array:24 [
  "pii" => "S1578219016000111"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2016.01.009"
  "estado" => "S300"
  "fechaPublicacion" => "2016-03-01"
  "aid" => "1244"
  "copyright" => "AEDV"
  "copyrightAnyo" => "2015"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "cita" => "Actas Dermosifiliogr. 2016;107:158-62"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 637
    "formatos" => array:3 [
      "EPUB" => 38
      "HTML" => 409
      "PDF" => 190
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0001731015003488"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2015.06.009"
      "estado" => "S300"
      "fechaPublicacion" => "2016-03-01"
      "aid" => "1244"
      "copyright" => "AEDV"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "crp"
      "cita" => "Actas Dermosifiliogr. 2016;107:158-62"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 347
        "formatos" => array:3 [
          "EPUB" => 3
          "HTML" => 184
          "PDF" => 160
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Carta cient&#237;fico-cl&#237;nica</span>"
        "titulo" => "&#191;Por qu&#233; la cirug&#237;a microgr&#225;fica de Mohs est&#225; infrautilizada en el tratamiento del dermatofibrosarcoma protuberans infantil&#63;"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "158"
            "paginaFinal" => "162"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Why Is Mohs Micrographic Surgery Underused in the Treatment of Dermatofibrosarcoma Protuberans in Children&#63;"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1920
                "Ancho" => 1800
                "Tamanyo" => 916599
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#46; Proliferaci&#243;n de c&#233;lulas fusiformes organizadas en fasc&#237;culos &#40;hematoxilina-eosina<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#41;&#46; B&#46; Espacios pseudovasculares irregulares delineados por c&#233;lulas gigantes multinucleadas &#40;hematoxilina-eosina<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#41; C&#46; Ocupaci&#243;n de la dermis con extensi&#243;n al tejido celular subcut&#225;neo &#40;hematoxilina-eosina<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>20&#41; D&#46; Las c&#233;lulas fusiformes expresan el marcador CD34 &#40;&#215;<span class="elsevierStyleHsp" style=""></span>20&#41;&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "E&#46; Jubert, L&#46;J&#46; del Pozo, C&#46; Saus, A&#46; Mart&#237;n-Santiago"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Jubert"
              ]
              1 => array:2 [
                "nombre" => "L&#46;J&#46;"
                "apellidos" => "del Pozo"
              ]
              2 => array:2 [
                "nombre" => "C&#46;"
                "apellidos" => "Saus"
              ]
              3 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Mart&#237;n-Santiago"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1578219016000111"
          "doi" => "10.1016/j.adengl.2016.01.009"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016000111?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015003488?idApp=UINPBA000044"
      "url" => "/00017310/0000010700000002/v2_201603080122/S0001731015003488/v2_201603080122/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S157821901600010X"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2016.01.008"
    "estado" => "S300"
    "fechaPublicacion" => "2016-03-01"
    "aid" => "1245"
    "copyright" => "AEDV"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Actas Dermosifiliogr. 2016;107:162-3"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 656
      "formatos" => array:3 [
        "EPUB" => 44
        "HTML" => 392
        "PDF" => 220
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>"
      "titulo" => "Abdominal Wall Angiosarcoma in a Patient With Drug-Induced Immunosuppression Following Renal Transplantation"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "162"
          "paginaFinal" => "163"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Angiosarcoma de pared abdominal en paciente con inmunosupresi&#243;n farmacol&#243;gica por trasplante renal"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 723
              "Ancho" => 1000
              "Tamanyo" => 119052
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Large bruise-like reddish-purple plaque covering nearly the entire lower half of the abdomen&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "P&#46; Mart&#237;n, A&#46; Pulpillo, R&#46; Cabrera, J&#46; Conejo-Mir"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Mart&#237;n"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Pulpillo"
            ]
            2 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Cabrera"
            ]
            3 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Conejo-Mir"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S000173101500349X"
        "doi" => "10.1016/j.ad.2015.07.010"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101500349X?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901600010X?idApp=UINPBA000044"
    "url" => "/15782190/0000010700000002/v2_201703220318/S157821901600010X/v2_201703220318/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1578219016000123"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2016.01.010"
    "estado" => "S300"
    "fechaPublicacion" => "2016-03-01"
    "aid" => "1243"
    "copyright" => "AEDV"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Actas Dermosifiliogr. 2016;107:156-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 756
      "formatos" => array:3 [
        "EPUB" => 34
        "HTML" => 498
        "PDF" => 224
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>"
      "titulo" => "Milia en plaque on the posterior surface of both auricules following radiation therapy"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "156"
          "paginaFinal" => "158"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Milia en Placa en la Cara Posterior de Ambos Pabellones Auriculares Secundaria a Radioterapia"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 1295
              "Ancho" => 975
              "Tamanyo" => 457019
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cystic cavity in the superficial dermis&#46; The cyst contains orthokeratotic keratin and is lined by a stratified squamous epithelium&#46; Hematoxylin-eosin&#44; original magnification x10&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A&#46;M&#46; Pisauri, A&#46; Alvarez-Gracia, C&#46; Ferrandiz-Foraster, J&#46; Bassas-Vila"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "A&#46;M&#46;"
