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angulated shape formed when the overlying skin is stretched between the fingers&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Another recently described sign&#44; the skin crease sign&#44; refers to the skin crease or fold that is formed when the edges of the tumor are gently pressed between the thumbs perpendicularly to the tension lines of the skin&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Pilomatricoma typically presents as a solitary lesion&#44; and while no inheritance patterns have been described&#44; there have been reports of familial cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> Multiple lesions &#40;&#8805;2&#41; have been reported in between 2&#37; and 3&#46;5&#37; of patients&#44; depending on the series&#46; Multiple pilomatricomas appear to be more common in patients with systemic disease and diverse syndromes&#44; and may be indirect markers of underlying disease&#46; Despite its frequency&#44; pilomatricoma is clinically underdiagnosed and the differential diagnosis includes numerous benign skin lesions &#40;epidermoid and dermoid cysts&#44; swollen lymph nodes&#44; foreign body granuloma&#44; molluscum contagiosum&#44; xanthogranuloma&#44; and adnexal subcutaneous tumors&#41; and malignant lesions &#40;basal cell carcinoma and melanoma&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Highman and Ogden<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> provided the first histologic description of pilomatricoma in 1944&#44; and referred to the characteristic anucleate cells in pilomatricoma known as ghost or shadow cells&#46; Histologically&#44; pilomatricoma appears as a well-circumscribed tumor with a mixed population of basaloid epithelial cells and shadow cells in the center of the lesion and a fibroblastic mesenchymal component&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Foci of calcification are common and ossification may be seen&#44; but much less frequently&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Diagnosis is confirmed by histology&#44; but clinical suspicion can be supported preoperatively by imaging studies and soft-tissue ultrasound in particular&#46; Ultrasound scans show a hyperechoic and isoechoic nodule with a peripheral halo and a posterior shadow&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Computed tomography and magnetic resonance imaging have also been used in some cases&#46; The role of fine-needle aspiration is unclear due to the high likelihood of false positives&#44; and most authors believe that its effectiveness depends on the experience of the person performing the procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Pilomatricoma is&#44; by definition&#44; a benign tumor&#44; but there have been reports of malignant transformation and even metastasis&#44; although it is believed that these cases were primarily malignant &#40;i&#46;e&#46;&#44; pilomatricoma carcinoma&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Treatment is surgical&#44; but there is no consensus on optimal excision margins&#44; surgical technique&#44; or age for surgery in young patients&#46; Spontaneous remission has not been reported&#44; and up to 3&#37; to 4&#37; of cases recur after surgery&#44; although recurrence in such cases is probably due to incomplete excision&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The main aim of the present study was to determine the frequency of solitary and multiple pilomatricoma in our hospital after noticing what appeared to be a high rate of cases&#46; A second aim was to describe the clinical and ultrasound features of these lesions&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This was a descriptive retrospective study of all pilomatricomas surgically removed at Hospital Universitario de Fuenlabrada in Madrid&#44; Spain&#44; which serves a population of 250 000 inhabitants&#46; We studied all cases registered in the database of the pathology database in our hospital between January 2004 and December 2012&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The variables analyzed were patient sex&#44; age at diagnosis&#44; tumor location&#44; associated symptoms&#44; a clear history of trauma&#44; preoperative clinical diagnosis&#44; concomitant diseases&#44; multiple and familial cases and possible associations&#44; ultrasound and histologic features&#44; surgical and anesthetic technique&#44; and subsequent complications&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">We identified 261 surgically excised pilomatricomas in 239 patients&#46; Most of the patients &#40;83&#46;68&#37;&#41; were from the dermatology department&#46; The rest had been evaluated and operated on in other departments&#44; namely the general surgery department &#40;34 patients&#44; 14&#46;23&#37;&#41;&#44; the ear&#44; nose&#44; and throat department &#40;4 patients&#44; 1&#46;67&#37;&#41;&#44; and the ophthalmology department &#40;1 patient&#44; 0&#46;42&#37;&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Of the 239 patients&#44; 120 &#40;50&#46;21&#37;&#41; were female and 119 &#40;49&#46;79&#37;&#41; were male&#46; Age at diagnosis ranged from 1 to 83 years&#44; with a mean age of 26&#46;4 years&#59; 46&#46;03&#37; of the patients were aged 16 years or younger&#46; The most common tumor location was the head and neck &#40;49&#46;81&#37; of cases&#41;&#44; followed by the upper extremities &#40;24&#46;52&#37;&#41;&#44; the trunk &#40;15&#46;32&#37;&#41;&#44; and the lower extremities &#40;9&#46;58&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The most common clinical presentation was a firm subcutaneous nodule that was asymptomatic in 82&#37; of cases &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The preoperative clinical diagnosis was pilomatricoma in 54&#46;4&#37; of cases&#59; the second most common clinical diagnosis was epidermal cyst &#40;26&#46;44&#37;&#41;&#46; Many clinical entities&#44; both benign and malignant&#44; were initially suspected&#59; these are shown together with the corresponding number of cases in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; Fifty-nine of the 239 patients had a concomitant disease&#58; 16 patients had another skin condition &#40;multiple melanocytic nevi and pigmented lesions under follow-up in 5 cases&#44; acne in 2&#44; basal cell carcinoma in 2&#44; and psoriasis&#44; acanthosis nigricans&#44; lichen planus&#44; genital lichen sclerosus&#44; multiple lipomatosis&#44; ptosis&#44; sebaceous nevus&#44; and multiple common warts&#41;&#59; 10 patients had a malignant tumor &#40;breast cancer in 2 cases and melanoma&#44; pheochromocytoma&#44; and cancer of the colon&#44; endometrium&#44; cervix&#44; prostate&#44; pancreas&#44; and liver&#41;&#59; 9 patients had cardiovascular disease &#40;ischemic heart disease&#44; chronic venous insufficiency&#44; aortic stenosis&#44; temporal arteritis&#44; hypertension&#44; and diabetes&#41;&#59; 7 patients had a hormonal disorder &#40;hypothyroidism&#44; low height&#44; morbid obesity&#44; polycystic ovary syndrome&#44; premature pubarche&#44; overgrowth syndrome&#44; and hyperandrogenism&#41;&#59; 6 patients had respiratory disease &#40;asthma&#44; obstructive sleep apnea syndrome&#44; and chronic obstructive lung disease&#41;&#59; 3 patients had Steinert disease&#59; 2 patients had a digestive disease &#40;hepatopathy and celiac disease&#41;&#59; 2 patients had attention deficit hyperactivity disorder&#59; and there were isolated cases of vasovagal syncope&#44; migraine&#44; arthrosis&#44; and renal cysts &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Seven patients reported prior trauma at the site of the tumor &#40;2 recalled injury with a pencil tip&#44; 1 recalled an insect bite&#47;sting&#44; and 1 recalled vaccination&#41;&#46; There were 20 cases of multiple pilomatricoma &#40;8&#46;39&#37;&#41;&#59; 1 patient had 4 lesions&#44; 4 patients had 3 lesions&#44; and 15 patients had 2 lesions&#46; The patient with 4 tumors was being evaluated for overgrowth syndrome and had a sister with a confirmed case of pilomatricoma that had been surgically removed&#46; Two of the other patients with multiple pilomatricoma had confirmed Steinert disease &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 2</a>&#41; and 1 had endometrial carcinoma&#46; Three of the 239 patients had a history of pilomatricoma at another site that had been excised at a different hospital&#59; the corresponding pathology reports were included in the database&#46; Fifty-seven &#40;21&#46;84&#37;&#41; of the 261 lesions were examined by soft-tissue ultrasound&#44; which revealed images consistent with pilomatricoma in 48 cases &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 3</a>&#41;&#46; The other 9 tumors exhibited nonspecific or incompatible features&#46; Histologically&#44; most of the tumors had typical features of pilomatricoma &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 4</a>&#41;&#46; Additionally&#44; there were 5 hybrid cysts &#40;epidermal cyst and pilomatricoma in the same