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The majority of free neoplastic cells are destroyed by the immune system&#44; whereas groups of 6 or 7 cells appear to have a greater likelihood of forming a metastasis&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> These cells&#44; in turn&#44; must have certain properties&#44; such as cellular suspension and an adequate mitotic index&#44; in order to survive&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Development of a clone with metastatic potential is initially favored by the activation of specific oncogenes<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#44;24</span></a> and the loss of tumor suppressor genes&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;26</span></a> For neoplastic cells in the circulatory system to become established&#44; they must pass through the vessel walls&#46; After the cells adhere to the vessel wall&#44; a thrombus forms around them due to a lesion of the endothelial cells&#46; This thrombus serves to protect the neoplastic cells&#46; The metastasis becomes established and initially obtains its nutrients by means of diffusion phenomena<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#59; later it will form its own vessels &#40;angiogenesis&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;29</span></a> In this classical model of cancer development&#44; the metastases correspond to the final stage of the metastatic cascade&#46; However&#44; recent studies suggest a different model&#44; which predicts that the expression of proteins that regulate epithelial-mesenchymal transition promote oncogenesis concomitantly with metastatic spread&#46; In this alternative model&#44; cell spread from the primary tumor can occur at any time during development of the cancer<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Epidemiology</span><p id="par0035" class="elsevierStylePara elsevierViewall">The true incidence of SMs is unknown&#46; However&#44; the incidence appears to be higher in some recent studies compared with historical series&#44; although this may due to higher rates of biopsy and diagnosis rather than a true increase in the incidence&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> SMs are a rare finding in clinical practice&#44; and their prevalence varies between 0&#46;7&#37; and 9&#37; of patients with internal tumors&#44; depending on the series&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In theory&#44; any malignant tumor can spread to the skin&#46; However&#44; in practice&#44; a direct relationship has been found between the frequency of different malignant tumors and the appearance of SMs&#44; with the most common malignant tumors in each sex being those that most frequently give rise to SMs&#46; Thus&#44; breast cancer in women&#44; lung cancer in men&#44; and adenocarcinomas of the digestive tract in both sexes are the most common origins of SMs&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">A meta-analysis published in 2003 reviewed 1080 cases of SM in 20&#160;380 cancer patients&#44; and reported an estimated SM rate of 5&#46;3&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> In a classic study from 1972&#44; Brownstein and Helwig<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> examined the distribution of SMs in 724 male and female patients&#46; In men&#44; the most common malignant tumors that metastasized to the skin were carcinoma of the lung &#40;24&#37;&#41;&#44; colorectal carcinoma &#40;19&#37;&#41;&#44; melanoma &#40;13&#37;&#41;&#44; and oral squamous cell carcinoma &#40;12&#37;&#41;&#44; whereas&#44; in women&#44; the most common tumors were breast cancer &#40;69&#37;&#41;&#44; colorectal carcinoma &#40;9&#37;&#41;&#44; melanoma &#40;5&#37;&#41;&#44; and carcinoma of the ovary &#40;4&#37;&#41;&#46; The area most commonly affected was the anterior chest wall&#59; the lower limbs were the least common sites&#46; In men&#44; around 75&#37; of SMs were observed on the head and neck&#44; whereas&#44; in women&#44; 75&#37; of cases were found on the anterior chest wall and on the abdomen&#46; In general&#44; the back was an uncommon site for SMs&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In women the most common site of SMs is the thorax&#44; followed by the abdomen&#44; the back&#44; the upper limbs&#44; the scalp&#44; and the neck&#59; in men&#44; the thorax is also the area most commonly affected&#44; followed&#44; in descending order of frequency&#44; by the abdomen&#44; the back&#44; the scalp&#44; the neck&#44; the face&#44; the upper and lower limbs&#44; and the pelvis&#46; The frequency of SMs by age and sex is summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; SMs are very rare in children&#46; The most common primary tumors that produce SMs in this age group are rhabdomyosarcoma and neuroblastoma&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Clinical Presentation</span><p id="par0055" class="elsevierStylePara elsevierViewall">In the majority of cases&#44; SMs develop after diagnosis of the primary tumor&#46; However&#44; in a notable proportion of patients &#40;up to a third of cases&#41;&#44; the metastases are discovered prior to<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> or simultaneously with<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> the primary tumor&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">SMs tend to appear in a body region close to the primary tumor&#46; Presentation is typically in the form of rapidly growing&#44; mobile&#44; round or oval nodules of firm or elastic consistency<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a>&#59; they may be ulcerated&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> However&#44; they can present as any primary or secondary skin lesion<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The nodules are usually skin-colored&#44; although metastatic nodules from renal cell or thyroid carcinoma often have a characteristic reddish or violaceous discoloration<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">42&#44;43</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Some recent studies report that skin metastases present most often as a single nodular lesion&#44; whereas older studies more commonly reported multiple nodules&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> This may be because more SMs are now diagnosed earlier&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Although most SMs are asymptomatic&#44; patients may describe pain&#44; particularly with lesions in certain areas&#44; such as subungual metastases&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Gastrointestinal cancers &#40;specifically&#44; colorectal and gastric carcinomas&#41; often give rise to metastases on the abdomen and pelvis&#46; These carcinomas can spread along the urachus to produce umbilical nodules known as Sister Mary Joseph&#39;s nodules&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a> SMs from squamous cell carcinoma of the oral cavity usually arise in the same body region&#44; and most frequently affect the face and neck&#46; Renal cell carcinoma&#44; among others&#44; typically metastasizes to the scalp and&#44; because it is a highly vascular tumour&#44; the lesions may be confused with hemangiomas or pyogenic granulomas&#46; SMs from hepatocellular carcinoma often develop on the fingers&#44; palms&#44; soles&#44; or the back&#44; while those from gastric carcinoma tend to develop on the head and neck&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a> Thus&#44; the site of an SM can suggest a possible origin &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Specific Clinical Forms of SMs</span><p id="par0075" class="elsevierStylePara elsevierViewall">A very large number of specific clinical forms of SMs have been described&#46; Erysipeloid or inflammatory carcinoma is often observed in patients with adenocarcinoma of the breast and is not uncommon in other types of cancer &#40;pancreas&#44; rectum&#44; lung&#44; ovary&#44; and parotid&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">48&#44;49</span></a> It presents as well-defined erythematous lesions that are hot and tender&#44; similar to erysipelas&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> Lymphatic obstruction by the neoplastic cells can give rise to localized lymphedema with peau d&#8217;orange&#46; Lymphedema can cause the skin to become fibrous and yellowish&#44; with a similar appearance to carcinoma en cuirasse<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> or scirrhous carcinoma&#46; This clinical form presents as indurated erythematous plaques that infiltrate the chest wall&#46; It is usually observed in metastases from breast cancer&#44; although it can be a form of presentation of a primary breast tumor or of SMs of other origins&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a> The main differential diagnosis of this presentation is with infectious disorders&#46; Erysipeloid carcinoma localized to the breast can be difficult to distinguish from mastitis&#46; Persistent inflammation that does not respond to conventional therapy must therefore be carefully evaluated to exclude metastatic infiltration&#44; particularly when there is no fever or leukocytosis&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Telangiectatic carcinoma&#44; described by Weber<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">54</span></a> in 1933 in a patient with metastatic breast cancer&#44; is characterized by the appearance of nodules&#44; papules&#44; or purpuric plaques on the chest wall&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">55</span></a> usually in the proximity of a surgical scar&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">56&#44;57</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Zosteriform or herpetiform metastases present as papules&#44; vesicles&#44; nodules&#44; or blisters affecting individual dermatomes&#44;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">58&#44;59</span></a> mimicking herpes zoster<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">60&#44;61</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; Although their etiology and pathogenesis are not fully understood&#44; most hypotheses suggest there is spread of the tumor cells from the cutaneous lymph vessels to the sensory nerves&#44; via which they reach the dorsal root ganglia&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">62&#44;63</span></a></p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Clown nose is considered to be the result of an SM arising on the tip of the nose&#44; typically from a carcinoma of the lung or breast&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">64</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Alopecia neoplastica is defined as hair loss secondary to invasion of the scalp by malignant cells&#46; It can present as 1 or more plaques of scarring alopecia that are often indurated and have a bluish or violaceous color&#46; These plaques must be differentiated from alopecia areata<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">65</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; The neoplastic cells can destroy the hair follicles by producing fibroplasia induced by the release of inflammatory mediators that bring inflammatory cells into the area&#44; and&#47;or by substitution of the normal cells&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">66</span></a> Breast cancer is the underlying primary malignant tumor in 84&#37; of patients with alopecia neoplastica&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">67</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Paget&#39;s disease of the nipple and areola is a skin sign associated with an underlying adenocarcinoma of the breast in 100&#37; of cases&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">68</span></a> This skin condition is produced by epidermotropic SMs due to the spread of an intraductal tumor along the lactiferous ducts to reach the overlying skin&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Subungual metastases merit special consideration&#46; These metastatic lesions are usually painful and often need to be differentiated from infectious disorders&#44; in particular acute paronychia&#44; or from glomus tumors<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">69</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; Presentation as painless dactylitis has been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">70</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Sister Mary Joseph&#39;s nodule or umbilical metastasis is widely described in the literature&#46; This form of metastasis presents as single or multiple&#44; indurated umbilical or periumbilical nodules that can sometimes ulcerate or have a friable appearance &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; Although the site of the primary tumor is unknown in approximately 29&#37; of cases&#44;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">71</span></a> the majority of umbilical metastases come from tumors that arise in the stomach&#44; ovary&#44; colon&#44; rectum&#44; or pancreas&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">72</span></a> The proposed pathogenesis of metastases in the umbilical region includes both contiguous infiltration and spread via the blood or lymph&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">73</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Finally&#44; clinically occult metastases are those with no detectable clinical findings but which are discovered as incidental findings on a histopathological examination performed for some other reason&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">74</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Differential Diagnosis</span><p id="par0120" class="elsevierStylePara elsevierViewall">The differential diagnosis of SMs is very broad and includes many more disorders in addition to those mentioned above&#46; First we must consider primary skin tumors&#44;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">75</span></a> both benign &#40;dermatofibroma&#44; pyogenic granuloma&#44;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">76</span></a> epidermal cyst&#44;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">77</span></a> adnexal tumors<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">78</span></a>&#41; and malignant &#40;basal or squamous cell carcinoma&#44; melanoma&#44; Merkel cell tumor&#44; angiosarcoma<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">79</span></a>&#41;&#46; Other skin diseases to be considered are eczema&#44; erythema annulare centrifugum&#44;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">80</span></a> erythema multiforme &#91;target-shaped SMs&#93;&#44; and vasculitis&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">81</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Diagnosis</span><p id="par0125" class="elsevierStylePara elsevierViewall">A detailed medical history and complete physical examination are essential to establish the initial diagnostic suspicion&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The histopathology of SMs may reveal the same characteristics as the tumor of origin&#44; or there may be a more anaplastic appearance&#46; Immunohistochemistry can help to determine the possible origin in the case of undifferentiated tumors&#46; Incisional or excisional skin biopsy is essential to reach a diagnosis&#46; Cytology study by fine-needle aspiration biopsy can be useful in certain circumstances&#46;<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">82&#44;83</span></a> The pattern observed and the microscopic appearance of the tissue often suggest its origin&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">84</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">In some cases&#44; such as renal cell carcinoma&#44; characteristic histological findings will identify the primary tumor&#44; but the majority of SMs can only be classified in general terms as adenocarcinoma&#44; squamous cell carcinoma&#44; or undifferentiated carcinoma&#46; It is also necessary to differentiate between metastatic skin lesions and primary skin tumors&#59; as these 2 types of lesion frequently have very similar morphological patterns&#44; immunohistochemical markers can be very useful for their differentiation&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> summarizes the results of the literature review published by Sarya et al&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">85</span></a> in 2007&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">Certain histological features differentiate metastases from primary tumors&#46; Characteristics suggestive of SMs include the presence of neoplastic cells within the lymph and blood vessels&#44; localization of the lesion in the deep reticular dermis and hypodermis&#44; and the presence of neoplastic cells running along the bundles of collagen&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">86</span></a> Metastatic tumors typically develop as round nodules located in the dermis or hypodermis&#44; and are not usually in contact with the epidermis&#46; This Grenz zone is much more common in metastatic lesions&#46; Fibrosis and inflammation may be evident &#40;<a class="elsevierStyleCrossRefs" href="#fig0025">Figs&#46; 5 and 6</a>&#41;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">Immunohistochemical markers and&#44; sometimes&#44; ultrastructural studies are valuable tools for establishing the origin of SMs&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">87</span></a><a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 7</a> shows the diagnostic algorithm that should be applied for undifferentiated SMs&#46; The basic recommended battery of markers includes CD45 &#40;for lymphoid tumors&#41;&#44; pancytokeratin AE1&#47;AE3 &#40;for the majority of carcinomas&#41;&#44; S100 &#40;for melanoma&#41; and CD34 &#40;for vascular tumors and leukemia&#41;&#46; The second recommended battery of markers includes lymphoid markers &#40;CD3 and CD20&#41;&#44; epithelial