              "apellidos" => "Pisauri"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Alvarez-Gracia"
            ]
            2 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Ferrandiz-Foraster"
            ]
            3 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Bassas-Vila"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731015003476"
        "doi" => "10.1016/j.ad.2015.07.009"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015003476?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016000123?idApp=UINPBA000044"
    "url" => "/15782190/0000010700000002/v2_201703220318/S1578219016000123/v2_201703220318/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>"
    "titulo" => "Why Is Mohs Micrographic Surgery Underused in the Treatment of Dermatofibrosarcoma Protuberans in Children&#63;"
    "tieneTextoCompleto" => true
    "saludo" => "<span class="elsevierStyleItalic">To the Editor&#58;</span>"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "158"
        "paginaFinal" => "162"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "E&#46; Jubert, L&#46;J&#46; del Pozo, C&#46; Saus, A&#46; Mart&#237;n-Santiago"
        "autores" => array:4 [
          0 => array:3 [
            "nombre" => "E&#46;"
            "apellidos" => "Jubert"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "L&#46;J&#46;"
            "apellidos" => "del Pozo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "C&#46;"
            "apellidos" => "Saus"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:4 [
            "nombre" => "A&#46;"
            "apellidos" => "Mart&#237;n-Santiago"
            "email" => array:1 [
              0 => "anahsd&#64;telefonica&#46;net"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital Universitario Son Espases&#44; Palma de Mallorca&#44; Espa&#241;a"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Anatom&#237;a Patol&#243;gica&#44; Hospital Universitario Son Espases&#44; Palma de Mallorca&#44; Espa&#241;a"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "&#191;Por qu&#233; la cirug&#237;a microgr&#225;fica de Mohs est&#225; infrautilizada en el tratamiento del dermatofibrosarcoma protuberans infantil&#63;"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1915
            "Ancho" => 1800
            "Tamanyo" => 932647
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#46; Proliferation of spindle cells arranged in fascicles &#40;original magnification&#44; hematoxylin-eosin<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#41;&#46; B&#44; Irregular pseudovascular spaces surrounded by multinucleated giant cells &#40;original magnification&#44; hematoxylin-eosin<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#41;&#46;<span class="elsevierStyleHsp" style=""></span>C&#44; Involvement of full thickness of the dermis with extension into the subcutaneous tissue &#40;original magnification&#44; hematoxylin-eosin<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>20&#41;&#46; D&#44; Spindle cells expressing CD34 &#40;&#215;<span class="elsevierStyleHsp" style=""></span>20&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Dermatofibrosarcoma protuberans &#40;DFSP&#41; is a slow-growing&#44; intermediate-grade fibrohistiocytic tumor characterized by high rates of local recurrence but low metastatic potential&#46; Few cases of congenital forms have been reported&#44; but this is probably because early lesions can go unnoticed or be confused with other entities&#46; There is evidence that recurrence rates are lower with Mohs micrographic surgery &#40;MMS&#41; than with conventional surgery with wide margins&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Nonetheless&#44; in 3 recently published pediatric series&#44; wide excision was used in the vast majority of patients &#40;41&#47;43&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2&#8211;4</span></a> We present a case of congenital giant-cell fibroblastoma&#44; a histologic subtype of DFSP&#44; which was diagnosed and treated in an 8-year-old boy&#46; In this report&#44; we highlight the advantages of MMS and the use of negative-pressure wound therapy &#40;NPWT&#41; in children with DFSP&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was an 8-year-old boy with no relevant past history who was seen for a lesion in the right axilla that had grown and become progressively harder&#46; The lesion&#44; which was initially flat and reddish in color&#44; had been present since birth&#46; Examination revealed an indurated&#44; mobile plaque measuring 4<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>2&#46;5<span class="elsevierStyleHsp" style=""></span>cm&#46; The plaque was pink but had a purple&#44; slightly elevated area&#46; The regional lymph nodes were not enlarged&#46; Biopsy showed a poorly delimited tumorous lesion composed of spindle and oval cells that occupied practically the entire dermis and extended down into the subcutaneous tissue&#46; Pseudovascular spaces surrounded by multinucleated giant cells were also visible&#46; The spindle cells expressed CD34 and were negative for S-100 protein and smooth muscle actin &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; A diagnosis of giant cell fibroblastoma was established&#44; and extracutaneous invasion was ruled out by magnetic resonance imaging&#46; The tumor was excised under general anesthesia&#46; The technique chosen was slow MMS &#40;Breuninger technique&#41;&#44; with excision of 1-cm margins in the first stage &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; This technique consists of the en bloc resection of the tumor at a 90&#176; angle to the surface and the achievement of a uniform wound bed&#46; In our case&#44; the depth of excision reached the fascia&#46; The resected specimen was fixed in formol and embedded in paraffin&#46; Because the slides with samples from the deep and peripheral margins were to be reviewed at a later date&#44; it was decided to cover the surgical defect with a NPWT system with a negative continuous pressure of 125&#160;mm<span class="elsevierStyleHsp" style=""></span>Hg &#40;Kinetic Concepts Inc&#46;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> A-C&#41;&#46; On day 9&#44; with histologic confirmation of tumor-free margins&#44; the surgical defect was reconstructed using a Limberg flap over the granulation tissue formed during NPWT&#59; no specific preparation was required &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>D&#41;&#46; There have been no recurrences in 4 years of