specimen&#41;&#44; 1 anetodermic pilomatricoma&#44; which was diagnosed preoperatively&#44; 1 case of ossification&#44; 1 pilomatricoma with acanthotic seborrheic keratosis&#44; and 1 follicular cyst with trichilemmal-epidermal-like areas and pilomatricoma&#46; There were no cases of pilomatrical carcinoma or signs of malignant transformation in any of the lesions&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><elsevierMultimedia ident="fig0035"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">In total&#44; 185 tumors &#40;70&#46;88&#37;&#41; were excised using local anesthesia and 76 &#40;29&#46;12&#37;&#41; using a combination of local and general anesthesia or sedation&#59; 1 patient died from anesthesia-related complications&#46; Postsurgical complications included hypertrophic scarring &#40;1 case&#41; and dehiscence of the surgical wound that required no further action &#40;1 case&#41;&#46; There have been no reports of recurrence to date&#59; just 1 patient needed additional surgery on a lesion on the wing of the nose that had been incompletely excised by curettage following a clinical suspicion of molluscum contagiosum&#46; The lesion was completely excised in the second operation&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">In 1880&#44; Malherbe and Chanantais<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> described a group of tumors they believed were derived from the sebaceous gland and that they called calcifying epitheliomas of sebaceous glands&#46; In 1961&#44; Forbis and Helwig<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> studied 228 cases of the same tumor and proposed the name <span class="elsevierStyleItalic">pilomatricoma</span> because they concluded that the tumor was derived from the matrix of the hair&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Pilomatricoma is a very common skin tumor&#44; so much so that the high rates of undiagnosed cases reported in the literature are very surprising&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Most of the reports in the literature describe a similar presentation&#58; a firm subcutaneous nodule&#44; located preferentially on the head and neck in female patients that appears in first 2 decades of life&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In 1943&#44; Cordiviola and Quevedo<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> described a special anetodermic clinical form consisting of a firm subcutaneous tumor covered by thin&#44; folded skin&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> lists the studies that have analyzed series of over 100 pilomatricomas&#46; The largest series published to date is that of Moehlenbeck<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> from 1973&#44; which described 1569 pilomatricomas&#44; including 170 cases seen at the author&#39;s hospital&#46; The most common tumor location in our series&#44; coinciding with previous reports&#44; was the head and neck&#46; Unlike other studies&#44; however&#44; we found no significant differences for sex&#46; Although pilomatricoma shows a predilection for the female sex&#44; Guinot-Moya et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> found that these tumors were slightly more common in male patients&#46; A prior history of recognizable trauma &#40;e&#46;g&#46;&#44; insect bite&#47;sting&#44; vaccine&#41; at the site of the tumor has been reported in up to 9&#37; of patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;18</span></a> although the association could be coincidental given the high frequency of pilomatricoma&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">As already mentioned&#44; even though pilomatricoma is very common&#44; the tumor is only diagnosed preoperatively in 6&#37; to 29&#37; of cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;19</span></a> This low diagnostic rate could possibly be explained by the fact that most series have been published in journals outside the field of dermatology&#46; In our series&#44; 54&#46;4&#37; of pilomatricomas were correctly diagnosed prior to surgery&#59; this rate is high compared with reports in the literature and can probably be explained by the fact that most patients were initially evaluated by the dermatology department&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The diagnostic role of soft-tissue ultrasound in pilomatricoma is growing&#46; In a series of 124 pilomatricomas reported by Solivetti et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> 25&#46;8&#37; of the tumors were evaluated by ultrasound&#46; The tumor is viewed as a hyperechoic or isoechoic nodule with a peripheral halo and a posterior shadow&#46; Solivetti et al&#46; described 5 characteristic ultrasound patterns of pilomatricoma&#44; and recognized the importance of ultrasound as a preoperative diagnostic tool in this setting&#46; In our series 57 tumors &#40;21&#46;84&#37;&#41; were examined by soft-tissue ultrasound&#44; and the images were consistent with pilomatricoma in 48 cases &#40;84&#46;21&#37;&#41; and inconsistent or nonspecific in 9 cases&#59; these results are possibly related to varying levels of experience and the use of different criteria&#44; as not all the examinations were performed and reported by the same radiologist&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Histology showed that most of the lesions in our series were well-circumscribed subepidermal tumors composed of a mix of basaloid and shadow cells&#44; fibroblastic cells without atypia&#44; and a variable amount of calcified material&#46; Although hybrid cysts are rare in pilomatricoma&#44; there have been some reports of cysts containing one or more components of the pilosebaceous unit&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> In such cases&#44; there is a mixed variable component with evident transition between the 2 areas&#59; this is a different concept from coexisting or collision tumors&#46; Our findings support reports to date that ossification&#44; anetodermic pilomatricomas&#44; and hybrid cysts are rare&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;10&#44;20</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The highest reported rate of multiple pilomatricomas in large series &#40;&#60;<span class="elsevierStyleHsp" style=""></span>100 cases&#44; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41; is 3&#46;5&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> In our series&#44; 8&#46;39&#37; of patients had multiple pilomatricomas&#59; 1 of the patients had 4 lesions and also had a first-degree relative with a confirmed diagnosis of pilomatricoma&#46; Multiple pilomatricoma has been described in Steinert disease &#40;myotonic dystrophy&#41;&#44; Gardner syndrome&#44; Turner syndrome&#44; Sotos syndrome&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Rubinstein-Taybi syndrome&#44; medullary thyroid carcinoma&#44; and sarcoidosis&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> More recently&#44; it has also been described in isolated cases of trisomy syndromes&#44; cerebral glioblastoma&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> celiac disease&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> 21-hydroxylase deficiency&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> and Kabuki syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Concerning the etiology and pathogenesis of pilomatricoma&#44; several studies have demonstrated the presence of mutations in the &#946;-catenin pathway&#44; a signaling protein involved in the development of the hair follicle&#59; these studies have shown that the mutations favor the development of pilomatricoma and other adnexal tumors&#44; and may also affect other cancer-related genes&#44; possibly explaining why malignant tumors are more common in patients with multiple pilomatricomas&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#8211;29</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Two patients with multiple pilomatricoma in our series had Steiner syndrome&#46; The presence of multiple lesions in a patient with overgrowth syndrome and another with endometrial carcinoma has not been previously reported&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The association between solitary pilomatricoma and other diseases has not been previously studied&#46; The most common concomitant diseases in our series were other skin disorders&#44; malignant tumors&#44; and cardiovascular disease&#46; However&#44; given the high incidence of both pilomatricomas and these diseases&#44; it is easy to assume that the association is purely coincidental&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Pilomatricoma is treated by surgical excision&#44; but there is no consensus on the optimal age at which surgery should be performed in children&#44; or on the most appropriate technique and margins&#46; Our patients underwent simple excision without wide margins&#46; The choice of anesthetic technique was governed by clinical criteria&#44; including medical history&#44; concomitant medication&#44; age&#44; and