markers such as epithelial membrane antigen and carcinoembryonic antigen&#44; chromogranin &#40;neuroendocrine tumors&#41;&#44; prostate specific antigen and acid phosphatase &#40;carcinoma of the prostate&#41;&#44; thyroid transcription factor &#40;carcinoma of the lung&#41;&#44; Wilms&#8217; tumor protein &#40;carcinoma of the ovary&#41;&#44; CDX2<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">88</span></a> &#40;intestinal carcinomas&#41;&#44; and Hep Par1<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">89</span></a> &#40;hepatocellular carcinoma&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">90</span></a> The immunophenotypes of the main tumors that metastasize to the skin are summarized in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46;</p><elsevierMultimedia ident="fig0035"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">Ultrastructural studies can be useful in the identification of certain undifferentiated tumors&#46; Desmosomes may be observed in carcinomas&#44; cytoplasmic vacuoles in adenocarcinomas&#44; melanosomes in melanomas&#44; and neurosecretory granules in neuroendocrine tumors&#46; However&#44; ultrastructural studies are long and costly techniques that are not available in the majority of centers and require highly specialized staff&#59; immunohistochemical studies therefore tend to be more useful in clinical practice&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Positron emission tomography &#40;PET&#41; gives a large number of false positives&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">91</span></a> PET-computed tomography is more useful&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">92</span></a> However&#44; PET may understage tumors in some cases&#44; and small metastases or cerebral lesions may be missed&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">93</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Prognosis</span><p id="par0160" class="elsevierStylePara elsevierViewall">The presence of metastatic disease in the skin usually implies widespread systemic disease with a high mortality&#44; although the prognosis varies considerably depending on the type of primary tumor&#46;<a class="elsevierStyleCrossRefs" href="#bib0470"><span class="elsevierStyleSup">94&#44;95</span></a> SMs in the absence of other distant metastases only occur in 6&#46;4&#37; to 7&#46;8&#37; of cases&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">96</span></a> However&#44; it would appear that recent advances in chemotherapy have considerably increased survival&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">97</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">It is estimated that mean survival after the diagnosis of SMs is 50&#37; at 6 months&#46; A number of survival analyses of patients with SMs have been published&#44; those of Benmously et al&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">98</span></a> and Schoenlaub et al&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">97</span></a> being particularly relevant All the analyses report a better survival in cases of breast cancer than in other types of cancer&#46;<a class="elsevierStyleCrossRefs" href="#bib0495"><span class="elsevierStyleSup">99&#44;100</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">The mean interval between the diagnosis of a primary tumor and the appearance of SMs varies between 2 and 3 years&#44; but periods of up to 22 years have been reported&#46; Recent studies indicate that this interval varies depending on the type of primary tumor&#46;<a class="elsevierStyleCrossRefs" href="#bib0505"><span class="elsevierStyleSup">101&#44;102</span></a> In 141 patients analyzed by Hu et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">103</span></a> the mean interval between the excision or treatment of the primary tumor and the appearance of SMs was longer in patients with breast cancer &#40;47&#46;2 months&#41; than in those with other tumors&#44; such as lung cancer &#40;15&#46;7 months&#41;&#44; colorectal cancer &#40;16&#46;5 months&#41;&#44; or stomach cancer &#40;19&#46;8 months&#41;&#46; According to some studies&#44; lung cancer is the tumor that most rapidly metastasizes to the skin&#46;<a class="elsevierStyleCrossRefs" href="#bib0520"><span class="elsevierStyleSup">104&#44;105</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Treatment</span><p id="par0175" class="elsevierStylePara elsevierViewall">The therapeutic approach to SMs is based on appropriate management of the primary tumor&#44; if it has been identified&#46;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">106</span></a> As the presence of SMs implies the coexistence of other metastatic lesions in most cases&#44; chemotherapy directed against the tumor of origin is usually the only option that might achieve complete remission&#46;<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">107</span></a> Surgery and radiation therapy are often used to treat SMs due to the ease of access to the majority of these lesions&#59; however&#44; no clear increase in survival has been demonstrated&#44; and the aim of such treatments is often only palliative&#46;<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">108</span></a> It has been suggested that surgery might improve survival in cases of SM from lung cancer<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">109</span></a> or gastric cancer&#46;<a class="elsevierStyleCrossRefs" href="#bib0550"><span class="elsevierStyleSup">110&#44;111</span></a> Radiation therapy has achieved complete responses and lasting palliation in some cases of metastases from renal cell carcinoma&#46;<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">112</span></a> In 1 study&#44; pulsed brachytherapy achieved local control in 41 &#40;89&#37;&#41; of 46 cases of SMs from breast cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">113</span></a> The topical application of 6&#37; miltefosine solution to SMs from carcinoma of the breast achieved good control of the SM in comparison with placebo in a randomized study&#46;<a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">114</span></a> In another study&#44; 10 patients with SM from breast or colon cancer were treated with intratumoral injections of recombinant single-chain antibodies targeted to ErbB2&#47;HER2&#44; with complete remission in 4 cases&#46;<a class="elsevierStyleCrossRef" href="#bib0575"><span class="elsevierStyleSup">115</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">The results after intralesional immunotherapy with interferon alfa or interleukin 2<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">116</span></a> have been variable&#46;<a class="elsevierStyleCrossRefs" href="#bib0585"><span class="elsevierStyleSup">117&#44;118</span></a> Reports of metastatic melanoma treated with imiquimod have also been published&#46;<a class="elsevierStyleCrossRef" href="#bib0595"><span class="elsevierStyleSup">119</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Other locally ablative procedures&#44; such as electrochemotherapy&#44;<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">120</span></a> electrocoagulation&#44; electroporation&#44; and electrovaporization&#44;<a class="elsevierStyleCrossRef" href="#bib0605"><span class="elsevierStyleSup">121</span></a> have also been used successfully&#46; In particular&#44; electrochemotherapy with bleomycin is an option in multiple skin and subcutaneous metastases&#46; One study of electrochemotherapy with bleomycin included 174 tumor nodules in 52 patients with breast cancer<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">122</span></a>&#59; complete responses were observed in 80&#37; and partial remission in 20&#37; after repeated application&#46; Electrochemotherapy with cisplatin has also been evaluated in the treatment of SMs from breast cancer&#44; but was less successful&#46;<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">123</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">No specific chemotherapy has been shown to be the most effective for the systemic treatment of SMs&#46; Observations of SMs that have regressed after systemic chemotherapy are limited to case reports&#44; such as a patient with SMs from cancer of the pancreas treated with gemcitabine&#44;<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">124</span></a> and a patient with urothelial carcinoma of the bladder treated with cyclophosphamide&#44; methotrexate&#44; and 5-fluorouracil&#46;<a class="elsevierStyleCrossRef" href="#bib0625"><span class="elsevierStyleSup">125</span></a> Case reports of SMs from carcinomas of unknown origin treated with cisplatin&#44; gemcitabine&#44; vinorelbine&#44; and paclitaxel have also been published&#46;<a class="elsevierStyleCrossRefs" href="#bib0630"><span class="elsevierStyleSup">126&#44;127</span></a> Determination of the expression of certain molecules such as EGF&#44; Her-2&#47;neu kinase&#44; and c-kit tyrosine kinase is very important as it will provide possible targets for systemic therapy&#46; In addition&#44; drugs targeted against stromal function and angiogenesis could prove useful&#46;<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">128</span></a>The palliative treatment of SMs includes adequate management of the pain&#44; pruritus&#44; possible bacterial superinfection&#44; and&#44; in some cases&#44; of the unpleasant smell that these lesions can produce&#46;<a class="elsevierStyleCrossRefs" href="#bib0645"><span class="elsevierStyleSup">129&#8211;132</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conclusions</span><p id="par0195" class="elsevierStylePara elsevierViewall">The majority of tumor recurrences are diagnosed on the basis of a detailed medical history and complete physical examination&#44; combined with the relevant imaging studies&#46; As SMs are usually asymptomatic&#44; active screening is essential&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">SMs can play a crucial role in alerting the physician to a possible tumor recurrence or may even be the first sign of previously unknown tumor&#46; The site and distribution of the skin lesions can suggest the organ of origin&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Histological and immunohistochemical study of SMs is required in order to identify the primary tumor&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Early detection of SMs is essential in order to start appropriate treatment&#46; Although strong scientific evidence of a survival benefit is lacking&#44; case reports and certain preliminary publications would suggest that early diagnosis improves life expectancy&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflicts of Interest</span><p id="par0215" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "identificador" => "xres295324"
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          "titulo" => "Keywords"
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          "titulo" => "Introduction"
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        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Etiology and Pathogenesis"
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        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Epidemiology"
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          "identificador" => "sec0020"
          "titulo" => "Clinical Presentation"
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        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Specific Clinical Forms of SMs"
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        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Differential Diagnosis"
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        10 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Diagnosis"
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        11 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Prognosis"
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          "titulo" => "Treatment"
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          "identificador" => "sec0050"
          "titulo" => "Conclusions"
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          "identificador" => "sec0055"
          "titulo" => "Conflicts of Interest"
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          "identificador" => "xack69009"
          "titulo" => "Acknowledgments"
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        16 => array:1 [
          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2011-12-06"
    "fechaAceptado" => "2012-06-02"
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          "clase" => "keyword"
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          "palabras" => array:6 [
            0 => "Cutaneous metastases"
            1 => "Metastatic cascade"
            2 => "Nodule"
            3 => "Dissemination"
            4 => "Metastatic pattern"
            5 => "Immunohistochemistry"
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          "palabras" => array:6 [
            0 => "Met&#225;stasis cut&#225;neas"
            1 => "Cascada metast&#225;sica"
            2 => "N&#243;dulo"
            3 => "Diseminaci&#243;n"
            4 => "Patrones metast&#225;sicos"
            5 => "Inmunohistoqu&#237;mica"
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        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cutaneous metastases are relatively rare in clinical practice and their diagnosis requires a high index of suspicion because clinical findings can be subtle&#46; These metastases reveal the presence of disseminated malignant disease and can lead to the diagnosis of unsuspected internal tumors or the spread or recurrence of an already diagnosed tumor&#46; Early recognition of cutaneous metastases can facilitate prompt and accurate diagnosis resulting in early treatment&#59; however&#44; they are generally indicative of a poor prognosis&#46; Some tumors have a predilection to metastasize to specific areas&#46; Recognition of these patterns provides essential information that can guide the search for the underlying tumor&#46;</p>"
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      "es" => array:2 [
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        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Las met&#225;stasis cut&#225;neas son relativamente raras en la pr&#225;ctica cl&#237;nica&#46; Su diagn&#243;stico requiere un alto &#237;ndice de sospecha&#44; pues los hallazgos cl&#237;nicos pueden ser sutiles&#46; Las met&#225;stasis cut&#225;neas ponen de manifiesto la presencia de un tumor maligno diseminado y pueden permitir el diagn&#243;stico de neoplasias internas no conocida o indicar la diseminaci&#243;n o recurrencia de otras ya diagnosticadas&#46; Su reconocimiento temprano puede llevar a un diagn&#243;stico preciso y r&#225;pido&#44; con el consiguiente tratamiento oportuno&#44; aunque en la mayor&#237;a de los casos son indicativas de un pron&#243;stico infausto&#46; Algunos tumores tienen predilecci&#243;n por metastatizar en &#225;reas espec&#237;ficas&#46; El reconocimiento de esos patrones es esencial para dirigir la b&#250;squeda del tumor subyacente&#46;</p>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Fern&#225;ndez-Ant&#243;n Mart&#237;nez MC&#44; Parra-Blanco V&#44; Avil&#233;s Izquierdo JA&#44; Su&#225;rez Fern&#225;ndez RM&#46; Met&#225;stasis cut&#225;neas de origen visceral&#46; Actas Dermosifiliogr&#46; 2013&#59;104&#58;841&#8211;853&#46;</p>"
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        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">This review is part of the introduction to the doctoral thesis entitled Met&#225;stasis cut&#225;neas&#58; estudio descriptivo cl&#237;nico-histopatol&#243;gico de las met&#225;stasis cut&#225;neas de neoplasias viscerales&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Pathogenesis of skin metastases&#46; Diagram that compares the classical model of metastasis production with the most recent hypotheses&#46; Source&#58; S&#225;nchez-Garc&#237;a I&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Skin metastases can manifest as primary or secondary skin lesions&#46; A&#44; Metastasis from a gastric adenocarcinoma&#46; Papule of 7<span class="elsevierStyleHsp" style=""></span>mm diameter on the abdomen&#46; B&#44; Metastasis from an adenocarcinoma of the ovary presenting as a plaque&#46; C&#44; Metastasis from a urothelial carcinoma of the bladder presenting as a nodule&#46; D&#44; Metastasis from an adenocarcinoma of the breast&#46; The lesion started as a macule over the mastectomy scar&#46; E&#44; Ulcerated infiltrated plaque corresponding to a metastasis from an adenocarcinoma of the lung&#46;</p>"
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Unusual skin metastases&#46; A&#44; Zosteriform metastases from a ductal adenocarcinoma of the breast&#46; Clusters of infiltrated papules&#44; some confluent and some ulcerated&#44; in a metameric distribution&#46; B&#44; Umbilical metastasis &#40;Sister Mary Joseph&#39;s nodule&#41;&#59; multiple&#44; confluent&#44; ulcerated papules and nodules in the umbilical and periumbilical regions&#46; C&#44; Alopecia neoplastica&#46; Plaque of alopecia over a metastasis from a ductal adenocarcinoma of the breast in a woman&#46; D&#46; Subungual metastasis&#46; Metastasis from a squamous cell carcinoma of the lung presenting as a painful inflammatory nodule that deformed the distal phalanx of the second finger of the left hand&#46;</p>"
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Histological images of skin metastases&#46; A&#44; Dermal metastasis from a poorly differentiated carcinoma of unknown origin&#46; Infiltration of the dermis by cords and nests of epithelioid cells &#40;hematoxylin-eosin&#44; original magnification x10&#41;&#46; B&#44; Dermal metastasis from a moderately differentiated adenocarcinoma of the pancreas&#46; Glandular lumens lined by a layer of epithelial cells can be seen between the dermal collagen bundles &#40;hematoxylin-eosin&#44; original magnification x10&#41;&#46;</p>"