follow-up&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">DFSP is a rare tumor in children&#44; with an estimated incidence of 1 case per 1&#160;000&#160;000 population under the age of 20 years&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> Its prevalence could&#44; however&#44; be underestimated as time to diagnosis ranges from 5 to 15 years&#46; Congenital forms of DFSP are even rarer&#46; In 1 series of 152 cases of childhood DFSP&#44; for example&#44; only 20 tumors were congenital&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Childhood and adult forms are similar in terms of immunohistochemical characteristics&#44; the translocation of genetic material between chromosomes 17 and 22&#44; and the association with the <span class="elsevierStyleItalic">COL1A1-PDGFB</span> fusion gene&#46; Congenital variants of DFSP present more frequently as a stain or an atrophic plaque than as a tumorous lesion&#46; The differential diagnosis is broad and includes vascular anomalies&#44; aplasia cutis congenita&#44; atrophoderma&#44; myofibromatosis&#44; childhood fibromatosis&#44; and fibrosarcomas&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Compared with adults&#44; in children&#44; tumors are more frequently located on the lower extremities and at acral sites&#46; Other differences in children include lower recurrence rates&#44; very few cases of metastasis&#44; and little use of MMS&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The treatment of choice for DFSP is surgery&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> with imatinib<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> and radiation therapy reserved for recurrent&#44; unresectable&#44; or metastatic tumors&#46; In a report of 74 patients&#44; mostly adults&#44; with DFSP&#44; and a review of the literature&#44; Serra-Guillen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> concluded that MMS was associated with considerably fewer recurrences than conventional surgery with wide margins&#44; and also achieved greater preservation of healthy tissue&#46; The most common MMS technique used is slow MMS&#44; which requires coverage of the surgical defect with biosynthetic skin substitutes or other dressings&#46; NPWT&#44; however&#44; has been proposed as an alternative to skin substitutes for temporary wound coverage&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> This system reduces the need for analgesia and sedation and also requires less frequent wound dressing&#46; In our case&#44; it additionally allowed the patient to walk around and move his arm&#46; Portable vacuum systems can be used on an outpatient basis&#44; but because of the geographic distribution of our community &#40;our hospital is on an island&#41;&#44; we were not able to use a portable NPWT system&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In 2014&#44; there were 3 reports of childhood DFSP in hospitals in Taiwan&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> Canada&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> and Spain&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> The series included&#44; respectively&#44; 13&#44; 17&#44; and 13 patients under the age of 18 years&#44; but surprisingly&#44; MMS was used in just 2 of these 43 patients&#46; If MMS has been shown to achieve better therapeutic&#44; functional&#44; and cosmetic results&#44; why is it underused in children with DFSP&#63; Finally&#44; we would like to stress the importance of working closely with multidisciplinary teams to ensure that children with DFSP are diagnosed and treated correctly&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Jubert E&#44; del Pozo LJ&#44; Saus C&#44; Mart&#237;n-Santiago A&#46; &#191;Por qu&#233; la cirug&#237;a microgr&#225;fica de Mohs est&#225; infrautilizada en el tratamiento del dermatofibrosarcoma protuberans infantil&#63;&#46; Actas Dermosifiliogr&#46; 2016&#59;107&#58;158&#8211;162&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1915
            "Ancho" => 1800
            "Tamanyo" => 932647
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#46; Proliferation of spindle cells arranged in fascicles &#40;original magnification&#44; hematoxylin-eosin<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#41;&#46; B&#44; Irregular pseudovascular spaces surrounded by multinucleated giant cells &#40;original magnification&#44; hematoxylin-eosin<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#41;&#46;<span class="elsevierStyleHsp" style=""></span>C&#44; Involvement of full thickness of the dermis with extension into the subcutaneous tissue &#40;original magnification&#44; hematoxylin-eosin<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>20&#41;&#46; D&#44; Spindle cells expressing CD34 &#40;&#215;<span class="elsevierStyleHsp" style=""></span>20&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1872
            "Ancho" => 1500
            "Tamanyo" => 573330
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A&#44; Schematic of specimen&#46; B&#44; Ring-shaped excision of a 1-cm margin of healthy skin around the debulking specimen&#46; C&#44; Specimen from first slow MMS stage embedded in paraffin for examination&#46; D&#44; Final surgical defect measuring 6<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>4&#46;5<span class="elsevierStyleHsp" style=""></span>cm&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1587
            "Ancho" => 1900
            "Tamanyo" => 531959
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Negative pressure wound therapy &#40;NPWT&#41; system&#46; A&#44; Coverage of skin defect with foam&#46; B&#44; Placement of adhesive film over the foam to seal the system&#46; C&#44; Placement of vacuum tube connected to NPWT system&#46; D&#44; Reconstruction of surgical defect with Limberg flap&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:9 [
            0 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mohs micrographic surgery in dermatofibrosarcoma protuberans allows tumour clearance with smaller margins and greater preservation of healthy tissue compared with conventional surgery&#58; A study of 74 primary cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Serra-Guill&#233;n"
                            1 => "B&#46; Llombart"
                            2 => "E&#46; Nagore"
                            3 => "C&#46; Guill&#233;n"
                            4 => "C&#46; Requena"
                            5 => "V&#46; Traves"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/bjd.13417"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2015"
                        "volumen" => "172"