tumor characteristics &#40;e&#46;g&#46;&#44; location and size&#41;&#46; One of the girls in our series died as a result of anesthetic complications in the postoperative period&#46; She had a progressively growing tumor and the results of the ultrasound evaluation had been inconclusive&#46; This is the first report of postsurgical complications in a patient with pilomatricoma&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The main limitations of our study are related to its retrospective design&#44; particularly in terms of the lack of uniformity in the collection of clinical data&#44; probably due to the large number of physicians involved&#46; In many cases&#44; for example&#44; there was no information on prior trauma at the tumor site&#44; possibly because the physician did not ask this question or note down the answer&#46; Furthermore&#44; the true frequency of pilomatricomas in our hospital is higher than that reported as our study design excluded patients with a clinical diagnosis of pilomatricoma who had not undergone surgery&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In conclusion&#44; this retrospective study of pilomatricomas is the largest to date in Spain and considering the number of years studied and the size of the population served by our hospital &#40;250 000&#41;&#44; we have reported one of the highest incidence rates of pilomatricoma&#46; We would also like to stress the high proportion of lesions evaluated by ultrasound and the considerable number of patients with multiple pilomatricoma&#46; To our knowledge&#44; this is the first study to describe concomitant diseases&#44; surgical treatment&#44; anesthetic techniques&#44; and postoperative complications in patients with pilomatricoma&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of Interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Background and objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Pilomatricoma is the second most common skin tumor in childhood and youth and it has a broad differential diagnosis&#46; The main objective of the present study was to determine the incidence of pilomatricomas in our hospital and to analyze the following variables&#58; patient age and sex&#44; tumor site&#44; symptoms&#44; previous trauma&#44; clinical diagnosis&#44; associated diseases&#44; number of cases of multiple tumors&#44; ultrasound findings&#44; anesthetic and surgical techniques&#44; and postoperative complications&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Material and method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This was a retrospective study of the pilomatricomas surgically excised between January 2004 and December 2012 and registered in the database of the pathology department of our hospital&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We found 261 pilomatricomas in 239 patients &#40;120 female and 119 male&#41; between 1 and 83 years of age &#40;mean age&#44; 26&#46;4 years&#41;&#46; The most common presentation was as a firm subcutaneous nodule&#44; which was asymptomatic in 82&#37; of cases&#46; Tumors most commonly affected the head and neck &#40;49&#46;81&#37;&#41;&#46; Preoperative diagnosis was correct in 54&#46;4&#37; of cases&#44; concomitant diseases were present in 59 cases&#44; and 7 patients reported a history of trauma in the area of the tumor&#46; There were 17 cases of multiple tumors&#44; 1 case in a patient with familial disease and 2 in patients with Steinert disease&#46; Soft-tissue ultrasound was performed on 57 lesions&#59; images were compatible with pilomatricoma in 48 cases&#46; Tumor excision was performed under local anesthesia in 185 cases and under local and general anesthesia in 76&#46; The postoperative complications were hypertrophic scarring and wound dehiscence &#40;1 case each&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">This was a retrospective study with the largest series recorded in Spain and with one of the highest incidences&#46; In addition&#44; we report on variables not described in other studies&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n y objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El pilomatricoma es la segunda neoformaci&#243;n cut&#225;nea m&#225;s frecuente en la infancia y la juventud&#44; con un amplio diagn&#243;stico diferencial&#46; El objetivo principal del estudio fue determinar la incidencia de pilomatricomas en nuestro hospital y sus caracter&#237;sticas en relaci&#243;n con&#58; edad&#44; sexo&#44; localizaci&#243;n&#44; s&#237;ntomas&#44; traumatismo previo&#44; diagn&#243;stico cl&#237;nico&#44; enfermedades asociadas&#44; casos m&#250;ltiples&#44; caracter&#237;sticas ecogr&#225;ficas&#44; tratamiento quir&#250;rgico y t&#233;cnica anest&#233;sica y complicaciones posteriores&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se recogieron de forma retrospectiva los pilomatricomas extirpados quir&#250;rgicamente en nuestro hospital de enero de 2004 a diciembre de 2012 a partir de la base de datos de anatom&#237;a patol&#243;gica&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se estudiaron 261 pilomatricomas en 239 pacientes&#44; 120 eran mujeres y 119 varones de edades comprendidas entre 1 y 83 a&#241;os&#44; con una media de 26&#44;4 a&#241;os&#46; La forma de presentaci&#243;n m&#225;s frecuente fue como un n&#243;dulo firme&#44; subcut&#225;neo&#44; asintom&#225;tico en el 82&#37; de los casos&#46; La localizaci&#243;n m&#225;s frecuente fue la cabeza y el cuello &#40;49&#44;81&#37;&#41;&#46; El diagn&#243;stico cl&#237;nico preoperatorio fue acertado en el 54&#44;4&#37;&#46; Cincuenta y nueve pacientes ten&#237;an otras enfermedades y 7 recordaban traumatismo previo en la zona&#46; Se registraron 17 casos m&#250;ltiples&#44; uno familiar&#44; y 2 en pacientes con enfermedad de Steinert&#46; En 57 lesiones se realiz&#243; ecograf&#237;a de partes blandas&#44; con im&#225;genes compatibles con pilomatricoma en 48&#46; Ciento ochenta y cinco pilomatricomas se extirparon con anestesia local y 76 con anestesia local y general&#46; Como complicaciones posquir&#250;rgicas hubo un caso de cicatriz hipertr&#243;fica y otro de dehiscencia&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El nuestro es el estudio retrospectivo que recoge el mayor n&#250;mero de casos en nuestro pa&#237;s y uno de los que comunica mayor incidencia de casos&#46; Adem&#225;s&#44; se estudian variables no recogidas en otras series&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Hern&#225;ndez-N&#250;&#241;ez A&#44; N&#225;jera Botello L&#44; Romero Mat&#233; A&#44; Mart&#237;nez-S&#225;nchez C&#44; Utrera Busquets M&#44; Calder&#243;n Kom&#225;romy A&#44; et al&#46; Estudio retrospectivo de pilomatricomas&#58; 261 tumores en 239 pacientes&#46; Actas Dermosifiliogr&#46; 2014&#59;105&#58;699&#8211;705&#46;</p>"
      ]
    ]
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A&#44; Firm&#44; subcutaneous nodular lesion with pigmentation in the overlying skin and whitish areas in the left frontotemporal region&#46; B&#44; Dermoscopic image of the same lesion&#46;</p>"
        ]
      ]
      1 => array:7 [
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Subcutaneous tumor measuring several centimeters&#44; with firm whitish lobulated areas in the left parietal area in a patient with Steinert disease&#46;</p>"
        ]
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      2 => array:7 [
        "identificador" => "fig0030"
        "etiqueta" => "Figure 3"
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        "mostrarFloat" => true
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        "figura" => array:1 [
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        "identificador" => "fig0035"
        "etiqueta" => "Figure 4"