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          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A&#44; Dermal metastasis from a carcinoma of the ovary&#46; Dilated dermal blood vessels occupied by atypical epithelial cells &#40;hematoxylin-eosin&#44; original magnification x20&#41;&#46; B&#44; Extensive dermal and vascular infiltration &#40;lymphangitis carcinomatosa&#41; by a poorly differentiated carcinoma&#46;</p>"
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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"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Men&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Women&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;&#160;40 y&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">MelanomaColon cancerLung cancer&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">Breast cancerCarcinoma of the colonOvarian cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;&#160;40 y&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">Lung cancerColon cancerSquamous cell carcinoma of the oral cavityMelanoma&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">Carcinoma of the breastCarcinoma of the colonLung cancerCarcinoma of the ovaryMelanoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Frequency of Skin Metastases According to Age and Sex &#40;in Decreasing Frequency&#41;&#46;</p>"
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        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:1 [
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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"><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Site of the Skin Metastases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Most Common Primary Tumors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Scalp&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">Breast&#44; lung&#44; and kidney&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Neck&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">Oral squamous cell carcinoma&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">Face&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">Oral squamous cell carcinoma&#44; renal cell&#44; and lung&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chest&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">Breast and lung&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abdomen&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">Colon&#44; lung&#44; stomach&#44; breast&#44; and ovary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Umbilicus&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">Stomach&#44; pancreas&#44; colon&#44; kidney&#44; ovary&#44; and breast&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pelvis&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">Colon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lower abdomen&#44; groin&#44; or thigh&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">Ovary and uterus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Limbs&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">Breast&#44; lung&#44; kidney&#44; and bowel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Back&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">Lung&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab430528.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Most Common Primary Tumors Giving Rise to Skin Metastases According to the Site of the Metastases&#46;</p>"
        ]
      ]
      9 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Source&#58; Sarya et al&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">85</span></a> Abbreviations&#58; BCC&#44; basal cell carcinoma&#59; SCC&#44; squamous cell carcinoma&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Antibodies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">General Characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Metastatic Carcinomas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Adnexal Tumors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Usefulness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p63&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">Homolog of p53&#44; expressed in the basal cells of the skin and mucosas and in the myoepithelial cells of the breast&#44; salivary glands&#44; and prostatePositive in SCC at various sites&#44; urothelial carcinoma&#44; BCC&#44; adnexal tumors&#44; 30&#37; of lung cancers&#44; and some pancreatic&#44; biliary&#44; gastric&#44; ovarian&#44; breast&#44; hepatic&#44; renal&#44; colon&#44; and thymus cancers&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">Negative in the published literatureNegative in 25&#47;32&#44; positive in 2&#47;2 from urothelial tumors&#44; 2&#47;8 from lung tumors&#44; 1&#47;2 from gastric tumors&#44; and 2&#47;6 from carcinomas of the breast&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">Positive in all cases published in the literaturePositive in 24&#47;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">Most useful markerHowever&#44; it should not be used alone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B72&#46;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">Tumor-associated glycoprotein&#46; Expressed in many adenocarcinomas&#46; Useful to differentiate lung cancer from mesothelioma and in adnexal tumors of apocrine origin&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">Positive 26&#47;31&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">Negative in 18&#47;25&#44; focally positive in 6&#47;25&#44; and diffusely positive in 1 mucinous carcinoma&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">Positivity useful in metastatic carcinomas that are positive for p63 and CK5&#47;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Calretinin&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">Calcium-binding protein expressed in mesothelial&#44; epithelial&#44; and stromal cells&#46; Used to differentiate adenocarcinoma from mesothelioma and in sex-cord stromal tumors of the testis and ovary&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">Negative in 23&#47;32&#44; positive in 9 &#40;pancreas&#44; lung&#44; breast sporadically&#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">Positive in 16&#47;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">Negativity useful in metastatic carcinomas that are positive for p63 and CK5&#47;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CK5&#47;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">Intermediate-sized cytokeratin expressed in the skin&#44; squamous mucosa&#44; myoepithelial cells of breast&#44; salivary glands&#44; and prostatePositive in SCC&#44; BCC&#44; thymoma&#44; salivary gland tumors&#44; biphasic mesothelioma&#44; and some urothelial&#44; pancreatic&#44; endometrial&#44; breast&#44; and ovarian tumors&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">Negative in the published literatureNegative in 14&#47;32&#44; positive in 18&#47;32&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">Positive in the published literaturePositive in 25&#47;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">Consistent expression in skin tumors&#46; Useful in the panel of markers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab430530.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Summary of the Immunohistochemical Markers Useful for the Differentiation Between Skin Metastases and Primary Skin Tumors&#44; and Synopsis of the Data Obtained in the Series by Sarya et al&#46;</p>"
        ]
      ]
      10 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Primary Tumor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Immunohistochemical Markers<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Breast&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">CK7 &#40;&#43;&#41;&#44; CAM 5&#46;2 &#40;&#43;&#41;&#44; vimentin &#40;&#8722;&#41;&#44; TTF-1 &#40;&#8722;&#41;&#44; Ber-EP4 &#40;&#43;&#41;&#44; WT-1 &#40;&#8722;&#41;&#44; DPC4 &#40;&#8722;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adenocarcinoma of the lung&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">CK7 &#40;&#43;&#41;&#44; CAM 5&#46;2 &#40;&#43;&#41;&#44; CEA &#40;&#43;&#41;&#44; Ber-EP4 &#40;&#43;&#41;&#44; WT-1 &#40;&#8722;&#41;&#44; DPC4 &#40;&#8722;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Colon and rectum&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">CK20 &#40;&#43;&#41;&#44; CAM 5&#46;2 &#40;&#43;&#41;&#44; CK17 &#40;&#8722;&#41;&#44; CK19 &#40;&#43;&#41;&#44; CEA &#40;&#43;&#41;&#44; TTF-1 &#40;&#8722;&#41;&#44; Ber-EP4 &#40;&#43;&#41;&#44; S100 &#40;&#8722;&#41;&#44; WT-1 &#40;&#8722;&#41;&#44; DPC4 &#40;&#8722;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Stomach&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">CAM 5&#46;2 &#40;&#43;&#41;&#44; vimentin &#40;&#8722;&#41;&#44; TTF-1 &#40;&#8722;&#41;&#44; ER &#40;&#8722;&#41;&#44; Ber-EP4 &#40;&#43;&#41;&#44; WT-1 &#40;&#8722;&#41;&#44; DPC4 &#40;&#8722;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prostate&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">CK7 &#40;&#8722;&#41;&#44; CK20 &#40;&#8722;&#41;&#44; CAM 5&#46;2 &#40;&#43;&#41;&#44; CD5&#47;6 &#40;&#8722;&#41;&#44; CK17 &#40;&#8722;&#41;&#44; CEA &#40;&#8722;&#41;&#44; vimentin &#40;&#8722;&#41;&#44; TTF-1 &#40;&#8722;&#41;&#44; ER &#40;&#8722;&#41;&#44; Ber-EP4 &#40;&#43;&#41;&#44; S100 &#40;&#8722;&#41;&#44; WT-1 &#40;&#8722;&#41;&#44; DPC4 &#40;&#8722;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pancreas&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">CK7 &#40;&#43;&#41;&#44; CAM 5&#46;2 &#40;&#43;&#41;&#44; vimentin &#40;&#8722;&#41;&#44; TTF-1 &#40;&#40;&#41;&#44; ER &#40;&#8722;&#41;&#44; Ber-EP4 &#40;&#43;&#41;&#44; S100 &#40;&#8722;&#41;&#44; WT-1 &#40;&#8722;&#41;&#44; DPC 4 &#40;&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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          "identificador" => "bibs0005"
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            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metastatic tumors"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:4 [
                        "titulo" => "Clinical Dermatology"
                        "paginaInicial" => "1"
                        "paginaFinal" => "7"
                        "serieFecha" => "1997"
                      ]
                    ]
                  ]
                ]
              ]
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            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Do all roads lead to Rome&#63; Routes to metastasis development&#63;"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ijc.26027"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cancer"
                        "fecha" => "2011"
                        "volumen" => "128"
                        "paginaInicial" => "2511"
                        "paginaFinal" => "2526"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tumor cells caught in the act of invading&#58; their strategy for enhanced cell motility"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.tcb.2005.01.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Trends Cell Biol"
                        "fecha" => "2005"
                        "volumen" => "15"
                        "paginaInicial" => "138"
                        "paginaFinal" => "145"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The lymph node as a bridgehead in the metastatic dissemination of tumors"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Recent Results Cancer Res"
                        "fecha" => "2000"
                        "volumen" => "157"
                        "paginaInicial" => "55"
                        "paginaFinal" => "81"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dissemination and growth of cancer cells in metastatic sites"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/nrc865"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Rev Cancer"
                        "fecha" => "2002"
                        "volumen" => "2"
                        "paginaInicial" => "563"
                        "paginaFinal" => "572"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous manifestations of internal malignancies"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Dermatol"
                        "fecha" => "2001"
                        "volumen" => "19"
                        "paginaInicial" => "290"
                        "paginaFinal" => "297"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous metastatic disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Acad Dermalol"
                        "fecha" => "1995"
                        "volumen" => "33"
                        "paginaInicial" => "161"
                        "paginaFinal" => "182"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "El proceso metast&#225;tico &#40;<span class="elsevierStyleSmallCaps">ii</span>&#41;&#58; diseminaci&#243;n tumoral directa&#44; linf&#225;tica y hem&#225;tica"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "1999"
                        "volumen" => "90"
                        "paginaInicial" => "277"
                        "paginaFinal" => "290"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous metastases in internal malignancy"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Egypt Dermatol Online J"
                        "fecha" => "2007"
                        "volumen" => "3"
                        "paginaInicial" => "1"
                        "itemHostRev" => array:3 [ …3]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Met&#225;stasis cut&#225;nea inflamatoria como primer signo de recidiva de carcinoma escamoso de pulm&#243;n"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2008"
                        "volumen" => "99"
                        "paginaInicial" => "157"
                        "paginaFinal" => "159"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skin involvement as the presenting sign of internal carcinoma&#58; a retrospective study of 7&#44;316 cancer patients"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "1990"
                        "volumen" => "22"
                        "paginaInicial" => "19"
                        "paginaFinal" => "26"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patterns of cutaneous metastasis"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "1972"
                        "volumen" => "105"
                        "paginaInicial" => "862"
                        "paginaFinal" => "868"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous metastases of internal malignancies"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/0378-6323.60548"
                      "Revista" => array:7 [
                        "tituloSerie" => "Indian J Dermatol Venereol Leprol"
                        "fecha" => "2010"
                        "volumen" => "76"
                        "paginaInicial" => "125"
                        "paginaFinal" => "131"
                        "link" => array:1 [ …1]
                        "itemHostRev" => array:3 [ …3]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metastatic tumors of the skin"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "1972"
                        "volumen" => "29"
                        "paginaInicial" => "1298"
                        "paginaFinal" => "1307"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metastasis mechanisms"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Biochim Biophys Acta"
                        "fecha" => "1796"
                        "volumen" => "2009"
                        "paginaInicial" => "293"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous metastases from internal carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "1966"
                        "volumen" => "19"
                        "paginaInicial" => "162"
                        "paginaFinal" => "168"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skin metastases in cancer patients"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Cutis"
                        "fecha" => "1987"
                        "volumen" => "39"
                        "paginaInicial" => "119"
                        "paginaFinal" => "121"
                        "link" => array:1 [ …1]
                        "itemHostRev" => array:3 [ …3]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complex networks orchestrate epithelial-mesenchymal transitions"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/nrm1835"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Rev Mol Cell Biol"
                        "fecha" => "2006"
                        "volumen" => "7"
                        "paginaInicial" => "131"
                        "paginaFinal" => "142"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hepatic and skin metastases after laparoscopic radical prostatectomy for prostate cancer"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Gastrointestin Liver"
                        "fecha" => "2007"
                        "volumen" => "16"
                        "paginaInicial" => "333"
                        "paginaFinal" => "335"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous metastasis of pleural mesothelioma&#58; two cases"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Dermatol Venereol"
                        "fecha" => "2003"
                        "volumen" => "130"
                        "paginaInicial" => "455"
                        "paginaFinal" => "459"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transiently entrapped circulating tumor cells interact with neutrophils to facilitate lung metastasis development"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1158/0008-5472.CAN-09-4442"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer Res"
                        "fecha" => "2010"
                        "volumen" => "70"
                        "paginaInicial" => "6071"
                        "paginaFinal" => "6082"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The pathogenesis of cancer metastasis"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Nature"