                        "paginaInicial" => "1303"
                        "paginaFinal" => "1307"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25244003"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermatofibrosarcoma protuberans in children and adolescents&#58; Clinical presentation&#44; histology&#44; treatment&#44; and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Y&#46;J&#46; Tsai"
                            1 => "P&#46;Y&#46; Lin"
                            2 => "K&#46;Y&#46; Chew"
                            3 => "Y&#46;C&#46; Chiang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bjps.2014.05.031"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Plast Reconstr Aesthet Surg"
                        "fecha" => "2014"
                        "volumen" => "67"
                        "paginaInicial" => "1222"
                        "paginaFinal" => "1229"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24973861"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermatofibrosarcoma protuberans in pediatric patients&#58; A report of 17 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;J&#46; Posso-de Los Rios"
                            1 => "I&#46; Lara-Corrales"
                            2 => "N&#46; Ho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2310/7750.2013.13099"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cutan Med Surg"
                        "fecha" => "2014"
                        "volumen" => "18"
                        "paginaInicial" => "180"
                        "paginaFinal" => "185"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24800706"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pediatric dermatofibrosarcoma protuberans in Madrid&#44; Spain&#58; Multi-institutional outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Valdivielso-Ramos"
                            1 => "A&#46; Torrelo"
                            2 => "M&#46; Campos"
                            3 => "M&#46; Feito"
                            4 => "R&#46; Gamo"
                            5 => "J&#46;L&#46; Rodriguez-Peralto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/pde.12371"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Dermatol"
                        "fecha" => "2014"
                        "volumen" => "31"
                        "paginaInicial" => "676"
                        "paginaFinal" => "682"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25424208"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermato&#64257;brosarcoma protuberans in children&#58; An update on the diagnosis and treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;I&#46; Kornik"
                            1 => "L&#46;K&#46; Muchard"
                            2 => "J&#46;M&#46; Teng"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1525-1470.2012.01767.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Dermatol"
                        "fecha" => "2012"
                        "volumen" => "29"
                        "paginaInicial" => "707"
                        "paginaFinal" => "712"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22780227"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermatofibrosarcoma protuberans in childhood"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Valdivielso-Ramos"
                            1 => "J&#46;M&#46; Hernanz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.adengl.2011.12.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2012"
                        "volumen" => "103"
                        "paginaInicial" => "863"
                        "paginaFinal" => "873"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23154247"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Dermato&#64257;brosarcoma protuberans&#46; NCCN Guidelines for treatment of cancer by site&#46; &#91;access 19 Mar 2015&#93;&#46; Available from&#58; <a href="http://www.nccn.org/">www&#46;nccn&#46;org</a>"
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Imatinib mesylate for children with dermatofibrosarcoma protuberans"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;L&#46; Gooskens"
                            1 => "A&#46;P&#46; Oranje"
                            2 => "L&#46;N&#46; van Adrichem"
                            3 => "F&#46;B&#46; de Waard-van der Spek"
                            4 => "J&#46;C&#46; den Hollander"
                            5 => "C&#46;P&#46; van den Ven"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/pbc.22494"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Blood Cancer"
                        "fecha" => "2010"
                        "volumen" => "55"
                        "paginaInicial" => "369"
                        "paginaFinal" => "373"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20582941"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermatofibrosarcoma protuberans in childhood treated with slow Mohs micrographic surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Barysch"
                            1 => "L&#46; Weibel"
                            2 => "K&#46; Neuhaus"
                            3 => "U&#46; Subotic"
                            4 => "L&#46; Sch&#228;rer"
                            5 => "D&#46; Donghi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/pde.12039"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Dermatol"
                        "fecha" => "2013"
                        "volumen" => "30"
                        "paginaInicial" => "462"
                        "paginaFinal" => "468"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23432099"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000010700000002/v2_201703220318/S1578219016000111/v2_201703220318/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "6157"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Case and Research Letters"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010700000002/v2_201703220318/S1578219016000111/v2_201703220318/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016000111?idApp=UINPBA000044"
]
Compartir
Información de la revista

Estadísticas

Siga este enlace para acceder al texto completo del artículo

Case and Research Letters
Why Is Mohs Micrographic Surgery Underused in the Treatment of Dermatofibrosarcoma Protuberans in Children?
¿Por qué la cirugía micrográfica de Mohs está infrautilizada en el tratamiento del dermatofibrosarcoma protuberans infantil?
E. Juberta, L.J. del Pozoa, C. Sausb, A. Martín-Santiagoa,
Autor para correspondencia
anahsd@telefonica.net

Corresponding author.