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          "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Well-circumscribed tumor with a mixed epithelial component composed of basaloid and shadow cells in the center of the lesion&#44; and a peripheral mesenchymal component formed by fibroblastic cells&#46; A&#44; Hematoxylin-eosin&#44; original magnification &#215;40&#46; B&#44; Hematoxylin-eosin&#44; original magnification &#215;100&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" 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" style="border-bottom: 2px solid black">Location&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" style="border-bottom: 2px solid black">No&#46; of Cases&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" style="border-bottom: 2px solid black">&#37;&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">Head and 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">130&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#46;81&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">Upper extremities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;52&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">Trunk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;32&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 extremities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;58&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">Not reported&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Location of Excised Pilomatricomas&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" 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" style="border-bottom: 2px solid black">Clinical Diagnosis&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" style="border-bottom: 2px solid black">No&#46; of Cases&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pilomatricoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">142&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#46;4&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">Epidermal cyst&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;44&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">Subcutaneous tumor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;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">Trichilemmal cyst&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;29&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">Basal 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;29&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">Foreign body granuloma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;53&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">Molluscum contagiosum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;15&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">Dermatofibroma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;77&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">Juvenile xanthogranuloma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;77&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">Cutaneous leishmaniasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;77&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">Other<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;21&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">Not reported&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Includes 1 case of each of the following&#58; lipoma&#44; diseased lymph node&#44; skin metastasis&#44; squamous cell carcinoma&#44; salivary gland tumor&#44; hydrocystoma&#44; dermoid cyst&#44; angioleiomyoma&#44; angioma&#44; xanthomous lesion pending study&#44; and keratoacanthoma&#46;</p>"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Preoperative Clinical Diagnosis for 261 Surgically Excised Pilomatricomas&#46;</p>"
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        "identificador" => "tbl0015"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Total cases&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">59&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Skin disorders or lesions&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Malignant tumor<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cardiovascular disease&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&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">Hormonal disorder<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></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">Respiratory disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></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">Steinert disease<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&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">Digestive disease&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&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">Attention deficit hyperactivity disorder&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&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">Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            1 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Multiple pilomatricomas in a patient with endometrial cancer&#44; a patient with overgrowth syndrome&#44; and 2 patients with Steinert disease&#46;</p>"
            ]
          ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Concomitant Diseases in Patients With Pilomatricomas&#46;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a></p>"
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        "identificador" => "tbl0020"
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                  \t\t\t\t" style="border-bottom: 2px solid black">Authors&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">No&#46; of Patients&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">No&#46; of Years Covered&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Mohlenbeck<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#46;569&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Not reported&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Pirouzmanesh et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">346&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">11&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">Julian et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">209&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">20&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">Guinot-Moya et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">205&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">33&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">O¿Connor et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">201&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&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">Lan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">179&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">11&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">Gay Scoda et al&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">179&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">17&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">Current study&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">261&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&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="spar0085" class="elsevierStyleSimplePara elsevierViewall">Series of &#62;<span class="elsevierStyleHsp" style=""></span>100 Cases of Pilomatricomas in the Literature&#46;</p>"
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      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:32 [
            0 => array:3 [
              "identificador" => "bib0005"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiolog&#237;a de la cirug&#237;a dermatol&#243;gica pedi&#225;trica&#46; Un estudio retrospectivo de 996 ni&#241;os"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "V&#46; L&#243;pez"
                            1 => "J&#46;M&#46; Mart&#237;n"
                            2 => "C&#46; Monteagudo"
                            3 => "E&#46; Jord&#225;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2010"
                        "volumen" => "101"
                        "paginaInicial" => "771"
                        "paginaFinal" => "777"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21034707"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pilomatrixoma&#58; A review of 346 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Pirouzmanesh"
                            1 => "J&#46;F&#46; Reinisch"
                            2 => "I&#46; Gonz&#225;lez-G&#243;mez"
                            3 => "E&#46;M&#46; Smith"
                            4 => "J&#46;G&#46; Meara"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.PRS.0000091160.54278.64"
                      "Revista" => array:6 [
                        "tituloSerie" => "Plast Reconstr Surg"
                        "fecha" => "2003"
                        "volumen" => "112"
                        "paginaInicial" => "1784"
                        "paginaFinal" => "1789"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14663221"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The tent sign of pilomatricoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;L&#46; Graham"
                            1 => "C&#46;F&#46; Merwin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cutis"
                        "fecha" => "1978"
                        "volumen" => "22"
                        "paginaInicial" => "577"
                        "paginaFinal" => "580"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/729402"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
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              ]
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            3 => array:3 [
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              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The skin crease sign&#58; A diagnostic sign of pilomatricoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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Original Article
Retrospective Study of Pilomatricoma: 261 Tumors in 239 Patients
Estudio retrospectivo de pilomatricomas: 261 tumores en 239 pacientes
A. Hernández-Núñeza,
Autor para correspondencia
ahernandezn@salud.madrid.org

Corresponding author.