                        "fecha" => "1979"
                        "volumen" => "283"
                        "paginaInicial" => "139"
                        "paginaFinal" => "146"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Ras branch of small GTPases&#58; Ras family members don&#8217;t fall far from the tree"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Curr Opin Cell Biol"
                        "fecha" => "2000"
                        "volumen" => "12"
                        "paginaInicial" => "157"
                        "paginaFinal" => "165"
                        "link" => array:1 [ …1]
                        "itemHostRev" => array:3 [ …3]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The mitogen activated protein kinase signal transduction pathway&#58; From the cell surface to the nucleus"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cell Signal"
                        "fecha" => "1994"
                        "volumen" => "6"
                        "paginaInicial" => "581"
                        "paginaFinal" => "589"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ras oncogenes in human cancer&#58; A review"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer Res"
                        "fecha" => "1989"
                        "volumen" => "49"
                        "paginaInicial" => "4682"
                        "paginaFinal" => "4689"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inhibitors of the ras oncogene as therapeutic targets"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Hematol Oncol Clin North Am"
                        "fecha" => "2002"
                        "volumen" => "16"
                        "paginaInicial" => "1065"
                        "paginaFinal" => "1088"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Molecular mechanisms of tumor metastasis and angiogenesis"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Langenbecks Arch Surg"
                        "fecha" => "1999"
                        "volumen" => "384"
                        "paginaInicial" => "133"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "General mechanisms of metastasis"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "1997"
                        "volumen" => "80"
                        "paginaInicial" => "1529"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Axis of evil&#58; molecular mechanisms of cancer metastasis"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/sj.onc.1206757"
                      "Revista" => array:6 [
                        "tituloSerie" => "Oncogene"
                        "fecha" => "2003"
                        "volumen" => "22"
                        "paginaInicial" => "6524"
                        "link" => array:1 [ …1]
                        "itemHostRev" => array:3 [ …3]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The crossroads of oncogenesis and metastasis"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2009"
                        "volumen" => "15"
                        "paginaInicial" => "297"
                        "paginaFinal" => "299"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metastases in carcinoma&#59; analysis of 1000 autopsied cases"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "1950"
                        "volumen" => "3"
                        "paginaInicial" => "74"
                        "paginaFinal" => "85"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous metastases&#46; Clinical pathological review"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Med Chil"
                        "fecha" => "1996"
                        "volumen" => "124"
                        "paginaInicial" => "1519"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous metastases in patients with metastatic carcinoma&#58; A retrospective study of 4020 patients"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "1993"
                        "volumen" => "29"
                        "paginaInicial" => "228"
                        "paginaFinal" => "236"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous metastases&#58; a metaanalysis of data"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.SMJ.0000053676.73249.E5"
                      "Revista" => array:6 [
                        "tituloSerie" => "South Med J"
                        "fecha" => "2003"
                        "volumen" => "96"
                        "paginaInicial" => "164"
                        "paginaFinal" => "167"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metastatic Patterns of Cancers&#58; Results From a Large Autopsy Study"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arch Pathol Lab Med"
                        "fecha" => "2008"
                        "volumen" => "6"
                        "paginaInicial" => "931 L 939"
                        "itemHostRev" => array:3 [ …3]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Non-hematopoietic cutaneous metastases in children and adolescents&#58; thirty years experience at St&#46; Jude Children&#39;s Research Hospital"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cutan Pathol"
                        "fecha" => "2000"
                        "volumen" => "27"
                        "paginaInicial" => "485"
                        "paginaFinal" => "492"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Met&#225;stasis cut&#225;nea por carcinoma pancre&#225;tico como primera manifestaci&#243;n cl&#237;nica"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2010"
                        "volumen" => "101"
                        "paginaInicial" => "93"
                        "paginaFinal" => "95"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Met&#225;stasis cut&#225;neas generalizadas como forma de presentaci&#243;n de un adenocarcinoma g&#225;strico"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2007"
                        "volumen" => "98"
                        "paginaInicial" => "213"
                        "paginaFinal" => "218"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A study of 70 cases of cutaneous metastases from internal carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metastatic cancer of the skin"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [ …4]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous manifestations of malignant disease"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [ …7]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous metastasis of a radiation associated thyroid medullary carcinoma"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/BF03349501"
                      "Revista" => array:5 [ …5]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous metastasis from follicular carcinoma of the thyroid gland"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1089/thy.1993.3.235"
                      "Revista" => array:5 [ …5]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous infiltration by cancer"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2007.01.034"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metastatic tumors to the nail unit&#58; subungueal metastases"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "N&#243;dulo umbilical"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous lesions of metastatic visceral malignancy mimicking pyogenic granuloma"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Carcinoma erysipelatoides from squamous cell carcinoma of unknown origin"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1368-5031.2005.00588.x"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Met&#225;stasis cut&#225;nea inflamatoria como primer signo de recidiva de carcinoma escamoso de pulm&#243;n"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous metastases from carcinoma breast&#58; the common and the rare"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/0378-6323.55395"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Narrative review&#58; diseases that masquerade as infection cellulitis"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [ …7]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous metastases&#8211;carcinoma en cuirasse"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inflammatory metastatic carcinoma&#46; Carcinoma erysipelatoides"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bilateral thoracic zosteroid spreading marginate telangiectasia &#8211; probably a variety of carcinoma erysipelatoides &#8211; associated with unilateral mammary carcinoma&#44; and better termed carcinoma telangiectaticum"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [ …5]
                    ]
                  ]
                ]
              ]
            ]
            54 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "55"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Telangiectatic metastatic breast carcinoma preceded by en cuirasse metastatic breast carcinoma"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2004.06140.x"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "56"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recognizing malignant skin changes following breast cancer"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [ …7]
                    ]
                  ]
                ]
              ]
            ]
            56 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "57"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bilateral thoracic zosteroid spreading marginate telangiectasia&#8211;probably a variant of carcinoma telangiectatum"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
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            57 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "58"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Zosteriform cutaneous metastases&#58; a literature meta-analysis and a clinical report of three melanoma cases"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2009.01241.x"
                      "Revista" => array:6 [ …6]
                    ]
                  ]
                ]
              ]
            ]
            58 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "59"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Met&#225;stasis cut&#225;neas de adenocarcinoma de recto con distribuci&#243;n herpetiforme"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [ …7]
                    ]
                  ]
                ]
              ]
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            59 => array:3 [
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              "etiqueta" => "60"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Zosteriform metastasis&#58; case presentation and review of the literature"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [ …6]
                    ]
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            60 => array:3 [
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous malignancies mimicking herpes zoster"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [ …6]
                    ]
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                ]
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            61 => array:3 [
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                0 => array:2 [
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                    0 => array:1 [
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                      "titulo" => "Dermal and subcutaneous tumors"
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                    0 => array:1 [
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                      "titulo" => "Metastatic breast carcinoma mimicking granular cell tumor"
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                    0 => array:1 [
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                      "titulo" => "Cutaneous metastasis from hepatocellular carcinoma resembling pyogenic granuloma"
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                    0 => array:1 [
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                    0 => array:1 [
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                      "titulo" => "Inflammatory carcinoma masquerading as erythema annulare centrifugum"
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                    0 => array:1 [
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                    0 => array:1 [
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                      "titulo" => "The significance of cutaneous metastasis from visceral tumors diagnosed by fine-needle aspiration biopsy"
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                    0 => array:1 [
                      "Revista" => array:6 [ …6]
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                    0 => array:1 [
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                    0 => array:1 [
                      "Revista" => array:5 [ …5]
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                    0 => array:1 [
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                    0 => array:2 [
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Review
Cutaneous Metastases of Internal Tumors
Metástasis cutáneas de origen visceral
M.C. Fernández-Antón Martíneza,
Autor para correspondencia
, V. Parra-Blancob, J.A. Avilés Izquierdoa, R.M. Suárez Fernándeza
a Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
b Servicio de Anatomía Patológica, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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parallel progression&#44; self-seeding of circulating tumor cells from the primary tumor&#44; and the induction of premetastatic niches in organs at a distance from the primary tumor are now at the forefront of research&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Skin metastases &#40;SMs&#41; are the result of infiltration of the skin by proliferations of cells from distant malignant tumors&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> The early detection of metastases within the body often requires sophisticated additional tests&#59; however&#44; SMs are usually easily observed on careful&#44; targeted physical examination&#46; Up to a third of SMs are diagnosed before or simultaneously with the primary tumor&#44; and the role of the dermatologist in establishing an adequate clinical suspicion<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> is essential&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The early clinical recognition of SMs is crucial&#44; as it can lead to the diagnosis of a previously unidentified primary malignant tumor&#44; provide evidence of the dissemination of a previously known tumor&#44; or be an early sign of recurrence of a malignant tumor apparently in remission&#46; The diagnosis of SMs can therefore alter the staging of a malignant disease&#44; with the consequent therapeutic and prognostic implications<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#59; their presence will often lead to drastic changes in the management plan&#44; particularly when the metastases indicate the persistence of a tumor thought to be in remission&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Furthermore&#44; SMs are easy to biopsy&#44; which facilitates tests of sensitivity of the primary tumor to specific treatments&#44; such as inhibitors of epidermal growth factor or of c-kit&#47;CD117&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Some tumors appear to have a predilection to metastasize to certain areas&#46; Recognition of these patterns can help to target the search for an unknown underlying tumor&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The recent presentation in various countries of a number of retrospective studies of SMs reflects current international interest in this subject&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Etiology and Pathogenesis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Metastases arise when neoplastic cells break away from a primary tumor and disseminate to other sites&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a> Several mechanisms involving various pathways are implicated in the development of metastases&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a> Hematogenous and lymphatic spread are the most common&#44; although separation of these 2 pathways can be difficult as they are interconnected&#46; Lymphatic spread is the most common initial route of propagation of the majority of malignant tumors and its role in the determination of metastatic patterns is a subject of current research&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Regional spread usually occurs through the body cavities&#44; in particular the peritoneal cavity&#46; Tumor-cell transplant due to the mechanical transport of fragments of tumor on surgical instruments during surgery or other invasive procedures can happen but is rare&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Traditionally it has been postulated that a series of steps must occur for a metastasis to develop&#46; First&#44; the primary tumor must be large enough to release a sufficient number of neoplastic cells into the circulatory or lymphatic systems&#46; The majority of free neoplastic cells are destroyed by the immune system&#44; whereas groups of 6 or 7 cells appear to have a greater likelihood of forming a metastasis&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> These cells&#44; in turn&#44; must have certain properties&#44; such as cellular suspension and an adequate mitotic index&#44; in order to survive&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Development of a clone with metastatic potential is initially favored by the activation of specific oncogenes<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#44;24</span></a> and the loss of tumor suppressor genes&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;26</span></a> For neoplastic cells