a Servicio de Dermatología, Hospital Universitario Son Espases, Palma de Mallorca, España
b Servicio de Anatomía Patológica, Hospital Universitario Son Espases, Palma de Mallorca, España
Leído
4962
Veces
se ha leído el artículo
1719
Total PDF
3243
Total HTML
Compartir estadísticas
 array:24 [
  "pii" => "S1578219016000111"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2016.01.009"
  "estado" => "S300"
  "fechaPublicacion" => "2016-03-01"
  "aid" => "1244"
  "copyright" => "AEDV"
  "copyrightAnyo" => "2015"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "cita" => "Actas Dermosifiliogr. 2016;107:158-62"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 637
    "formatos" => array:3 [
      "EPUB" => 38
      "HTML" => 409
      "PDF" => 190
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0001731015003488"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2015.06.009"
      "estado" => "S300"
      "fechaPublicacion" => "2016-03-01"
      "aid" => "1244"
      "copyright" => "AEDV"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "crp"
      "cita" => "Actas Dermosifiliogr. 2016;107:158-62"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 347
        "formatos" => array:3 [
          "EPUB" => 3
          "HTML" => 184
          "PDF" => 160
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Carta cient&#237;fico-cl&#237;nica</span>"
        "titulo" => "&#191;Por qu&#233; la cirug&#237;a microgr&#225;fica de Mohs est&#225; infrautilizada en el tratamiento del dermatofibrosarcoma protuberans infantil&#63;"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "158"
            "paginaFinal" => "162"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Why Is Mohs Micrographic Surgery Underused in the Treatment of Dermatofibrosarcoma Protuberans in Children&#63;"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1920
                "Ancho" => 1800
                "Tamanyo" => 916599
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#46; Proliferaci&#243;n de c&#233;lulas fusiformes organizadas en fasc&#237;culos &#40;hematoxilina-eosina<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#41;&#46; B&#46; Espacios pseudovasculares irregulares delineados por c&#233;lulas gigantes multinucleadas &#40;hematoxilina-eosina<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#41; C&#46; Ocupaci&#243;n de la dermis con extensi&#243;n al tejido celular subcut&#225;neo &#40;hematoxilina-eosina<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>20&#41; D&#46; Las c&#233;lulas fusiformes expresan el marcador CD34 &#40;&#215;<span class="elsevierStyleHsp" style=""></span>20&#41;&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "E&#46; Jubert, L&#46;J&#46; del Pozo, C&#46; Saus, A&#46; Mart&#237;n-Santiago"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Jubert"
              ]
              1 => array:2 [
                "nombre" => "L&#46;J&#46;"
                "apellidos" => "del Pozo"
              ]
              2 => array:2 [
                "nombre" => "C&#46;"
                "apellidos" => "Saus"
              ]
              3 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Mart&#237;n-Santiago"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1578219016000111"
          "doi" => "10.1016/j.adengl.2016.01.009"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016000111?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015003488?idApp=UINPBA000044"
      "url" => "/00017310/0000010700000002/v2_201603080122/S0001731015003488/v2_201603080122/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S157821901600010X"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2016.01.008"
    "estado" => "S300"
    "fechaPublicacion" => "2016-03-01"
    "aid" => "1245"
    "copyright" => "AEDV"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Actas Dermosifiliogr. 2016;107:162-3"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 656
      "formatos" => array:3 [
        "EPUB" => 44
        "HTML" => 392
        "PDF" => 220
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>"
      "titulo" => "Abdominal Wall Angiosarcoma in a Patient With Drug-Induced Immunosuppression Following Renal Transplantation"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "162"
          "paginaFinal" => "163"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Angiosarcoma de pared abdominal en paciente con inmunosupresi&#243;n farmacol&#243;gica por trasplante renal"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 723
              "Ancho" => 1000
              "Tamanyo" => 119052
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Large bruise-like reddish-purple plaque covering nearly the entire lower half of the abdomen&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "P&#46; Mart&#237;n, A&#46; Pulpillo, R&#46; Cabrera, J&#46; Conejo-Mir"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Mart&#237;n"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Pulpillo"
            ]
            2 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Cabrera"
            ]
            3 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Conejo-Mir"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S000173101500349X"
        "doi" => "10.1016/j.ad.2015.07.010"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101500349X?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901600010X?idApp=UINPBA000044"
    "url" => "/15782190/0000010700000002/v2_201703220318/S157821901600010X/v2_201703220318/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1578219016000123"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2016.01.010"
    "estado" => "S300"
    "fechaPublicacion" => "2016-03-01"
    "aid" => "1243"
    "copyright" => "AEDV"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Actas Dermosifiliogr. 2016;107:156-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 756
      "formatos" => array:3 [
        "EPUB" => 34
        "HTML" => 498
        "PDF" => 224
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>"
      "titulo" => "Milia en plaque on the posterior surface of both auricules following radiation therapy"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "156"
          "paginaFinal" => "158"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Milia en Placa en la Cara Posterior de Ambos Pabellones Auriculares Secundaria a Radioterapia"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 1295
              "Ancho" => 975
              "Tamanyo" => 457019
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cystic cavity in the superficial dermis&#46; The cyst contains orthokeratotic keratin and is lined by a stratified squamous epithelium&#46; Hematoxylin-eosin&#44; original magnification x10&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A&#46;M&#46; Pisauri, A&#46; Alvarez-Gracia, C&#46; Ferrandiz-Foraster, J&#46; Bassas-Vila"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "A&#46;M&#46;"
              "apellidos" => "Pisauri"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Alvarez-Gracia"
            ]