, L. Nájera Botellob, A. Romero Matéa, C. Martínez-Sáncheza, M. Utrera Busquetsa, A. Calderón Komáromya, J. Borbujo Martíneza
a Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Madrid, Spain
b Servicio de Anatomía Patológica, Hospital Universitario de Fuenlabrada, Madrid, Spain
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Subcutaneous tumor measuring several centimeters&#44; with firm whitish lobulated areas in the left parietal area in a patient with Steinert disease&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Pilomatricoma&#44; also known as pilomatrixoma and trichomatricoma&#44; is a benign tumor that differentiates towards the hair matrix&#44; cortex&#44; and epithelial sheath&#46; It is the second most common benign skin tumor in the first 2 decades of life after epidermal cyst&#44; but despite its frequency it has a broad clinical differential diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It has been described more frequently in females and is most commonly located on the head and neck&#44; followed by the trunk and the extremities&#46; The most common clinical presentation is a firm&#44; movable subcutaneous lesion with a lobulated surface&#59; the overlying skin may acquire a red or bluish hue&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The tent sign is a characteristic feature of pilomatricoma and refers to the firm&#44; angulated shape formed when the overlying skin is stretched between the fingers&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Another recently described sign&#44; the skin crease sign&#44; refers to the skin crease or fold that is formed when the edges of the tumor are gently pressed between the thumbs perpendicularly to the tension lines of the skin&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Pilomatricoma typically presents as a solitary lesion&#44; and while no inheritance patterns have been described&#44; there have been reports of familial cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> Multiple lesions &#40;&#8805;2&#41; have been reported in between 2&#37; and 3&#46;5&#37; of patients&#44; depending on the series&#46; Multiple pilomatricomas appear to be more common in patients with systemic disease and diverse syndromes&#44; and may be indirect markers of underlying disease&#46; Despite its frequency&#44; pilomatricoma is clinically underdiagnosed and the differential diagnosis includes numerous benign skin lesions &#40;epidermoid and dermoid cysts&#44; swollen lymph nodes&#44; foreign body granuloma&#44; molluscum contagiosum&#44; xanthogranuloma&#44; and adnexal subcutaneous tumors&#41; and malignant lesions &#40;basal cell carcinoma and melanoma&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Highman and Ogden<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> provided the first histologic description of pilomatricoma in 1944&#44; and referred to the characteristic anucleate cells in pilomatricoma known as ghost or shadow cells&#46; Histologically&#44; pilomatricoma appears as a well-circumscribed tumor with a mixed population of basaloid epithelial cells and shadow cells in the center of the lesion and a fibroblastic mesenchymal component&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Foci of calcification are common and ossification may be seen&#44; but much less frequently&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Diagnosis is confirmed by histology&#44; but clinical suspicion can be supported preoperatively by imaging studies and soft-tissue ultrasound in particular&#46; Ultrasound scans show a hyperechoic and isoechoic nodule with a peripheral halo and a posterior shadow&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Computed tomography and magnetic resonance imaging have also been used in some cases&#46; The role of fine-needle aspiration is unclear due to the high likelihood of false positives&#44; and most authors believe that its effectiveness depends on the experience of the person performing the procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Pilomatricoma is&#44; by definition&#44; a benign tumor&#44; but there have been reports of malignant transformation and even metastasis&#44; although it is believed that these cases were primarily malignant &#40;i&#46;e&#46;&#44; pilomatricoma carcinoma&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Treatment is surgical&#44; but there is no consensus on optimal excision margins&#44; surgical technique&#44; or age for surgery in young patients&#46; Spontaneous remission has not been reported&#44; and up to 3&#37; to 4&#37; of cases recur after surgery&#44; although recurrence in such cases is probably due to incomplete excision&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The main aim of the present study was to determine the frequency of solitary and multiple pilomatricoma in our hospital after noticing what appeared to be a high rate of cases&#46; A second aim was to describe the clinical and ultrasound features of these lesions&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This was a descriptive retrospective study of all pilomatricomas surgically removed at Hospital Universitario de Fuenlabrada in Madrid&#44; Spain&#44; which serves a population of 250 000 inhabitants&#46; We studied all cases registered in the database of the pathology database in our hospital between January 2004 and December 2012&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The variables analyzed were patient sex&#44; age at diagnosis&#44; tumor location&#44; associated symptoms&#44; a clear history of trauma&#44; preoperative clinical diagnosis&#44; concomitant diseases&#44; multiple and familial cases and possible associations&#44; ultrasound and histologic features&#44; surgical and anesthetic technique&#44; and subsequent complications&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">We identified 261 surgically excised pilomatricomas in 239 patients&#46; Most of the patients &#40;83&#46;68&#37;&#41; were from the dermatology department&#46; The rest had been evaluated and operated on in other departments&#44; namely the general surgery department &#40;34 patients&#44; 14&#46;23&#37;&#41;&#44; the ear&#44; nose&#44; and throat department &#40;4 patients&#44; 1&#46;67&#37;&#41;&#44; and the ophthalmology department &#40;1 patient&#44; 0&#46;42&#37;&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Of the 239 patients&#44; 120 &#40;50&#46;21&#37;&#41; were female and 119 &#40;49&#46;79&#37;&#41; were male&#46; Age at diagnosis ranged from 1 to 83 years&#44; with a mean age of 26&#46;4 years&#59; 46&#46;03&#37; of the patients were aged 16 years or younger&#46; The most common tumor location was the head and neck &#40;49&#46;81&#37; of cases&#41;&#44; followed by the upper extremities &#40;24&#46;52&#37;&#41;&#44; the trunk &#40;15&#46;32&#37;&#41;&#44; and the lower extremities &#40;9&#46;58&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The most common clinical presentation was a firm subcutaneous nodule that was asymptomatic in 82&#37; of cases &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The preoperative clinical diagnosis was pilomatricoma in 54&#46;4&#37; of cases&#59; the second most common clinical diagnosis was epidermal cyst &#40;26&#46;44&#37;&#41;&#46; Many clinical entities&#44; both benign and malignant&#44; were initially suspected&#59; these are shown together with the corresponding number of cases in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; Fifty-nine of the 239 patients had a concomitant disease&#58; 16 patients had another skin condition &#40;multiple melanocytic nevi and pigmented lesions under follow-up in 5 cases&#44; acne in 2&#44; basal cell carcinoma in 2&#44; and psoriasis&#44; acanthosis nigricans&#44; lichen planus&#44; genital lichen sclerosus&#44; multiple lipomatosis&#44; ptosis&#44; sebaceous nevus&#44; and multiple common warts&#41;&#59; 10 patients had a malignant tumor &#40;breast cancer in 2 cases and melanoma&#44; pheochromocytoma&#44; and cancer of the colon&#44; endometrium&#44; cervix&#44; prostate&#44; pancreas&#44; and liver&#41;&#59; 9 patients had cardiovascular disease &#40;ischemic heart disease&#44; chronic venous insufficiency&#44; aortic stenosis&#44; temporal arteritis&#44; hypertension&#44; and diabetes&#41;&#59; 7 patients had a hormonal disorder &#40;hypothyroidism&#44; low height&#44; morbid obesity&#44; polycystic ovary syndrome&#44; premature pubarche&#44; overgrowth syndrome&#44; and hyperandrogenism&#41;&#59; 6 patients had respiratory disease &#40;asthma&#44; obstructive sleep apnea syndrome&#44; and chronic obstructive lung disease&#41;&#59; 3 patients had Steinert disease&#59; 2 patients had a digestive disease &#40;hepatopathy and celiac disease&#41;&#59; 2 patients had attention deficit hyperactivity disorder&#59; and there were isolated cases of vasovagal syncope&#44; migraine&#44; arthrosis&#44; and renal cysts &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Seven