in the circulatory system to become established&#44; they must pass through the vessel walls&#46; After the cells adhere to the vessel wall&#44; a thrombus forms around them due to a lesion of the endothelial cells&#46; This thrombus serves to protect the neoplastic cells&#46; The metastasis becomes established and initially obtains its nutrients by means of diffusion phenomena<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#59; later it will form its own vessels &#40;angiogenesis&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;29</span></a> In this classical model of cancer development&#44; the metastases correspond to the final stage of the metastatic cascade&#46; However&#44; recent studies suggest a different model&#44; which predicts that the expression of proteins that regulate epithelial-mesenchymal transition promote oncogenesis concomitantly with metastatic spread&#46; In this alternative model&#44; cell spread from the primary tumor can occur at any time during development of the cancer<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Epidemiology</span><p id="par0035" class="elsevierStylePara elsevierViewall">The true incidence of SMs is unknown&#46; However&#44; the incidence appears to be higher in some recent studies compared with historical series&#44; although this may due to higher rates of biopsy and diagnosis rather than a true increase in the incidence&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> SMs are a rare finding in clinical practice&#44; and their prevalence varies between 0&#46;7&#37; and 9&#37; of patients with internal tumors&#44; depending on the series&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In theory&#44; any malignant tumor can spread to the skin&#46; However&#44; in practice&#44; a direct relationship has been found between the frequency of different malignant tumors and the appearance of SMs&#44; with the most common malignant tumors in each sex being those that most frequently give rise to SMs&#46; Thus&#44; breast cancer in women&#44; lung cancer in men&#44; and adenocarcinomas of the digestive tract in both sexes are the most common origins of SMs&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">A meta-analysis published in 2003 reviewed 1080 cases of SM in 20&#160;380 cancer patients&#44; and reported an estimated SM rate of 5&#46;3&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> In a classic study from 1972&#44; Brownstein and Helwig<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> examined the distribution of SMs in 724 male and female patients&#46; In men&#44; the most common malignant tumors that metastasized to the skin were carcinoma of the lung &#40;24&#37;&#41;&#44; colorectal carcinoma &#40;19&#37;&#41;&#44; melanoma &#40;13&#37;&#41;&#44; and oral squamous cell carcinoma &#40;12&#37;&#41;&#44; whereas&#44; in women&#44; the most common tumors were breast cancer &#40;69&#37;&#41;&#44; colorectal carcinoma &#40;9&#37;&#41;&#44; melanoma &#40;5&#37;&#41;&#44; and carcinoma of the ovary &#40;4&#37;&#41;&#46; The area most commonly affected was the anterior chest wall&#59; the lower limbs were the least common sites&#46; In men&#44; around 75&#37; of SMs were observed on the head and neck&#44; whereas&#44; in women&#44; 75&#37; of cases were found on the anterior chest wall and on the abdomen&#46; In general&#44; the back was an uncommon site for SMs&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In women the most common site of SMs is the thorax&#44; followed by the abdomen&#44; the back&#44; the upper limbs&#44; the scalp&#44; and the neck&#59; in men&#44; the thorax is also the area most commonly affected&#44; followed&#44; in descending order of frequency&#44; by the abdomen&#44; the back&#44; the scalp&#44; the neck&#44; the face&#44; the upper and lower limbs&#44; and the pelvis&#46; The frequency of SMs by age and sex is summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; SMs are very rare in children&#46; The most common primary tumors that produce SMs in this age group are rhabdomyosarcoma and neuroblastoma&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Clinical Presentation</span><p id="par0055" class="elsevierStylePara elsevierViewall">In the majority of cases&#44; SMs develop after diagnosis of the primary tumor&#46; However&#44; in a notable proportion of patients &#40;up to a third of cases&#41;&#44; the metastases are discovered prior to<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> or simultaneously with<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> the primary tumor&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">SMs tend to appear in a body region close to the primary tumor&#46; Presentation is typically in the form of rapidly growing&#44; mobile&#44; round or oval nodules of firm or elastic consistency<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a>&#59; they may be ulcerated&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> However&#44; they can present as any primary or secondary skin lesion<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The nodules are usually skin-colored&#44; although metastatic nodules from renal cell or thyroid carcinoma often have a characteristic reddish or violaceous discoloration<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">42&#44;43</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Some recent studies report that skin metastases present most often as a single nodular lesion&#44; whereas older studies more commonly reported multiple nodules&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> This may be because more SMs are now diagnosed earlier&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Although most SMs are asymptomatic&#44; patients may describe pain&#44; particularly with lesions in certain areas&#44; such as subungual metastases&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Gastrointestinal cancers &#40;specifically&#44; colorectal and gastric carcinomas&#41; often give rise to metastases on the abdomen and pelvis&#46; These carcinomas can spread along the urachus to produce umbilical nodules known as Sister Mary Joseph&#39;s nodules&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a> SMs from squamous cell carcinoma of the oral cavity usually arise in the same body region&#44; and most frequently affect the face and neck&#46; Renal cell carcinoma&#44; among others&#44; typically metastasizes to the scalp and&#44; because it is a highly vascular tumour&#44; the lesions may be confused with hemangiomas or pyogenic granulomas&#46; SMs from hepatocellular carcinoma often develop on the fingers&#44; palms&#44; soles&#44; or the back&#44; while those from gastric carcinoma tend to develop on the head and neck&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a> Thus&#44; the site of an SM can suggest a possible origin &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Specific Clinical Forms of SMs</span><p id="par0075" class="elsevierStylePara elsevierViewall">A very large number of specific clinical forms of SMs have been described&#46; Erysipeloid or inflammatory carcinoma is often observed in patients with adenocarcinoma of the breast and is not uncommon in other types of cancer &#40;pancreas&#44; rectum&#44; lung&#44; ovary&#44; and parotid&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">48&#44;49</span></a> It presents as well-defined erythematous lesions that are hot and tender&#44; similar to erysipelas&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> Lymphatic obstruction by the neoplastic cells can give rise to localized lymphedema with peau d&#8217;orange&#46; Lymphedema can cause the skin to become fibrous and yellowish&#44; with a similar appearance to carcinoma en cuirasse<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> or scirrhous carcinoma&#46; This clinical form presents as indurated erythematous plaques that infiltrate the chest wall&#46; It is usually observed in metastases from breast cancer&#44; although it can be a form of presentation of a primary breast tumor or of SMs of other origins&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a> The main differential diagnosis of this presentation is with infectious disorders&#46; Erysipeloid carcinoma localized to the breast can be difficult to distinguish from mastitis&#46; Persistent inflammation that does not respond to conventional therapy must therefore be carefully evaluated to exclude metastatic infiltration&#44; particularly when there is no fever or leukocytosis&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Telangiectatic carcinoma&#44; described by Weber<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">54</span></a> in 1933 in a patient with metastatic breast cancer&#44; is characterized by the appearance of nodules&#44; papules&#44; or purpuric plaques on the chest wall&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">55</span></a> usually in the proximity of a surgical scar&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">56&#44;57</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Zosteriform or herpetiform metastases present as papules&#44; vesicles&#44; nodules&#44; or blisters affecting individual dermatomes&#44;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">58&#44;59</span></a> mimicking herpes zoster<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">60&#44;61</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; Although their etiology and pathogenesis are not fully understood&#44; most hypotheses suggest there is spread of the tumor cells from the cutaneous lymph vessels to the sensory nerves&#44; via which they reach the dorsal root ganglia&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">62&#44;63</span></a></p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Clown nose is considered to be the result of an SM arising on the tip of the nose&#44; typically from a carcinoma of the lung or breast&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">64</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Alopecia neoplastica is defined as hair loss secondary to invasion of the scalp by malignant cells&#46; It can present as 1 or more plaques of scarring alopecia that are often indurated and have a bluish or violaceous color&#46; These plaques must be differentiated from alopecia areata<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">65</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; The neoplastic cells can destroy the hair follicles by producing fibroplasia induced by the release of inflammatory mediators that bring inflammatory cells into the area&#44; and&#47;or by substitution of the normal cells&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">66</span></a> Breast cancer is the underlying primary malignant tumor in 84&#37; of patients with alopecia neoplastica&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">67</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Paget&#39;s disease of the nipple and areola is a skin sign associated with an underlying adenocarcinoma of the breast in 100&#37; of cases&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">68</span></a> This skin condition is produced by epidermotropic SMs due to the spread of an intraductal tumor along the lactiferous ducts to reach the overlying skin&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Subungual metastases merit special consideration&#46; These metastatic lesions are usually painful and often need to be differentiated from infectious disorders&#44; in particular acute paronychia&#44; or from glomus tumors<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">69</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; Presentation as painless dactylitis has been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">70</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Sister Mary Joseph&#39;s nodule or umbilical metastasis is widely described in the literature&#46; This form of metastasis presents as single or multiple&#44; indurated umbilical or periumbilical nodules that can sometimes ulcerate or have a friable appearance &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; Although the site of the primary tumor is unknown in approximately 29&#37; of cases&#44;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">71</span></a> the majority of umbilical metastases come from tumors that arise in the stomach&#44; ovary&#44; colon&#44; rectum&#44; or pancreas&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">72</span></a> The proposed pathogenesis of metastases in the umbilical region includes both contiguous infiltration and spread via the blood or lymph&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">73</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Finally&#44; clinically occult metastases are those with no detectable clinical findings but which are discovered as incidental findings on a histopathological examination performed for some other reason&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">74</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Differential Diagnosis</span><p id="par0120" class="elsevierStylePara elsevierViewall">The differential diagnosis of SMs is very broad and includes many more disorders in addition to those mentioned above&#46; First we must consider primary skin tumors&#44;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">75</span></a> both benign &#40;dermatofibroma&#44; pyogenic granuloma&#44;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">76</span></a> epidermal cyst&#44;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">77</span></a> adnexal tumors<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">78</span></a>&#41; and malignant &#40;basal or squamous cell carcinoma&#44; melanoma&#44; Merkel cell tumor&#44; angiosarcoma<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">79</span></a>&#41;&#46; Other skin diseases to be considered are eczema&#44; erythema annulare centrifugum&#44;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">80</span></a> erythema multiforme &#91;target-shaped SMs&#93;&#44; and vasculitis&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">81</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Diagnosis</span><p id="par0125" class="elsevierStylePara elsevierViewall">A detailed medical history and complete physical examination are essential to establish the initial diagnostic suspicion&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The histopathology of SMs may reveal the same characteristics as the tumor of origin&#44; or there may be a more anaplastic appearance&#46; Immunohistochemistry can help to determine the possible origin in the case of undifferentiated tumors&#46; Incisional or excisional skin biopsy is essential to reach a diagnosis&#46; Cytology study by fine-needle aspiration biopsy can be useful in certain circumstances&#46;<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">82&#44;83</span></a> The pattern observed and the microscopic appearance of the tissue often suggest its origin&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">84</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">In some cases&#44; such as renal cell carcinoma&#44; characteristic histological findings will identify the primary tumor&#44; but the majority of SMs can only be classified in general terms as adenocarcinoma&#44; squamous cell carcinoma&#44; or undifferentiated carcinoma&#46; It is also necessary to differentiate between metastatic skin lesions and primary skin tumors&#59; as these 2 types of lesion frequently have very similar morphological patterns&#44; immunohistochemical markers can be very useful for their differentiation&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> summarizes the results of the literature review published by Sarya et al&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">85</span></a> in 2007&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">Certain histological features differentiate metastases from primary tumors&#46; Characteristics suggestive of SMs include the presence of neoplastic cells within the lymph and blood vessels&#44; localization of the lesion in the deep reticular dermis and hypodermis&#44; and the presence of neoplastic cells running along the bundles of collagen&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">86</span></a> Metastatic tumors typically develop as round nodules located in the dermis or hypodermis&#44; and are not usually in contact with the epidermis&#46; This Grenz zone is much more common in metastatic lesions&#46; Fibrosis and inflammation may be evident &#40;<a class="elsevierStyleCrossRefs" href="#fig0025">Figs&#46; 5 and 6</a>&#41;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">Immunohistochemical markers and&#44; sometimes&#44; ultrastructural studies are valuable tools for establishing the origin of SMs&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">87</span></a><a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 7</a> shows the diagnostic algorithm that should be applied for undifferentiated SMs&#46; The basic recommended battery of markers includes CD45 &#40;for lymphoid tumors&#41;&#44; pancytokeratin AE1&#47;AE3 &#40;for the majority of carcinomas&#41;&#44; S100 &#40;for melanoma&#41; and CD34 &#40;for vascular tumors and leukemia&#41;&#46; The second recommended battery of markers includes lymphoid markers &#40;CD3 and CD20&#41;&#44; epithelial markers such as epithelial membrane antigen and carcinoembryonic antigen&#44; chromogranin &#40;neuroendocrine tumors&#41;&#44; prostate specific antigen and acid phosphatase &#40;carcinoma of the prostate&#41;&#44; thyroid transcription factor &#40;carcinoma of the lung&#41;&#44; Wilms&#8217; tumor protein &#40;carcinoma of the ovary&#41;&#44; CDX2<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">88</span></a> &#40;intestinal carcinomas&#41;&#44; and Hep Par1<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">89</span></a> &#40;hepatocellular carcinoma&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">90</span></a> The immunophenotypes of the main tumors that metastasize to the skin are summarized in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46;</p><elsevierMultimedia