            2 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Ferrandiz-Foraster"
            ]
            3 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Bassas-Vila"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731015003476"
        "doi" => "10.1016/j.ad.2015.07.009"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015003476?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016000123?idApp=UINPBA000044"
    "url" => "/15782190/0000010700000002/v2_201703220318/S1578219016000123/v2_201703220318/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>"
    "titulo" => "Why Is Mohs Micrographic Surgery Underused in the Treatment of Dermatofibrosarcoma Protuberans in Children&#63;"
    "tieneTextoCompleto" => true
    "saludo" => "<span class="elsevierStyleItalic">To the Editor&#58;</span>"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "158"
        "paginaFinal" => "162"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "E&#46; Jubert, L&#46;J&#46; del Pozo, C&#46; Saus, A&#46; Mart&#237;n-Santiago"
        "autores" => array:4 [
          0 => array:3 [
            "nombre" => "E&#46;"
            "apellidos" => "Jubert"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "L&#46;J&#46;"
            "apellidos" => "del Pozo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "C&#46;"
            "apellidos" => "Saus"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:4 [
            "nombre" => "A&#46;"
            "apellidos" => "Mart&#237;n-Santiago"
            "email" => array:1 [
              0 => "anahsd&#64;telefonica&#46;net"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital Universitario Son Espases&#44; Palma de Mallorca&#44; Espa&#241;a"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Anatom&#237;a Patol&#243;gica&#44; Hospital Universitario Son Espases&#44; Palma de Mallorca&#44; Espa&#241;a"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "&#191;Por qu&#233; la cirug&#237;a microgr&#225;fica de Mohs est&#225; infrautilizada en el tratamiento del dermatofibrosarcoma protuberans infantil&#63;"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1915
            "Ancho" => 1800
            "Tamanyo" => 932647
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#46; Proliferation of spindle cells arranged in fascicles &#40;original magnification&#44; hematoxylin-eosin<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#41;&#46; B&#44; Irregular pseudovascular spaces surrounded by multinucleated giant cells &#40;original magnification&#44; hematoxylin-eosin<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#41;&#46;<span class="elsevierStyleHsp" style=""></span>C&#44; Involvement of full thickness of the dermis with extension into the subcutaneous tissue &#40;original magnification&#44; hematoxylin-eosin<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>20&#41;&#46; D&#44; Spindle cells expressing CD34 &#40;&#215;<span class="elsevierStyleHsp" style=""></span>20&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Dermatofibrosarcoma protuberans &#40;DFSP&#41; is a slow-growing&#44; intermediate-grade fibrohistiocytic tumor characterized by high rates of local recurrence but low metastatic potential&#46; Few cases of congenital forms have been reported&#44; but this is probably because early lesions can go unnoticed or be confused with other entities&#46; There is evidence that recurrence rates are lower with Mohs micrographic surgery &#40;MMS&#41; than with conventional surgery with wide margins&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Nonetheless&#44; in 3 recently published pediatric series&#44; wide excision was used in the vast majority of patients &#40;41&#47;43&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2&#8211;4</span></a> We present a case of congenital giant-cell fibroblastoma&#44; a histologic subtype of DFSP&#44; which was diagnosed and treated in an 8-year-old boy&#46; In this report&#44; we highlight the advantages of MMS and the use of negative-pressure wound therapy &#40;NPWT&#41; in children with DFSP&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was an 8-year-old boy with no relevant past history who was seen for a lesion in the right axilla that had grown and become progressively harder&#46; The lesion&#44; which was initially flat and reddish in color&#44; had been present since birth&#46; Examination revealed an indurated&#44; mobile plaque measuring 4<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>2&#46;5<span class="elsevierStyleHsp" style=""></span>cm&#46; The plaque was pink but had a purple&#44; slightly elevated area&#46; The regional lymph nodes were not enlarged&#46; Biopsy showed a poorly delimited tumorous lesion composed of spindle and oval cells that occupied practically the entire dermis and extended down into the subcutaneous tissue&#46; Pseudovascular spaces surrounded by multinucleated giant cells were also visible&#46; The spindle cells expressed CD34 and were negative for S-100 protein and smooth muscle actin &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; A diagnosis of giant cell fibroblastoma was established&#44; and extracutaneous invasion was ruled out by magnetic resonance imaging&#46; The tumor was excised under general anesthesia&#46; The technique chosen was slow MMS &#40;Breuninger technique&#41;&#44; with excision of 1-cm margins in the first stage &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; This technique consists of the en bloc resection of the tumor at a 90&#176; angle to the surface and the achievement of a uniform wound bed&#46; In our case&#44; the depth of excision reached the fascia&#46; The resected specimen was fixed in formol and embedded in paraffin&#46; Because the slides with samples from the deep and peripheral margins were to be reviewed at a later date&#44; it was decided to cover the surgical defect with a NPWT system with a negative continuous pressure of 125&#160;mm<span class="elsevierStyleHsp" style=""></span>Hg &#40;Kinetic Concepts Inc&#46;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> A-C&#41;&#46; On day 9&#44; with histologic confirmation of tumor-free margins&#44; the surgical defect was reconstructed using a Limberg flap over the granulation tissue formed during NPWT&#59; no specific preparation was required &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>D&#41;&#46; There have been no recurrences in 4 years of follow-up&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">DFSP is a rare tumor in children&#44; with an estimated incidence of 1 case per 1&#160;000&#160;000 population under the age of 20 years&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> Its prevalence could&#44; however&#44; be underestimated as time to diagnosis ranges from 5 to 15 years&#46; Congenital forms of DFSP are even rarer&#46; In 1 series of 152 cases of childhood DFSP&#44; for example&#44; only 20 tumors were congenital&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Childhood and adult forms are similar in terms of immunohistochemical characteristics&#44; the translocation of genetic material between chromosomes 17 and 22&#44; and