 10 &#40;52&#44;6&#37;&#41; hab&#237;an recibido alg&#250;n tratamiento previo&#46; La mediana de tiempo de seguimiento tras el tratamiento fue de 32 meses &#40;3-141&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">El an&#225;lisis comparativo entre ambos grupos puede observarse en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; El grupo 1&#44; de forma estad&#237;sticamente significativa&#44; difer&#237;a con respecto al grupo 2 en que incluy&#243; pacientes que no hab&#237;an sido tratados previamente &#40;37&#44;5&#37; vs&#46; 63&#44;6&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;049&#41;&#44; fueron tratados mayoritariamente con CMM &#40;87&#44;5&#37; vs&#46; 18&#44;2&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41; y tuvo una menor tasa de RL durante el seguimiento &#40;0&#37; vs&#46; 45&#44;5&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;026&#41;&#46; No se observaron diferencias significativas en el sexo&#44; edad&#44; tiempo de evoluci&#243;n&#44; localizaci&#243;n&#44; tama&#241;o&#44; tiempo de seguimiento&#44; n&#250;mero de cirug&#237;as previas&#44; RT adyuvante ni progresi&#243;n&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">La cohorte analizada presenta caracter&#237;sticas epidemiol&#243;gicas &#40;edad&#44; localizaci&#243;n&#44; tama&#241;o y tiempo de evoluci&#243;n&#41; similares al resto de cohortes publicadas&#44; a excepci&#243;n de una mayor prevalencia de hombres<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;10</span></a>&#46; En el an&#225;lisis comparativo se observaron diferencias significativas en el n&#250;mero de pacientes tratados previamente&#44; en el n&#250;mero de RL y en el tipo de cirug&#237;a practicada&#44; destacando una mayor aplicaci&#243;n de CMM en el grupo 1 y traduci&#233;ndose en una menor tasa de RL&#46; Adem&#225;s&#44; en el an&#225;lisis comparativo tambi&#233;n destacaron diferencias llamativas entre ambos grupos en el tiempo de evoluci&#243;n&#44; en el n&#250;mero de cirug&#237;as previas realizadas y en la administraci&#243;n de RT adyuvante &#40;mayor en el grupo 2&#41;&#44; aunque sin alcanzar significaci&#243;n estad&#237;stica en ninguna de ellas&#46; El mayor n&#250;mero de intervenciones previas&#44; mayor n&#250;mero de RL durante el seguimiento y mayor necesidad de RT adyuvante observado en el grupo 2&#44; posiblemente debido principalmente a pacientes multiintervenidos y algunos con m&#225;rgenes quir&#250;rgicos afectos&#44; puede hacernos inferir quiz&#225;s una mayor complejidad en los pacientes tratados en dicho grupo&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Las limitaciones de este trabajo se derivan de su car&#225;cter retrospectivo&#44; incluyendo una p&#233;rdida de datos en variables como el n&#250;mero de cirug&#237;as previas y el tiempo de evoluci&#243;n que no permiti&#243; obtener diferencias significativas en el estudio comparativo&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Los resultados obtenidos concuerdan con la superioridad de la CMM con respecto a la CV en el tratamiento del DFSP observada en la literatura&#46; Mediante este estudio se puede concluir que la atenci&#243;n y tratamiento del DFSP mediante la CMM por parte del Servicio de Dermatolog&#237;a disminuye el n&#250;mero de recidivas y&#44; por consiguiente&#44; puede evitar la necesidad de RT adyuvante y su morbilidad asociada&#46; Por tanto&#44; ser&#237;a conveniente que el DFSP sea tratado en servicios que realicen CMM y&#44; en caso de no ser posible&#44; derivar a la unidad de referencia&#46;</p></span>"
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                  \t\t\t\t  " align="" valign="\n
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                  \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" scope="col" style="border-bottom: 2px solid black">Grupo 1&#40;Dermatolog&#237;a&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">valor p&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" scope="col" style="border-bottom: 2px solid black">Grupo 2&#40;otras especialidades&#41;&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
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                  \t\t\t\t"><span class="elsevierStyleItalic">Total</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;42&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;57&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Hombres</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;37&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;109&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;81&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Edad media &#40;a&#241;os&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;843&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">42&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tiempo medio evoluci&#243;n &#40;a&#241;os&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;499&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Localizaci&#243;n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tronco&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">6 &#40;75&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;156&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;36&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Extremidades inferiores&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">2 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;27&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Craneofacial&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">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;36&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tama&#241;o &#40;cm&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 x 2&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;243&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;8 x 4&#44;9&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
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tiempo medio seguimiento &#40;meses&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">58&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tratados previamente</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;37&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;049&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;63&#44;6&#37;&#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="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N&#250;mero cirug&#237;as previas &#40;media&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;25&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">0&#44;529&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;3<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento realizado</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CV m&#225;rgenes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;12&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;81&#44;8&#37;&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cirug&#237;a de Mohs diferida&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;87&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;18&#44;2&#37;&#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="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Recidivas</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;026&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;45&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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ISSN: 00017310
Idioma original: Español
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