patients reported prior trauma at the site of the tumor &#40;2 recalled injury with a pencil tip&#44; 1 recalled an insect bite&#47;sting&#44; and 1 recalled vaccination&#41;&#46; There were 20 cases of multiple pilomatricoma &#40;8&#46;39&#37;&#41;&#59; 1 patient had 4 lesions&#44; 4 patients had 3 lesions&#44; and 15 patients had 2 lesions&#46; The patient with 4 tumors was being evaluated for overgrowth syndrome and had a sister with a confirmed case of pilomatricoma that had been surgically removed&#46; Two of the other patients with multiple pilomatricoma had confirmed Steinert disease &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 2</a>&#41; and 1 had endometrial carcinoma&#46; Three of the 239 patients had a history of pilomatricoma at another site that had been excised at a different hospital&#59; the corresponding pathology reports were included in the database&#46; Fifty-seven &#40;21&#46;84&#37;&#41; of the 261 lesions were examined by soft-tissue ultrasound&#44; which revealed images consistent with pilomatricoma in 48 cases &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 3</a>&#41;&#46; The other 9 tumors exhibited nonspecific or incompatible features&#46; Histologically&#44; most of the tumors had typical features of pilomatricoma &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 4</a>&#41;&#46; Additionally&#44; there were 5 hybrid cysts &#40;epidermal cyst and pilomatricoma in the same specimen&#41;&#44; 1 anetodermic pilomatricoma&#44; which was diagnosed preoperatively&#44; 1 case of ossification&#44; 1 pilomatricoma with acanthotic seborrheic keratosis&#44; and 1 follicular cyst with trichilemmal-epidermal-like areas and pilomatricoma&#46; There were no cases of pilomatrical carcinoma or signs of malignant transformation in any of the lesions&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><elsevierMultimedia ident="fig0035"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">In total&#44; 185 tumors &#40;70&#46;88&#37;&#41; were excised using local anesthesia and 76 &#40;29&#46;12&#37;&#41; using a combination of local and general anesthesia or sedation&#59; 1 patient died from anesthesia-related complications&#46; Postsurgical complications included hypertrophic scarring &#40;1 case&#41; and dehiscence of the surgical wound that required no further action &#40;1 case&#41;&#46; There have been no reports of recurrence to date&#59; just 1 patient needed additional surgery on a lesion on the wing of the nose that had been incompletely excised by curettage following a clinical suspicion of molluscum contagiosum&#46; The lesion was completely excised in the second operation&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">In 1880&#44; Malherbe and Chanantais<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> described a group of tumors they believed were derived from the sebaceous gland and that they called calcifying epitheliomas of sebaceous glands&#46; In 1961&#44; Forbis and Helwig<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> studied 228 cases of the same tumor and proposed the name <span class="elsevierStyleItalic">pilomatricoma</span> because they concluded that the tumor was derived from the matrix of the hair&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Pilomatricoma is a very common skin tumor&#44; so much so that the high rates of undiagnosed cases reported in the literature are very surprising&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Most of the reports in the literature describe a similar presentation&#58; a firm subcutaneous nodule&#44; located preferentially on the head and neck in female patients that appears in first 2 decades of life&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In 1943&#44; Cordiviola and Quevedo<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> described a special anetodermic clinical form consisting of a firm subcutaneous tumor covered by thin&#44; folded skin&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> lists the studies that have analyzed series of over 100 pilomatricomas&#46; The largest series published to date is that of Moehlenbeck<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> from 1973&#44; which described 1569 pilomatricomas&#44; including 170 cases seen at the author&#39;s hospital&#46; The most common tumor location in our series&#44; coinciding with previous reports&#44; was the head and neck&#46; Unlike other studies&#44; however&#44; we found no significant differences for sex&#46; Although pilomatricoma shows a predilection for the female sex&#44; Guinot-Moya et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> found that these tumors were slightly more common in male patients&#46; A prior history of recognizable trauma &#40;e&#46;g&#46;&#44; insect bite&#47;sting&#44; vaccine&#41; at the site of the tumor has been reported in up to 9&#37; of patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;18</span></a> although the association could be coincidental given the high frequency of pilomatricoma&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">As already mentioned&#44; even though pilomatricoma is very common&#44; the tumor is only diagnosed preoperatively in 6&#37; to 29&#37; of cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;19</span></a> This low diagnostic rate could possibly be explained by the fact that most series have been published in journals outside the field of dermatology&#46; In our series&#44; 54&#46;4&#37; of pilomatricomas were correctly diagnosed prior to surgery&#59; this rate is high compared with reports in the literature and can probably be explained by the fact that most patients were initially evaluated by the dermatology department&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The diagnostic role of soft-tissue ultrasound in pilomatricoma is growing&#46; In a series of 124 pilomatricomas reported by Solivetti et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> 25&#46;8&#37; of the tumors were evaluated by ultrasound&#46; The tumor is viewed as a hyperechoic or isoechoic nodule with a peripheral halo and a posterior shadow&#46; Solivetti et al&#46; described 5 characteristic ultrasound patterns of pilomatricoma&#44; and recognized the importance of ultrasound as a preoperative diagnostic tool in this setting&#46; In our series 57 tumors &#40;21&#46;84&#37;&#41; were examined by soft-tissue ultrasound&#44; and the images were consistent with pilomatricoma in 48 cases &#40;84&#46;21&#37;&#41; and inconsistent or nonspecific in 9 cases&#59; these results are possibly related to varying levels of experience and the use of different criteria&#44; as not all the examinations were performed and reported by the same radiologist&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Histology showed that most of the lesions in our series were well-circumscribed subepidermal tumors composed of a mix of basaloid and shadow cells&#44; fibroblastic cells without atypia&#44; and a variable amount of calcified material&#46; Although hybrid cysts are rare in pilomatricoma&#44; there have been some reports of cysts containing one or more components of the pilosebaceous unit&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> In such cases&#44; there is a mixed variable component with evident transition between the 2 areas&#59; this is a different concept from coexisting or collision tumors&#46; Our findings support reports to date that ossification&#44; anetodermic pilomatricomas&#44; and hybrid cysts are rare&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;10&#44;20</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The highest reported rate of multiple pilomatricomas in large series &#40;&#60;<span class="elsevierStyleHsp" style=""></span>100 cases&#44; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41; is 3&#46;5&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> In our series&#44; 8&#46;39&#37; of patients had multiple pilomatricomas&#59; 1 of the patients had 4 lesions and also had a first-degree relative with a confirmed diagnosis of pilomatricoma&#46; Multiple pilomatricoma has been described in Steinert disease &#40;myotonic dystrophy&#41;&#44; Gardner syndrome&#44; Turner syndrome&#44; Sotos syndrome&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Rubinstein-Taybi syndrome&#44; medullary thyroid carcinoma&#44; and sarcoidosis&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> More recently&#44; it has also been described in isolated cases of trisomy syndromes&#44; cerebral glioblastoma&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> celiac disease&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> 21-hydroxylase deficiency&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> and Kabuki syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Concerning the etiology and pathogenesis of pilomatricoma&#44; several studies have demonstrated the presence of mutations in the &#946;-catenin