ident="fig0035"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">Ultrastructural studies can be useful in the identification of certain undifferentiated tumors&#46; Desmosomes may be observed in carcinomas&#44; cytoplasmic vacuoles in adenocarcinomas&#44; melanosomes in melanomas&#44; and neurosecretory granules in neuroendocrine tumors&#46; However&#44; ultrastructural studies are long and costly techniques that are not available in the majority of centers and require highly specialized staff&#59; immunohistochemical studies therefore tend to be more useful in clinical practice&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Positron emission tomography &#40;PET&#41; gives a large number of false positives&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">91</span></a> PET-computed tomography is more useful&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">92</span></a> However&#44; PET may understage tumors in some cases&#44; and small metastases or cerebral lesions may be missed&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">93</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Prognosis</span><p id="par0160" class="elsevierStylePara elsevierViewall">The presence of metastatic disease in the skin usually implies widespread systemic disease with a high mortality&#44; although the prognosis varies considerably depending on the type of primary tumor&#46;<a class="elsevierStyleCrossRefs" href="#bib0470"><span class="elsevierStyleSup">94&#44;95</span></a> SMs in the absence of other distant metastases only occur in 6&#46;4&#37; to 7&#46;8&#37; of cases&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">96</span></a> However&#44; it would appear that recent advances in chemotherapy have considerably increased survival&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">97</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">It is estimated that mean survival after the diagnosis of SMs is 50&#37; at 6 months&#46; A number of survival analyses of patients with SMs have been published&#44; those of Benmously et al&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">98</span></a> and Schoenlaub et al&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">97</span></a> being particularly relevant All the analyses report a better survival in cases of breast cancer than in other types of cancer&#46;<a class="elsevierStyleCrossRefs" href="#bib0495"><span class="elsevierStyleSup">99&#44;100</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">The mean interval between the diagnosis of a primary tumor and the appearance of SMs varies between 2 and 3 years&#44; but periods of up to 22 years have been reported&#46; Recent studies indicate that this interval varies depending on the type of primary tumor&#46;<a class="elsevierStyleCrossRefs" href="#bib0505"><span class="elsevierStyleSup">101&#44;102</span></a> In 141 patients analyzed by Hu et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">103</span></a> the mean interval between the excision or treatment of the primary tumor and the appearance of SMs was longer in patients with breast cancer &#40;47&#46;2 months&#41; than in those with other tumors&#44; such as lung cancer &#40;15&#46;7 months&#41;&#44; colorectal cancer &#40;16&#46;5 months&#41;&#44; or stomach cancer &#40;19&#46;8 months&#41;&#46; According to some studies&#44; lung cancer is the tumor that most rapidly metastasizes to the skin&#46;<a class="elsevierStyleCrossRefs" href="#bib0520"><span class="elsevierStyleSup">104&#44;105</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Treatment</span><p id="par0175" class="elsevierStylePara elsevierViewall">The therapeutic approach to SMs is based on appropriate management of the primary tumor&#44; if it has been identified&#46;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">106</span></a> As the presence of SMs implies the coexistence of other metastatic lesions in most cases&#44; chemotherapy directed against the tumor of origin is usually the only option that might achieve complete remission&#46;<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">107</span></a> Surgery and radiation therapy are often used to treat SMs due to the ease of access to the majority of these lesions&#59; however&#44; no clear increase in survival has been demonstrated&#44; and the aim of such treatments is often only palliative&#46;<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">108</span></a> It has been suggested that surgery might improve survival in cases of SM from lung cancer<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">109</span></a> or gastric cancer&#46;<a class="elsevierStyleCrossRefs" href="#bib0550"><span class="elsevierStyleSup">110&#44;111</span></a> Radiation therapy has achieved complete responses and lasting palliation in some cases of metastases from renal cell carcinoma&#46;<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">112</span></a> In 1 study&#44; pulsed brachytherapy achieved local control in 41 &#40;89&#37;&#41; of 46 cases of SMs from breast cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">113</span></a> The topical application of 6&#37; miltefosine solution to SMs from carcinoma of the breast achieved good control of the SM in comparison with placebo in a randomized study&#46;<a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">114</span></a> In another study&#44; 10 patients with SM from breast or colon cancer were treated with intratumoral injections of recombinant single-chain antibodies targeted to ErbB2&#47;HER2&#44; with complete remission in 4 cases&#46;<a class="elsevierStyleCrossRef" href="#bib0575"><span class="elsevierStyleSup">115</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">The results after intralesional immunotherapy with interferon alfa or interleukin 2<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">116</span></a> have been variable&#46;<a class="elsevierStyleCrossRefs" href="#bib0585"><span class="elsevierStyleSup">117&#44;118</span></a> Reports of metastatic melanoma treated with imiquimod have also been published&#46;<a class="elsevierStyleCrossRef" href="#bib0595"><span class="elsevierStyleSup">119</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Other locally ablative procedures&#44; such as electrochemotherapy&#44;<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">120</span></a> electrocoagulation&#44; electroporation&#44; and electrovaporization&#44;<a class="elsevierStyleCrossRef" href="#bib0605"><span class="elsevierStyleSup">121</span></a> have also been used successfully&#46; In particular&#44; electrochemotherapy with bleomycin is an option in multiple skin and subcutaneous metastases&#46; One study of electrochemotherapy with bleomycin included 174 tumor nodules in 52 patients with breast cancer<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">122</span></a>&#59; complete responses were observed in 80&#37; and partial remission in 20&#37; after repeated application&#46; Electrochemotherapy with cisplatin has also been evaluated in the treatment of SMs from breast cancer&#44; but was less successful&#46;<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">123</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">No specific chemotherapy has been shown to be the most effective for the systemic treatment of SMs&#46; Observations of SMs that have regressed after systemic chemotherapy are limited to case reports&#44; such as a patient with SMs from cancer of the pancreas treated with gemcitabine&#44;<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">124</span></a> and a patient with urothelial carcinoma of the bladder treated with cyclophosphamide&#44; methotrexate&#44; and 5-fluorouracil&#46;<a class="elsevierStyleCrossRef" href="#bib0625"><span class="elsevierStyleSup">125</span></a> Case reports of SMs from carcinomas of unknown origin treated with cisplatin&#44; gemcitabine&#44; vinorelbine&#44; and paclitaxel have also been published&#46;<a class="elsevierStyleCrossRefs" href="#bib0630"><span class="elsevierStyleSup">126&#44;127</span></a> Determination of the expression of certain molecules such as EGF&#44; Her-2&#47;neu kinase&#44; and c-kit tyrosine kinase is very important as it will provide possible targets for systemic therapy&#46; In addition&#44; drugs targeted against stromal function and angiogenesis could prove useful&#46;<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">128</span></a>The palliative treatment of SMs includes adequate management of the pain&#44; pruritus&#44; possible bacterial superinfection&#44; and&#44; in some cases&#44; of the unpleasant smell that these lesions can produce&#46;<a class="elsevierStyleCrossRefs" href="#bib0645"><span class="elsevierStyleSup">129&#8211;132</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conclusions</span><p id="par0195" class="elsevierStylePara elsevierViewall">The majority of tumor recurrences are diagnosed on the basis of a detailed medical history and complete physical examination&#44; combined with the relevant imaging studies&#46; As SMs are usually asymptomatic&#44; active screening is essential&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">SMs can play a crucial role in alerting the physician to a possible tumor recurrence or may even be the first sign of previously unknown tumor&#46; The site and distribution of the skin lesions can suggest the organ of origin&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Histological and immunohistochemical study of SMs is required in order to identify the primary tumor&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Early detection of SMs is essential in order to start appropriate treatment&#46; Although strong scientific evidence of a survival benefit is lacking&#44; case reports and certain preliminary publications would suggest that early diagnosis improves life expectancy&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflicts of Interest</span><p id="par0215" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "identificador" => "xres295324"
          "titulo" => "Abstract"
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        1 => array:2 [
          "identificador" => "xpalclavsec279245"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xres295325"
          "titulo" => "Resumen"
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          "titulo" => "Palabras clave"
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        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Etiology and Pathogenesis"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Epidemiology"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Clinical Presentation"
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        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Specific Clinical Forms of SMs"
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        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Differential Diagnosis"
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        10 => array:2 [
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          "titulo" => "Diagnosis"
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          "identificador" => "sec0040"
          "titulo" => "Prognosis"
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          "titulo" => "Treatment"
        ]
        13 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Conclusions"
        ]
        14 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conflicts of Interest"
        ]
        15 => array:2 [
          "identificador" => "xack69009"
          "titulo" => "Acknowledgments"
        ]
        16 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2011-12-06"
    "fechaAceptado" => "2012-06-02"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec279245"
          "palabras" => array:6 [
            0 => "Cutaneous metastases"
            1 => "Metastatic cascade"
            2 => "Nodule"
            3 => "Dissemination"
            4 => "Metastatic pattern"
            5 => "Immunohistochemistry"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec279246"
          "palabras" => array:6 [
            0 => "Met&#225;stasis cut&#225;neas"
            1 => "Cascada metast&#225;sica"
            2 => "N&#243;dulo"
            3 => "Diseminaci&#243;n"
            4 => "Patrones metast&#225;sicos"
            5 => "Inmunohistoqu&#237;mica"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cutaneous metastases are relatively rare in clinical practice and their diagnosis requires a high index of suspicion because clinical findings can be subtle&#46; These metastases reveal the presence of disseminated malignant disease and can lead to the diagnosis of unsuspected internal tumors or the spread or recurrence of an already diagnosed tumor&#46; Early recognition of cutaneous metastases can facilitate prompt and accurate diagnosis resulting in early treatment&#59; however&#44; they are generally indicative of a poor prognosis&#46; Some tumors have a predilection to metastasize to specific areas&#46; Recognition of these patterns provides essential information that can guide the search for the underlying tumor&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Las met&#225;stasis cut&#225;neas son relativamente raras en la pr&#225;ctica cl&#237;nica&#46; Su diagn&#243;stico requiere un alto &#237;ndice de sospecha&#44; pues los hallazgos cl&#237;nicos pueden ser sutiles&#46; Las met&#225;stasis cut&#225;neas ponen de manifiesto la presencia de un tumor maligno diseminado y pueden permitir el diagn&#243;stico de neoplasias internas no conocida o indicar la diseminaci&#243;n o recurrencia de otras ya diagnosticadas&#46; Su reconocimiento temprano puede llevar a un diagn&#243;stico preciso y r&#225;pido&#44; con el consiguiente tratamiento oportuno&#44; aunque en la mayor&#237;a de los casos son indicativas de un pron&#243;stico infausto&#46; Algunos tumores tienen predilecci&#243;n por metastatizar en &#225;reas espec&#237;ficas&#46; El reconocimiento de esos patrones es esencial para dirigir la b&#250;squeda del tumor subyacente&#46;</p>"
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Fern&#225;ndez-Ant&#243;n Mart&#237;nez MC&#44; Parra-Blanco V&#44; Avil&#233;s Izquierdo JA&#44; Su&#225;rez Fern&#225;ndez RM&#46; Met&#225;stasis cut&#225;neas de origen visceral&#46; Actas Dermosifiliogr&#46; 2013&#59;104&#58;841&#8211;853&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">This review is part of the introduction to the doctoral thesis entitled Met&#225;stasis cut&#225;neas&#58; estudio descriptivo cl&#237;nico-histopatol&#243;gico de las met&#225;stasis cut&#225;neas de neoplasias viscerales&#46;</p>"
      ]
    ]
    "multimedia" => array:11 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
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        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Pathogenesis of skin metastases&#46; Diagram that compares the classical model of metastasis production with the most recent hypotheses&#46; Source&#58; S&#225;nchez-Garc&#237;a I&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Skin metastases can manifest as primary or secondary skin lesions&#46; A&#44; Metastasis from a gastric adenocarcinoma&#46; Papule of 7<span class="elsevierStyleHsp" style=""></span>mm diameter on the abdomen&#46; B&#44; Metastasis from an adenocarcinoma of the ovary presenting as a plaque&#46; C&#44; Metastasis from a urothelial carcinoma of the bladder presenting as a nodule&#46; D&#44; Metastasis from an adenocarcinoma of the breast&#46; The lesion started as a macule over the mastectomy scar&#46; E&#44; Ulcerated infiltrated plaque corresponding to a metastasis from an adenocarcinoma of the lung&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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            "Ancho" => 1000
            "Tamanyo" => 324168
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Metastases from a follicular thyroid carcinoma&#46; Violaceous nodules on the scalp with superficial telangiectasias&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Unusual skin metastases&#46; A&#44; Zosteriform metastases from a ductal adenocarcinoma of the breast&#46; Clusters of infiltrated papules&#44; some confluent and some ulcerated&#44; in a metameric distribution&#46; B&#44; Umbilical metastasis &#40;Sister Mary Joseph&#39;s nodule&#41;&#59; multiple&#44; confluent&#44; ulcerated papules and nodules in the umbilical and periumbilical regions&#46; C&#44; Alopecia neoplastica&#46; Plaque of alopecia over a metastasis from a ductal adenocarcinoma of the breast in a woman&#46; D&#46; Subungual metastasis&#46; Metastasis from a squamous cell carcinoma of the lung presenting as a painful inflammatory nodule that deformed the distal phalanx of the second finger of the left hand&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
        "tipo" => "MULTIMEDIAFIGURA"
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        "figura" => array:1 [
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            "Ancho" => 1500
            "Tamanyo" => 375619
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Histological images of skin metastases&#46; A&#44; Dermal metastasis from a poorly differentiated carcinoma of unknown origin&#46; Infiltration of the dermis by cords and nests of epithelioid cells &#40;hematoxylin-eosin&#44; original magnification x10&#41;&#46; B&#44; Dermal metastasis from a moderately differentiated adenocarcinoma of the pancreas&#46; Glandular lumens lined by a layer of epithelial cells can be seen between the dermal collagen bundles &#40;hematoxylin-eosin&#44; original magnification x10&#41;&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "fig0030"
        "etiqueta" => "Figure 6"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr6.jpeg"
            "Alto" => 1014
            "Ancho" => 1500
            "Tamanyo" => 464332
          ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A&#44; Dermal metastasis from a carcinoma of the ovary&#46; Dilated dermal blood vessels occupied by atypical epithelial cells &#40;hematoxylin-eosin&#44; original magnification x20&#41;&#46; B&#44; Extensive dermal and vascular infiltration &#40;lymphangitis carcinomatosa&#41; by a poorly differentiated carcinoma&#46;</p>"