the association with the <span class="elsevierStyleItalic">COL1A1-PDGFB</span> fusion gene&#46; Congenital variants of DFSP present more frequently as a stain or an atrophic plaque than as a tumorous lesion&#46; The differential diagnosis is broad and includes vascular anomalies&#44; aplasia cutis congenita&#44; atrophoderma&#44; myofibromatosis&#44; childhood fibromatosis&#44; and fibrosarcomas&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Compared with adults&#44; in children&#44; tumors are more frequently located on the lower extremities and at acral sites&#46; Other differences in children include lower recurrence rates&#44; very few cases of metastasis&#44; and little use of MMS&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The treatment of choice for DFSP is surgery&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> with imatinib<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> and radiation therapy reserved for recurrent&#44; unresectable&#44; or metastatic tumors&#46; In a report of 74 patients&#44; mostly adults&#44; with DFSP&#44; and a review of the literature&#44; Serra-Guillen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> concluded that MMS was associated with considerably fewer recurrences than conventional surgery with wide margins&#44; and also achieved greater preservation of healthy tissue&#46; The most common MMS technique used is slow MMS&#44; which requires coverage of the surgical defect with biosynthetic skin substitutes or other dressings&#46; NPWT&#44; however&#44; has been proposed as an alternative to skin substitutes for temporary wound coverage&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> This system reduces the need for analgesia and sedation and also requires less frequent wound dressing&#46; In our case&#44; it additionally allowed the patient to walk around and move his arm&#46; Portable vacuum systems can be used on an outpatient basis&#44; but because of the geographic distribution of our community &#40;our hospital is on an island&#41;&#44; we were not able to use a portable NPWT system&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In 2014&#44; there were 3 reports of childhood DFSP in hospitals in Taiwan&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> Canada&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> and Spain&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> The series included&#44; respectively&#44; 13&#44; 17&#44; and 13 patients under the age of 18 years&#44; but surprisingly&#44; MMS was used in just 2 of these 43 patients&#46; If MMS has been shown to achieve better therapeutic&#44; functional&#44; and cosmetic results&#44; why is it underused in children with DFSP&#63; Finally&#44; we would like to stress the importance of working closely with multidisciplinary teams to ensure that children with DFSP are diagnosed and treated correctly&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Jubert E&#44; del Pozo LJ&#44; Saus C&#44; Mart&#237;n-Santiago A&#46; &#191;Por qu&#233; la cirug&#237;a microgr&#225;fica de Mohs est&#225; infrautilizada en el tratamiento del dermatofibrosarcoma protuberans infantil&#63;&#46; Actas Dermosifiliogr&#46; 2016&#59;107&#58;158&#8211;162&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1915
            "Ancho" => 1800
            "Tamanyo" => 932647
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#46; Proliferation of spindle cells arranged in fascicles &#40;original magnification&#44; hematoxylin-eosin<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#41;&#46; B&#44; Irregular pseudovascular spaces surrounded by multinucleated giant cells &#40;original magnification&#44; hematoxylin-eosin<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#41;&#46;<span class="elsevierStyleHsp" style=""></span>C&#44; Involvement of full thickness of the dermis with extension into the subcutaneous tissue &#40;original magnification&#44; hematoxylin-eosin<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>20&#41;&#46; D&#44; Spindle cells expressing CD34 &#40;&#215;<span class="elsevierStyleHsp" style=""></span>20&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1872
            "Ancho" => 1500
            "Tamanyo" => 573330
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A&#44; Schematic of specimen&#46; B&#44; Ring-shaped excision of a 1-cm margin of healthy skin around the debulking specimen&#46; C&#44; Specimen from first slow MMS stage embedded in paraffin for examination&#46; D&#44; Final surgical defect measuring 6<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>4&#46;5<span class="elsevierStyleHsp" style=""></span>cm&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1587
            "Ancho" => 1900
            "Tamanyo" => 531959
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Negative pressure wound therapy &#40;NPWT&#41; system&#46; A&#44; Coverage of skin defect with foam&#46; B&#44; Placement of adhesive film over the foam to seal the system&#46; C&#44; Placement of vacuum tube connected to NPWT system&#46; D&#44; Reconstruction of surgical defect with Limberg flap&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:9 [
            0 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mohs micrographic surgery in dermatofibrosarcoma protuberans allows tumour clearance with smaller margins and greater preservation of healthy tissue compared with conventional surgery&#58; A study of 74 primary cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Serra-Guill&#233;n"
                            1 => "B&#46; Llombart"
                            2 => "E&#46; Nagore"
                            3 => "C&#46; Guill&#233;n"
                            4 => "C&#46; Requena"
                            5 => "V&#46; Traves"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/bjd.13417"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2015"
                        "volumen" => "172"
                        "paginaInicial" => "1303"
                        "paginaFinal" => "1307"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25244003"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermatofibrosarcoma protuberans in children and adolescents&#58; Clinical presentation&#44; histology&#44; treatment&#44; and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Y&#46;J&#46; Tsai"
                            1 => "P&#46;Y&#46; Lin"
                            2 => "K&#46;Y&#46; Chew"
                            3 => "Y&#46;C&#46; Chiang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bjps.2014.05.031"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Plast Reconstr Aesthet Surg"
                        "fecha" => "2014"
                        "volumen" => "67"
                        "paginaInicial" => "1222"
                        "paginaFinal" => "1229"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24973861"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermatofibrosarcoma protuberans in pediatric patients&#58; A report of 17 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;J&#46; Posso-de Los Rios"