pathway&#44; a signaling protein involved in the development of the hair follicle&#59; these studies have shown that the mutations favor the development of pilomatricoma and other adnexal tumors&#44; and may also affect other cancer-related genes&#44; possibly explaining why malignant tumors are more common in patients with multiple pilomatricomas&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#8211;29</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Two patients with multiple pilomatricoma in our series had Steiner syndrome&#46; The presence of multiple lesions in a patient with overgrowth syndrome and another with endometrial carcinoma has not been previously reported&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The association between solitary pilomatricoma and other diseases has not been previously studied&#46; The most common concomitant diseases in our series were other skin disorders&#44; malignant tumors&#44; and cardiovascular disease&#46; However&#44; given the high incidence of both pilomatricomas and these diseases&#44; it is easy to assume that the association is purely coincidental&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Pilomatricoma is treated by surgical excision&#44; but there is no consensus on the optimal age at which surgery should be performed in children&#44; or on the most appropriate technique and margins&#46; Our patients underwent simple excision without wide margins&#46; The choice of anesthetic technique was governed by clinical criteria&#44; including medical history&#44; concomitant medication&#44; age&#44; and tumor characteristics &#40;e&#46;g&#46;&#44; location and size&#41;&#46; One of the girls in our series died as a result of anesthetic complications in the postoperative period&#46; She had a progressively growing tumor and the results of the ultrasound evaluation had been inconclusive&#46; This is the first report of postsurgical complications in a patient with pilomatricoma&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The main limitations of our study are related to its retrospective design&#44; particularly in terms of the lack of uniformity in the collection of clinical data&#44; probably due to the large number of physicians involved&#46; In many cases&#44; for example&#44; there was no information on prior trauma at the tumor site&#44; possibly because the physician did not ask this question or note down the answer&#46; Furthermore&#44; the true frequency of pilomatricomas in our hospital is higher than that reported as our study design excluded patients with a clinical diagnosis of pilomatricoma who had not undergone surgery&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In conclusion&#44; this retrospective study of pilomatricomas is the largest to date in Spain and considering the number of years studied and the size of the population served by our hospital &#40;250 000&#41;&#44; we have reported one of the highest incidence rates of pilomatricoma&#46; We would also like to stress the high proportion of lesions evaluated by ultrasound and the considerable number of patients with multiple pilomatricoma&#46; To our knowledge&#44; this is the first study to describe concomitant diseases&#44; surgical treatment&#44; anesthetic techniques&#44; and postoperative complications in patients with pilomatricoma&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of Interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "titulo" => "Material and Methods"
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          "identificador" => "sec0015"
          "titulo" => "Results"
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          "titulo" => "Discussion"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2013-09-17"
    "fechaAceptado" => "2014-01-26"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec345132"
          "palabras" => array:4 [
            0 => "Pilomatricoma"
            1 => "Retrospective"
            2 => "Characteristics"
            3 => "Review"
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          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec345131"
          "palabras" => array:4 [
            0 => "Pilomatricoma"
            1 => "Retrospectivo"
            2 => "Caracter&#237;sticas"
            3 => "Revisi&#243;n"
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    "resumen" => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Background and objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Pilomatricoma is the second most common skin tumor in childhood and youth and it has a broad differential diagnosis&#46; The main objective of the present study was to determine the incidence of pilomatricomas in our hospital and to analyze the following variables&#58; patient age and sex&#44; tumor site&#44; symptoms&#44; previous trauma&#44; clinical diagnosis&#44; associated diseases&#44; number of cases of multiple tumors&#44; ultrasound findings&#44; anesthetic and surgical techniques&#44; and postoperative complications&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Material and method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This was a retrospective study of the pilomatricomas surgically excised between January 2004 and December 2012 and registered in the database of the pathology department of our hospital&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We found 261 pilomatricomas in 239 patients &#40;120 female and 119 male&#41; between 1 and 83 years of age &#40;mean age&#44; 26&#46;4 years&#41;&#46; The most common presentation was as a firm subcutaneous nodule&#44; which was asymptomatic in 82&#37; of cases&#46; Tumors most commonly affected the head and neck &#40;49&#46;81&#37;&#41;&#46; Preoperative diagnosis was correct in 54&#46;4&#37; of cases&#44; concomitant diseases were present in 59 cases&#44; and 7 patients reported a history of trauma in the area of the tumor&#46; There were 17 cases of multiple tumors&#44; 1 case in a patient with familial disease and 2 in patients with Steinert disease&#46; Soft-tissue ultrasound was performed on 57 lesions&#59; images were compatible with pilomatricoma in 48 cases&#46; Tumor excision was performed under local anesthesia in 185 cases and under local and general anesthesia in 76&#46; The postoperative complications were hypertrophic scarring and wound dehiscence &#40;1 case each&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">This was a retrospective study with the largest series recorded in Spain and with one of the highest incidences&#46; In addition&#44; we report on variables not described in other studies&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n y objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El pilomatricoma es la segunda neoformaci&#243;n cut&#225;nea m&#225;s frecuente en la infancia y la juventud&#44; con un amplio diagn&#243;stico diferencial&#46; El objetivo principal del estudio fue determinar la incidencia de pilomatricomas en nuestro hospital y sus caracter&#237;sticas en relaci&#243;n con&#58; edad&#44; sexo&#44; localizaci&#243;n&#44; s&#237;ntomas&#44; traumatismo previo&#44; diagn&#243;stico cl&#237;nico&#44; enfermedades asociadas&#44; casos m&#250;ltiples&#44; caracter&#237;sticas ecogr&#225;ficas&#44; tratamiento quir&#250;rgico y t&#233;cnica anest&#233;sica y complicaciones posteriores&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se recogieron de forma retrospectiva los pilomatricomas extirpados quir&#250;rgicamente en nuestro hospital de enero de 2004 a diciembre de 2012 a partir de la base de datos de anatom&#237;a patol&#243;gica&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se estudiaron 261 pilomatricomas en 239 pacientes&#44; 120 eran mujeres y 119 varones de edades comprendidas entre 1 y 83 a&#241;os&#44; con una media de 26&#44;4 a&#241;os&#46; La forma de presentaci&#243;n m&#225;s frecuente fue como un n&#243;dulo firme&#44; subcut&#225;neo&#44; asintom&#225;tico en el 82&#37; de los casos&#46; La localizaci&#243;n m&#225;s frecuente fue la cabeza y el cuello &#40;49&#44;81&#37;&#41;&#46; El diagn&#243;stico cl&#237;nico preoperatorio fue acertado en el 54&#44;4&#37;&#46; Cincuenta y nueve pacientes ten&#237;an otras enfermedades y 7 recordaban traumatismo previo en la zona&#46; Se registraron 17 casos m&#250;ltiples&#44; uno familiar&#44; y 2 en pacientes con enfermedad de Steinert&#46; En 57 lesiones se realiz&#243; ecograf&#237;a de partes blandas&#44; con im&#225;genes compatibles con pilomatricoma en 48&#46; Ciento ochenta y cinco pilomatricomas se extirparon con anestesia local y 76 con anestesia local y general&#46; Como complicaciones posquir&#250;rgicas hubo un caso de cicatriz hipertr&#243;fica y otro de dehiscencia&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El nuestro es el estudio retrospectivo que recoge el mayor n&#250;mero de casos en nuestro pa&#237;s y uno de los que comunica mayor incidencia de casos&#46; Adem&#225;s&#44; se estudian variables no recogidas en otras series&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Hern&#225;ndez-N&#250;&#241;ez A&#44; N&#225;jera Botello L&#44; Romero Mat&#233; A&#44; Mart&#237;nez-S&#225;nchez C&#44; Utrera Busquets M&#44; Calder&#243;n Kom&#225;romy A&#44; et al&#46; Estudio retrospectivo de pilomatricomas&#58; 261 tumores en 239 pacientes&#46; Actas Dermosifiliogr&#46; 2014&#59;105&#58;699&#8211;705&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A&#44; Firm&#44; subcutaneous nodular lesion with pigmentation in the overlying skin and whitish areas in the left frontotemporal region&#46; B&#44; Dermoscopic image of the same lesion&#46;</p>"