        ]
      ]
      6 => array:7 [
        "identificador" => "fig0035"
        "etiqueta" => "Figure 7"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr7.jpeg"
            "Alto" => 2503
            "Ancho" => 3253
            "Tamanyo" => 434786
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Diagnostic algorithm for undifferentiated skin metastases using immunohistochemical markers&#46;</p>"
        ]
      ]
      7 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Men&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Women&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;&#160;40 y&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">MelanomaColon cancerLung cancer&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">Breast cancerCarcinoma of the colonOvarian cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;&#160;40 y&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">Lung cancerColon cancerSquamous cell carcinoma of the oral cavityMelanoma&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">Carcinoma of the breastCarcinoma of the colonLung cancerCarcinoma of the ovaryMelanoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab430527.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Frequency of Skin Metastases According to Age and Sex &#40;in Decreasing Frequency&#41;&#46;</p>"
        ]
      ]
      8 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Site of the Skin Metastases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Most Common Primary Tumors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Scalp&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">Breast&#44; lung&#44; and kidney&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neck&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">Oral squamous cell carcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Face&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">Oral squamous cell carcinoma&#44; renal cell&#44; and lung&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chest&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">Breast and lung&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abdomen&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">Colon&#44; lung&#44; stomach&#44; breast&#44; and ovary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Umbilicus&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">Stomach&#44; pancreas&#44; colon&#44; kidney&#44; ovary&#44; and breast&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pelvis&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">Colon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lower abdomen&#44; groin&#44; or thigh&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">Ovary and uterus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Limbs&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">Breast&#44; lung&#44; kidney&#44; and bowel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Back&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">Lung&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Most Common Primary Tumors Giving Rise to Skin Metastases According to the Site of the Metastases&#46;</p>"
        ]
      ]
      9 => array:7 [
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        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Source&#58; Sarya et al&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">85</span></a> Abbreviations&#58; BCC&#44; basal cell carcinoma&#59; SCC&#44; squamous cell carcinoma&#46;</p>"
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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"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Antibodies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">General Characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Metastatic Carcinomas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Adnexal Tumors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Usefulness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p63&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">Homolog of p53&#44; expressed in the basal cells of the skin and mucosas and in the myoepithelial cells of the breast&#44; salivary glands&#44; and prostatePositive in SCC at various sites&#44; urothelial carcinoma&#44; BCC&#44; adnexal tumors&#44; 30&#37; of lung cancers&#44; and some pancreatic&#44; biliary&#44; gastric&#44; ovarian&#44; breast&#44; hepatic&#44; renal&#44; colon&#44; and thymus cancers&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">Negative in the published literatureNegative in 25&#47;32&#44; positive in 2&#47;2 from urothelial tumors&#44; 2&#47;8 from lung tumors&#44; 1&#47;2 from gastric tumors&#44; and 2&#47;6 from carcinomas of the breast&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">Positive in all cases published in the literaturePositive in 24&#47;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">Most useful markerHowever&#44; it should not be used alone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B72&#46;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">Tumor-associated glycoprotein&#46; Expressed in many adenocarcinomas&#46; Useful to differentiate lung cancer from mesothelioma and in adnexal tumors of apocrine origin&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">Positive 26&#47;31&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">Negative in 18&#47;25&#44; focally positive in 6&#47;25&#44; and diffusely positive in 1 mucinous carcinoma&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">Positivity useful in metastatic carcinomas that are positive for p63 and CK5&#47;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Calretinin&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">Calcium-binding protein expressed in mesothelial&#44; epithelial&#44; and stromal cells&#46; Used to differentiate adenocarcinoma from mesothelioma and in sex-cord stromal tumors of the testis and ovary&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">Negative in 23&#47;32&#44; positive in 9 &#40;pancreas&#44; lung&#44; breast sporadically&#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">Positive in 16&#47;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">Negativity useful in metastatic carcinomas that are positive for p63 and CK5&#47;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CK5&#47;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">Intermediate-sized cytokeratin expressed in the skin&#44; squamous mucosa&#44; myoepithelial cells of breast&#44; salivary glands&#44; and prostatePositive in SCC&#44; BCC&#44; thymoma&#44; salivary gland tumors&#44; biphasic mesothelioma&#44; and some urothelial&#44; pancreatic&#44; endometrial&#44; breast&#44; and ovarian tumors&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">Negative in the published literatureNegative in 14&#47;32&#44; positive in 18&#47;32&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">Positive in the published literaturePositive in 25&#47;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">Consistent expression in skin tumors&#46; Useful in the panel of markers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab430530.png"
              ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Summary of the Immunohistochemical Markers Useful for the Differentiation Between Skin Metastases and Primary Skin Tumors&#44; and Synopsis of the Data Obtained in the Series by Sarya et al&#46;</p>"
        ]
      ]
      10 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Primary Tumor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Immunohistochemical Markers<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Breast&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">CK7 &#40;&#43;&#41;&#44; CAM 5&#46;2 &#40;&#43;&#41;&#44; vimentin &#40;&#8722;&#41;&#44; TTF-1 &#40;&#8722;&#41;&#44; Ber-EP4 &#40;&#43;&#41;&#44; WT-1 &#40;&#8722;&#41;&#44; DPC4 &#40;&#8722;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adenocarcinoma of the lung&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">CK7 &#40;&#43;&#41;&#44; CAM 5&#46;2 &#40;&#43;&#41;&#44; CEA &#40;&#43;&#41;&#44; Ber-EP4 &#40;&#43;&#41;&#44; WT-1 &#40;&#8722;&#41;&#44; DPC4 &#40;&#8722;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Colon and rectum&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">CK20 &#40;&#43;&#41;&#44; CAM 5&#46;2 &#40;&#43;&#41;&#44; CK17 &#40;&#8722;&#41;&#44; CK19 &#40;&#43;&#41;&#44; CEA &#40;&#43;&#41;&#44; TTF-1 &#40;&#8722;&#41;&#44; Ber-EP4 &#40;&#43;&#41;&#44; S100 &#40;&#8722;&#41;&#44; WT-1 &#40;&#8722;&#41;&#44; DPC4 &#40;&#8722;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Stomach&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">CAM 5&#46;2 &#40;&#43;&#41;&#44; vimentin &#40;&#8722;&#41;&#44; TTF-1 &#40;&#8722;&#41;&#44; ER &#40;&#8722;&#41;&#44; Ber-EP4 &#40;&#43;&#41;&#44; WT-1 &#40;&#8722;&#41;&#44; DPC4 &#40;&#8722;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prostate&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">CK7 &#40;&#8722;&#41;&#44; CK20 &#40;&#8722;&#41;&#44; CAM 5&#46;2 &#40;&#43;&#41;&#44; CD5&#47;6 &#40;&#8722;&#41;&#44; CK17 &#40;&#8722;&#41;&#44; CEA &#40;&#8722;&#41;&#44; vimentin &#40;&#8722;&#41;&#44; TTF-1 &#40;&#8722;&#41;&#44; ER &#40;&#8722;&#41;&#44; Ber-EP4 &#40;&#43;&#41;&#44; S100 &#40;&#8722;&#41;&#44; WT-1 &#40;&#8722;&#41;&#44; DPC4 &#40;&#8722;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pancreas&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">CK7 &#40;&#43;&#41;&#44; CAM 5&#46;2 &#40;&#43;&#41;&#44; vimentin &#40;&#8722;&#41;&#44; TTF-1 &#40;&#40;&#41;&#44; ER &#40;&#8722;&#41;&#44; Ber-EP4 &#40;&#43;&#41;&#44; S100 &#40;&#8722;&#41;&#44; WT-1 &#40;&#8722;&#41;&#44; DPC 4 &#40;&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kidney&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">CK7 &#40;&#8722;&#41;&#44; CK20 &#40;&#8722;&#41;&#44; CAM 5&#46;2 &#40;&#43;&#41;&#44; CEA &#40;&#8722;&#41;&#44; TTF-1 &#40;&#8722;&#41;&#44; Ca-125 &#40;&#8722;&#41;&#44; ER &#40;&#8722;&#41;&#44; CD10 &#40;&#43;&#41;&#44; WT-1 &#40;&#8722;&#41;&#44; DPC4 &#40;&#8722;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neuroendocrine&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">CK20 &#40;&#8722;&#41;&#44; CK5&#47;6 &#40;&#8722;&#41;&#44; Ca-125 &#40;&#8722;&#41;&#44; ER &#40;&#8722;&#41;&#44; Ber-EP4 &#40;&#8722;&#41;&#44; WT-1 &#40;&#8722;&#41;&#44; DPC4 &#40;&#8722;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Squamous cell carcinoma&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">CK7 &#40;&#8722;&#41;&#44; CK20 &#40;&#8722;&#41;&#44; CK5&#47;6 &#40;&#43;&#41;&#44; CK17 &#40;&#43;&#41;&#44; TTF-1 &#40;&#8722;&#41;&#44; CA19&#46;9 &#40;&#8722;&#41;&#44; Ca-125 &#40;&#8722;&#41;&#44; ER &#40;&#8722;&#41;&#44; Ber-EP4 &#40;&#8722;&#41;&#44; CD10 &#40;&#8722;&#41;&#44; S100 &#40;&#8722;&#41;&#44; WT-1 &#40;&#8722;&#41;&#44; DPC4 &#40;&#8722;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab430529.png"
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          ]
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              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">&#40;&#43;&#41; indicates &#8220;always positive&#8221; and &#40;&#8722;&#41; &#8220;negative&#44; with rare exceptions&#8221;&#46; Abbreviations&#58; Ber-EP4&#44; human epithelial antigen&#59; CA&#44; carcinoid antigen&#59; CEA&#44; carcinoembryonic antigen&#59; CK&#44; cytokeratin&#59; ER&#44; estrogen receptors&#59; TTF&#44; thyroid transcription factor&#59; WT-1&#58; Wilms&#8217; tumor protein&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Immunophenotypes of the Metastases of the Principal Carcinomas&#46;</p>"
        ]
      ]
    ]
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metastatic tumors"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:4 [
                        "titulo" => "Clinical Dermatology"
                        "paginaInicial" => "1"
                        "paginaFinal" => "7"
                        "serieFecha" => "1997"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Do all roads lead to Rome&#63; Routes to metastasis development&#63;"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ijc.26027"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cancer"
                        "fecha" => "2011"
                        "volumen" => "128"
                        "paginaInicial" => "2511"
                        "paginaFinal" => "2526"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tumor cells caught in the act of invading&#58; their strategy for enhanced cell motility"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.tcb.2005.01.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Trends Cell Biol"
                        "fecha" => "2005"
                        "volumen" => "15"
                        "paginaInicial" => "138"
                        "paginaFinal" => "145"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The lymph node as a bridgehead in the metastatic dissemination of tumors"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Recent Results Cancer Res"
                        "fecha" => "2000"
                        "volumen" => "157"
                        "paginaInicial" => "55"
                        "paginaFinal" => "81"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dissemination and growth of cancer cells in metastatic sites"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/nrc865"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Rev Cancer"
                        "fecha" => "2002"
                        "volumen" => "2"
                        "paginaInicial" => "563"
                        "paginaFinal" => "572"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous manifestations of internal malignancies"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Dermatol"
                        "fecha" => "2001"
                        "volumen" => "19"
                        "paginaInicial" => "290"
                        "paginaFinal" => "297"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous metastatic disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Acad Dermalol"
                        "fecha" => "1995"
                        "volumen" => "33"
                        "paginaInicial" => "161"
                        "paginaFinal" => "182"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "El proceso metast&#225;tico &#40;<span class="elsevierStyleSmallCaps">ii</span>&#41;&#58; diseminaci&#243;n tumoral directa&#44; linf&#225;tica y hem&#225;tica"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "1999"
                        "volumen" => "90"
                        "paginaInicial" => "277"
                        "paginaFinal" => "290"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous metastases in internal malignancy"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Egypt Dermatol Online J"
                        "fecha" => "2007"
                        "volumen" => "3"
                        "paginaInicial" => "1"
                        "itemHostRev" => array:3 [ …3]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Met&#225;stasis cut&#225;nea inflamatoria como primer signo de recidiva de carcinoma escamoso de pulm&#243;n"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2008"
                        "volumen" => "99"
                        "paginaInicial" => "157"
                        "paginaFinal" => "159"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skin involvement as the presenting sign of internal carcinoma&#58; a retrospective study of 7&#44;316 cancer patients"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "1990"
                        "volumen" => "22"
                        "paginaInicial" => "19"
                        "paginaFinal" => "26"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patterns of cutaneous metastasis"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "1972"
                        "volumen" => "105"
                        "paginaInicial" => "862"
                        "paginaFinal" => "868"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous metastases of internal malignancies"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/0378-6323.60548"
                      "Revista" => array:7 [
                        "tituloSerie" => "Indian J Dermatol Venereol Leprol"
                        "fecha" => "2010"
                        "volumen" => "76"
                        "paginaInicial" => "125"
                        "paginaFinal" => "131"
                        "link" => array:1 [ …1]
                        "itemHostRev" => array:3 [ …3]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metastatic tumors of the skin"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "1972"
                        "volumen" => "29"
                        "paginaInicial" => "1298"
                        "paginaFinal" => "1307"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metastasis mechanisms"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Biochim Biophys Acta"
                        "fecha" => "1796"
                        "volumen" => "2009"
                        "paginaInicial" => "293"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous metastases from internal carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "1966"
                        "volumen" => "19"
                        "paginaInicial" => "162"
                        "paginaFinal" => "168"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skin metastases in cancer patients"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Cutis"
                        "fecha" => "1987"
                        "volumen" => "39"
                        "paginaInicial" => "119"
                        "paginaFinal" => "121"
                        "link" => array:1 [ …1]