                            1 => "I&#46; Lara-Corrales"
                            2 => "N&#46; Ho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2310/7750.2013.13099"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cutan Med Surg"
                        "fecha" => "2014"
                        "volumen" => "18"
                        "paginaInicial" => "180"
                        "paginaFinal" => "185"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24800706"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pediatric dermatofibrosarcoma protuberans in Madrid&#44; Spain&#58; Multi-institutional outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Valdivielso-Ramos"
                            1 => "A&#46; Torrelo"
                            2 => "M&#46; Campos"
                            3 => "M&#46; Feito"
                            4 => "R&#46; Gamo"
                            5 => "J&#46;L&#46; Rodriguez-Peralto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/pde.12371"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Dermatol"
                        "fecha" => "2014"
                        "volumen" => "31"
                        "paginaInicial" => "676"
                        "paginaFinal" => "682"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25424208"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermato&#64257;brosarcoma protuberans in children&#58; An update on the diagnosis and treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;I&#46; Kornik"
                            1 => "L&#46;K&#46; Muchard"
                            2 => "J&#46;M&#46; Teng"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1525-1470.2012.01767.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Dermatol"
                        "fecha" => "2012"
                        "volumen" => "29"
                        "paginaInicial" => "707"
                        "paginaFinal" => "712"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22780227"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermatofibrosarcoma protuberans in childhood"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Valdivielso-Ramos"
                            1 => "J&#46;M&#46; Hernanz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.adengl.2011.12.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2012"
                        "volumen" => "103"
                        "paginaInicial" => "863"
                        "paginaFinal" => "873"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23154247"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Dermato&#64257;brosarcoma protuberans&#46; NCCN Guidelines for treatment of cancer by site&#46; &#91;access 19 Mar 2015&#93;&#46; Available from&#58; <a href="http://www.nccn.org/">www&#46;nccn&#46;org</a>"
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Imatinib mesylate for children with dermatofibrosarcoma protuberans"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;L&#46; Gooskens"
                            1 => "A&#46;P&#46; Oranje"
                            2 => "L&#46;N&#46; van Adrichem"
                            3 => "F&#46;B&#46; de Waard-van der Spek"
                            4 => "J&#46;C&#46; den Hollander"
                            5 => "C&#46;P&#46; van den Ven"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/pbc.22494"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Blood Cancer"
                        "fecha" => "2010"
                        "volumen" => "55"
                        "paginaInicial" => "369"
                        "paginaFinal" => "373"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20582941"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermatofibrosarcoma protuberans in childhood treated with slow Mohs micrographic surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Barysch"
                            1 => "L&#46; Weibel"
                            2 => "K&#46; Neuhaus"
                            3 => "U&#46; Subotic"
                            4 => "L&#46; Sch&#228;rer"
                            5 => "D&#46; Donghi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/pde.12039"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Dermatol"
                        "fecha" => "2013"
                        "volumen" => "30"
                        "paginaInicial" => "462"
                        "paginaFinal" => "468"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23432099"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000010700000002/v2_201703220318/S1578219016000111/v2_201703220318/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "6157"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Case and Research Letters"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010700000002/v2_201703220318/S1578219016000111/v2_201703220318/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016000111?idApp=UINPBA000044"
]
Información del artículo
ISSN: 15782190
Idioma original: Inglés
Datos actualizados diariamente
año/Mes Html Pdf Total
2024 Noviembre 4 0 4
2024 Octubre 74 36 110
2024 Septiembre 81 18 99
2024 Agosto 90 59 149
2024 Julio 71 35 106
2024 Junio 67 33 100
2024 Mayo 78 37 115
2024 Abril 68 21 89
2024 Marzo 67 28 95
2024 Febrero 64 37 101
2024 Enero 58 33 91
2023 Diciembre 74 23 97
2023 Noviembre 72 24 96
2023 Octubre 82 23 105
2023 Septiembre 86 40 126
2023 Agosto 75 10 85
2023 Julio 60 33 93
2023 Junio 54 31 85
2023 Mayo 50 21 71
2023 Abril 48 20 68
2023 Marzo 54 22 76
2023 Febrero 58 37 95
2023 Enero 35 25 60
2022 Diciembre 52 34 86
2022 Noviembre 31 17 48
2022 Octubre 30 25 55
2022 Septiembre 22 38 60
2022 Agosto 19 33 52
2022 Julio 26 34 60
2022 Junio 18 22 40
2022 Mayo 33 33 66
2022 Abril 59 28 87
2022 Marzo 41 42 83
2022 Febrero 30 20 50
2022 Enero 40 23 63
2021 Diciembre 33 26 59
2021 Noviembre 43 41 84
2021 Octubre 54 42 96
2021 Septiembre 41 32 73
2021 Agosto 48 24 72
2021 Julio 48 24 72
2021 Junio 48 37 85
2021 Mayo 75 21 96
2021 Abril 61 39 100
2021 Marzo 76 15 91
2021 Febrero 56 25 81
2021 Enero 42 15 57
2020 Diciembre 48 19 67
2020 Noviembre 28 17 45
2020 Octubre 35 12 47
2020 Septiembre 36 8 44
2020 Agosto 28 26 54
2020 Julio 19 24 43
2020 Junio 48 31 79
2020 Mayo 26 20 46
2020 Abril 37 20 57
2020 Marzo 28 15 43
2020 Febrero 7 3 10
2019 Diciembre 4 2 6
2019 Septiembre 3 0 3
2019 Julio 4 0 4
2019 Mayo 3 1 4
2019 Abril 0 1 1
2019 Marzo 0 5 5
2019 Febrero 4 0 4
2018 Diciembre 2 0 2
2018 Noviembre 2 0 2
2018 Octubre 3 0 3
2018 Septiembre 5 0 5
2018 Agosto 0 2 2
2018 Mayo 0 8 8
2018 Marzo 1 0 1
2018 Febrero 23 5 28
2018 Enero 31 4 35
2017 Diciembre 27 8 35
2017 Noviembre 41 8 49
2017 Octubre 23 6 29
2017 Septiembre 13 6 19
2017 Agosto 19 8 27
2017 Julio 26 7 33
2017 Junio 24 7 31
2017 Mayo 19 15 34
2017 Abril 19 3 22
2017 Marzo 18 38 56
2017 Febrero 12 4 16
2017 Enero 21 7 28
2016 Diciembre 25 12 37
2016 Noviembre 18 10 28
2016 Octubre 17 17 34
2016 Junio 0 4 4
Mostrar todo

Siga este enlace para acceder al texto completo del artículo

Idiomas
Actas Dermo-Sifiliográficas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?