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Subcutaneous tumor measuring several centimeters&#44; with firm whitish lobulated areas in the left parietal area in a patient with Steinert disease&#46;</p>"
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          "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Well-circumscribed tumor with a mixed epithelial component composed of basaloid and shadow cells in the center of the lesion&#44; and a peripheral mesenchymal component formed by fibroblastic cells&#46; A&#44; Hematoxylin-eosin&#44; original magnification &#215;40&#46; B&#44; Hematoxylin-eosin&#44; original magnification &#215;100&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Location&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">No&#46; of Cases&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Head and neck&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">130&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">49&#46;81&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">Upper extremities&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">24&#46;52&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">Trunk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">15&#46;32&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Lower extremities&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">No&#46; of Cases&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" style="border-bottom: 2px solid black">&#37;&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">Pilomatricoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">142&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#46;4&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">Epidermal cyst&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;44&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">Subcutaneous tumor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;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">Trichilemmal cyst&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;29&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">Basal 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;29&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">Foreign body granuloma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;53&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">Molluscum contagiosum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;15&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">Dermatofibroma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;77&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">Juvenile xanthogranuloma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;77&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">Cutaneous leishmaniasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;77&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">Other<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;21&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">Not reported&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab549034.png"
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Includes 1 case of each of the following&#58; lipoma&#44; diseased lymph node&#44; skin metastasis&#44; squamous cell carcinoma&#44; salivary gland tumor&#44; hydrocystoma&#44; dermoid cyst&#44; angioleiomyoma&#44; angioma&#44; xanthomous lesion pending study&#44; and keratoacanthoma&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Preoperative Clinical Diagnosis for 261 Surgically Excised Pilomatricomas&#46;</p>"
        ]
      ]
      6 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
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            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">Total cases&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">59&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">Skin disorders or lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&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">Malignant tumor<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&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">Cardiovascular disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></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">Hormonal disorder<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></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">Respiratory disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></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">Steinert disease<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></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">Digestive disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></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">Attention deficit hyperactivity disorder&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></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">Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            0 => array:3 [
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Shown as number of cases&#46;</p>"
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            1 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Multiple pilomatricomas in a patient with endometrial cancer&#44; a patient with overgrowth syndrome&#44; and 2 patients with Steinert disease&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Concomitant Diseases in Patients With Pilomatricomas&#46;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a></p>"
        ]
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      7 => array:7 [
        "identificador" => "tbl0020"
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        "mostrarDisplay" => false
        "tabla" => array:1 [
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              "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">Authors&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">No&#46; of Patients&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">No&#46; of Years Covered&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">Mohlenbeck<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;569&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">Not reported&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">Pirouzmanesh et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">346&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11&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">Julian et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">209&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">20&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">Guinot-Moya et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">205&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">33&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">O¿Connor et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">201&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&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">Lan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&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">179&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11&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">Gay Scoda et al&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">179&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
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                  \t\t\t\t">17&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">Current study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">261&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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            3 => array:3 [
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                    0 => array:2 [
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                  "contribucion" => array:1 [
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                        0 => array:2 [
                          "etal" => false
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                            0 => "S&#46; Lopansri"
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Información del artículo
ISSN: 15782190
Idioma original: Inglés
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