                        "itemHostRev" => array:3 [ …3]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complex networks orchestrate epithelial-mesenchymal transitions"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/nrm1835"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Rev Mol Cell Biol"
                        "fecha" => "2006"
                        "volumen" => "7"
                        "paginaInicial" => "131"
                        "paginaFinal" => "142"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hepatic and skin metastases after laparoscopic radical prostatectomy for prostate cancer"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Gastrointestin Liver"
                        "fecha" => "2007"
                        "volumen" => "16"
                        "paginaInicial" => "333"
                        "paginaFinal" => "335"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous metastasis of pleural mesothelioma&#58; two cases"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Dermatol Venereol"
                        "fecha" => "2003"
                        "volumen" => "130"
                        "paginaInicial" => "455"
                        "paginaFinal" => "459"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transiently entrapped circulating tumor cells interact with neutrophils to facilitate lung metastasis development"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1158/0008-5472.CAN-09-4442"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer Res"
                        "fecha" => "2010"
                        "volumen" => "70"
                        "paginaInicial" => "6071"
                        "paginaFinal" => "6082"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The pathogenesis of cancer metastasis"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Nature"
                        "fecha" => "1979"
                        "volumen" => "283"
                        "paginaInicial" => "139"
                        "paginaFinal" => "146"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Ras branch of small GTPases&#58; Ras family members don&#8217;t fall far from the tree"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Curr Opin Cell Biol"
                        "fecha" => "2000"
                        "volumen" => "12"
                        "paginaInicial" => "157"
                        "paginaFinal" => "165"
                        "link" => array:1 [ …1]
                        "itemHostRev" => array:3 [ …3]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The mitogen activated protein kinase signal transduction pathway&#58; From the cell surface to the nucleus"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cell Signal"
                        "fecha" => "1994"
                        "volumen" => "6"
                        "paginaInicial" => "581"
                        "paginaFinal" => "589"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ras oncogenes in human cancer&#58; A review"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer Res"
                        "fecha" => "1989"
                        "volumen" => "49"
                        "paginaInicial" => "4682"
                        "paginaFinal" => "4689"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inhibitors of the ras oncogene as therapeutic targets"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Hematol Oncol Clin North Am"
                        "fecha" => "2002"
                        "volumen" => "16"
                        "paginaInicial" => "1065"
                        "paginaFinal" => "1088"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Molecular mechanisms of tumor metastasis and angiogenesis"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Langenbecks Arch Surg"
                        "fecha" => "1999"
                        "volumen" => "384"
                        "paginaInicial" => "133"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "General mechanisms of metastasis"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "1997"
                        "volumen" => "80"
                        "paginaInicial" => "1529"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Axis of evil&#58; molecular mechanisms of cancer metastasis"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/sj.onc.1206757"
                      "Revista" => array:6 [
                        "tituloSerie" => "Oncogene"
                        "fecha" => "2003"
                        "volumen" => "22"
                        "paginaInicial" => "6524"
                        "link" => array:1 [ …1]
                        "itemHostRev" => array:3 [ …3]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The crossroads of oncogenesis and metastasis"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2009"
                        "volumen" => "15"
                        "paginaInicial" => "297"
                        "paginaFinal" => "299"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metastases in carcinoma&#59; analysis of 1000 autopsied cases"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "1950"
                        "volumen" => "3"
                        "paginaInicial" => "74"
                        "paginaFinal" => "85"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous metastases&#46; Clinical pathological review"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Med Chil"
                        "fecha" => "1996"
                        "volumen" => "124"
                        "paginaInicial" => "1519"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous metastases in patients with metastatic carcinoma&#58; A retrospective study of 4020 patients"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "1993"
                        "volumen" => "29"
                        "paginaInicial" => "228"
                        "paginaFinal" => "236"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous metastases&#58; a metaanalysis of data"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
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                      "doi" => "10.1097/01.SMJ.0000053676.73249.E5"
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                        "tituloSerie" => "South Med J"
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                        "paginaInicial" => "164"
                        "paginaFinal" => "167"
                        "link" => array:1 [ …1]
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Metastatic Patterns of Cancers&#58; Results From a Large Autopsy Study"
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                        0 => array:2 [ …2]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arch Pathol Lab Med"
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                        "volumen" => "6"
                        "paginaInicial" => "931 L 939"
                        "itemHostRev" => array:3 [ …3]
                      ]
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                0 => array:2 [
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                      "titulo" => "Non-hematopoietic cutaneous metastases in children and adolescents&#58; thirty years experience at St&#46; Jude Children&#39;s Research Hospital"
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                        0 => array:2 [ …2]
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                        "paginaFinal" => "492"
                        "link" => array:1 [ …1]
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                    0 => array:1 [
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                        "tituloSerie" => "Actas Dermosifiliogr"
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                        "paginaInicial" => "93"
                        "paginaFinal" => "95"
                        "link" => array:1 [ …1]
                      ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Met&#225;stasis cut&#225;neas generalizadas como forma de presentaci&#243;n de un adenocarcinoma g&#225;strico"
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                        0 => array:2 [ …2]
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                        "tituloSerie" => "Actas Dermosifiliogr"
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                        "paginaInicial" => "213"
                        "paginaFinal" => "218"
                        "link" => array:1 [ …1]
                      ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A study of 70 cases of cutaneous metastases from internal carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [ …6]
                    ]
                  ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metastatic cancer of the skin"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [ …4]
                    ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous manifestations of malignant disease"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [ …7]
                    ]
                  ]
                ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous metastasis of a radiation associated thyroid medullary carcinoma"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/BF03349501"
                      "Revista" => array:5 [ …5]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Cutaneous metastasis from follicular carcinoma of the thyroid gland"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1089/thy.1993.3.235"
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                    ]
                  ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Cutaneous infiltration by cancer"
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                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2007.01.034"
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                0 => array:2 [
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                      "titulo" => "Metastatic tumors to the nail unit&#58; subungueal metastases"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [ …6]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "N&#243;dulo umbilical"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [ …6]
                    ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous lesions of metastatic visceral malignancy mimicking pyogenic granuloma"
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [ …6]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Carcinoma erysipelatoides from squamous cell carcinoma of unknown origin"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1368-5031.2005.00588.x"
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              "identificador" => "bib0245"
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                0 => array:2 [
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                      "titulo" => "Met&#225;stasis cut&#225;nea inflamatoria como primer signo de recidiva de carcinoma escamoso de pulm&#243;n"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [ …6]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous metastases from carcinoma breast&#58; the common and the rare"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/0378-6323.55395"
                      "Revista" => array:6 [ …6]
                    ]
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              "identificador" => "bib0255"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Narrative review&#58; diseases that masquerade as infection cellulitis"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [ …7]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Cutaneous metastases&#8211;carcinoma en cuirasse"
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [ …6]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inflammatory metastatic carcinoma&#46; Carcinoma erysipelatoides"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [ …6]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bilateral thoracic zosteroid spreading marginate telangiectasia &#8211; probably a variety of carcinoma erysipelatoides &#8211; associated with unilateral mammary carcinoma&#44; and better termed carcinoma telangiectaticum"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [ …5]
                    ]
                  ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Telangiectatic metastatic breast carcinoma preceded by en cuirasse metastatic breast carcinoma"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2004.06140.x"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recognizing malignant skin changes following breast cancer"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [ …7]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Bilateral thoracic zosteroid spreading marginate telangiectasia&#8211;probably a variant of carcinoma telangiectatum"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [ …6]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Zosteriform cutaneous metastases&#58; a literature meta-analysis and a clinical report of three melanoma cases"
                      "autores" => array:1 [ …1]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2009.01241.x"
                      "Revista" => array:6 [ …6]
                    ]
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                ]
              ]
            ]
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                0 => array:2 [
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                  "host" => array:1 [
                    0 => array:1 [
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                  "host" => array:1 [
                    0 => array:1 [
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                    0 => array:1 [
                      "Revista" => array:6 [ …6]
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                    0 => array:2 [
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [ …6]
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                0 => array:2 [
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                    0 => array:2 [
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1468-3083.2005.01205.x"
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                  "host" => array:1 [
                    0 => array:2 [
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              ]
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                0 => array:2 [
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                0 => array:2 [
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                      "titulo" => "Review of scalp alopecia due to a clinically unapparent or minimally apparent neoplasm &#40;SACUMAN&#41;"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                    ]
                  ]
                ]
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                0 => array:2 [
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                    0 => array:2 [
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [ …6]
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                    0 => array:1 [
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                  ]
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                    0 => array:1 [
                      "Libro" => array:5 [ …5]
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                    0 => array:1 [
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                    0 => array:1 [
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                    0 => array:1 [
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                  ]
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                    0 => array:1 [
                      "Revista" => array:5 [ …5]
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                    0 => array:1 [
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                    0 => array:1 [
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                    0 => array:1 [
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                    0 => array:2 [
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              "identificador" => "bib0635"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cisplatin and gemcitabine with either vinorelbine or paclitaxel in the treatment of carcinomas of unknown primary site&#58; results of an Italian multicenter&#44; randomized&#44; phase <span class="elsevierStyleSmallCaps">ii</span> study"
                      "autores" => array:1 [ …1]
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                    0 => array:2 [
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Stroma-targeted palliative tumor therapy with biomodulators"
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                    0 => array:2 [
                      "doi" => "10.1111/j.1610-0387.2006.05908.x"
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              "identificador" => "bib0645"
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              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "The management of cutaneous metastases"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00120-006-1278-1"
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                    0 => array:2 [
                      "doi" => "10.12968/bjcn.2008.13.1.27977"
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        "texto" => "<p id="par0220" class="elsevierStylePara elsevierViewall">We would like to thank Dr Concepci&#243;n Rom&#225;n Curto&#44; author of the doctoral thesis &#8220;Tumores cutaneous metast&#225;sicos&#46; <span class="elsevierStyleItalic">Estudio clinic&#44; histol&#243;gico y ultraestructural</span>&#8221; for her help and Dr Jes&#250;s Mill&#225;n N&#250;&#241;ez-Cort&#233;s&#44; Professor of Medicine&#44; Hospital General Universitario Gregorio Mara&#241;&#243;n&#44; Facultad de Medicina&#44; Universidad Complutense&#44; in Madrid&#44; Spain&#44; for his inestimable collaboration&#46;</p>"
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