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        "titulo" => "Descripci&#243;n de las intervenciones quir&#250;rgicas recogidas en el registro espa&#241;ol de cirug&#237;a de Mohs &#40;REGESMOHS&#41; &#40;2013-2015&#41;"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Mohs micrographic surgery &#40;MMS&#41; is a surgical technique used to treat locally invasive malignant cutaneous tumors&#46; It offers higher cure rates than other treatments and minimizes the removal of healthy peritumoral tissue&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The original technique described by Dr&#46; Mohs was the fixed-tissue technique&#44; in which zinc chloride paste was applied to a lesion to achieve in situ fixation of the tumor tissue&#46; The paste was removed after several hours and the tumor excised without anesthesia and with hardly any bleeding&#46; The excised specimen was frozen and then horizontally sectioned for examination under a microscope&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">2</span></a> This procedure was repeated on successive days until all the margins of the final specimen were free of tumor&#46; Dr&#46; Mohs later described the fresh-tissue technique&#44; in which successive layers of the tumor were removed under local anesthesia&#44; without prior application of zinc chloride&#46; This technique allowed surgeons to remove several layers of tumor and even repair the surgical defect on the same day and it became the method of choice for practically all MMS surgeons&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The use of paraffin sections instead of frozen sections emerged for several reasons&#44; including the difficulty of examining frozen sections for certain tumors&#44; such as lentigo maligna &#40;LM&#41; and dermatofibrosarcoma protuberans &#40;DFSP&#41;&#44; the possibility of using immunostains in other cases&#44; or simply lack of access to a cryostat&#46; This modified procedure is known as <span class="elsevierStyleItalic">slow Mohs</span>&#46; It has several variations&#44; which are more common in Europe&#44; that go under the names of <span class="elsevierStyleItalic">3D-histology</span>&#44; the <span class="elsevierStyleItalic">perimeter technique</span>&#44; the <span class="elsevierStyleItalic">Mohs-T&#252;bingen technique</span>&#44; and the <span class="elsevierStyleItalic">quadrant method</span>&#46; In all cases&#44; however&#44; including frozen-section MMS&#44; 100&#37; of tumor margins are examined through tangential sectioning rather than the standard vertical sectioning used in conventional surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Dr&#46; Mohs&#8217; technique was adopted first in the United States and then in Europe&#46; An increasing number of Spanish hospitals from both the private and public health sectors have introduced MMS in recent decades&#44; and their experience has been reported in both national and international journals&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">6&#8211;11</span></a> In 2012&#44; the Spanish Academy of Dermatology and Venereology Foundation &#40;FAEDV&#41;&#44; in conjunction with the working group on Surgical Dermatology&#44; Laser&#44; and Cutaneous Oncology of the AEDV&#44; decided to set up the Spanish Mohs Surgery Registry &#40;REGESMOHS&#41; in order to be able to describe the outcomes of MMS in Spain&#46; The first cases were registered in July 2003&#46; Previous studies have described the hospitals that perform MMS in Spain&#44; together with the characteristics of the patients and tumors included in REGESMOHS&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">12&#44;13</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In this article we analyze the cases of MMS registered in REGESMOHS to date&#44; with a focus on perioperative aspects &#40;e&#46;g&#46;&#44; use of anticoagulants and antiplatelet agents&#41;&#44; surgical technique&#44; number of stages required to achieve tumor-free margins&#44; surgical defect size and reconstruction&#44; intraoperative complications&#44; reconstruction of surgical defects&#44; and use of resources&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">REGESMOHS is a prospective cohort study involving 18 public and private hospitals throughout Spain that perform at least 1 MMS operation a week&#46; All patients who undergo evaluation prior to MMS are successively included in the registry&#46; The only patients not included are minors and those declared to be legally incapacitated&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The study was approved by the research ethics committee of Navarra&#44; the Spanish Agency for Medicines and Medical Devices &#40;AEMPS&#41;&#44; and all the participating hospitals&#46; It was conducted in compliance with the principles of the Declaration of Helsinki and current laws&#46; All patients gave their written consent to participate in the study&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The different outcome variables are collected during patient visits&#46; Data on demographics&#44; associated conditions such as immunosuppression and diabetes mellitus&#44; clinical and histopathologic features of the tumor&#44; and previous treatments are collected at the first visit&#46; At the second visit&#44; a record is made of type of surgery&#44; anesthesia&#44; hospitalization&#44; use of anticoagulants and antiplatelet agents during surgery&#44; surgical defect size&#44; other treatments&#44; surgery duration&#44; and intraoperative complications and morbidity&#46; Short-term outcomes and complications are evaluated at the third visit&#46; Finally&#44; patients are evaluated for surgical outcomes&#44; recurrences&#44; and appearance of new tumors at subsequent follow-up visits&#44; which are held at least once a year&#46; The development of subsequent tumors in a given patient is described in the registry but only the first tumor is subject to follow-up&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Data are entered by the participating hospitals into an online system provided by the Research Unit of the FAEDV &#40;OpenClinica Open Source software&#44; version 3&#46;1&#41; following a standard protocol&#46; The information entered is monitored continuously online&#46; Additional site checks are made once a year to assess adherence to the protocol and check the information entered against the source documents&#46; Stata statistical software &#40;version 14&#46;1&#41; is used for data analysis&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patient Characteristics</span><p id="par0050" class="elsevierStylePara elsevierViewall">REGESMOHS contains data for 1796 patients who underwent at least 1 MMS operation at 1 of the 18 participating hospitals and whose information was added to the registry between July 2013 and January 2016 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The characteristics of the population are similar to those previously described&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a> although the size of the database has grown&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The patients&#8217; characteristics are summarized in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; The mean &#40;SD&#41; age of the sample was 68&#46;5 &#40;14&#46;4&#41; years&#44; and 51&#46;2&#37; were men&#46; In all&#44; 77&#46;7&#37; of the population &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1391&#41; lived in the district served by the hospital where they underwent surgery&#46; The remaining 22&#46;4&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>405&#41; were referred from other districts&#46; A history of multiple cutaneous tumors was recorded for 3&#46;8&#37; of patients &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>68&#41;&#44; 6 of whom had a diagnosis of Gorlin syndrome&#46; Sixty-eight patients &#40;3&#46;8&#37;&#41; had some form of immunosuppression&#44; and the most common cause was solid organ transplantation &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#44; 2&#46;1&#37;&#41;&#46; Finally&#44; 10&#46;2&#37; of patients &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>179&#41; were diabetic&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Tumor Characteristics and Previous Treatments</span><p id="par0060" class="elsevierStylePara elsevierViewall">There were no relevant changes to the characteristics of tumors or to previous treatments with respect to the initial REGESMOHS report&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a> Similar findings were also observed for tumor type &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41; and location&#46; The most common locations&#44; accounting for 82&#37; of all tumor sites&#44; were the nasal pyramid&#44; the cheek&#44; the forehead&#44; the lateral canthus&#44; and the auricular area&#46; The median size of the largest tumor diameter was 10<span class="elsevierStyleHsp" style=""></span>mm &#40;interquartile range &#91;IQR&#93;&#44; 12<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; Just 1 patient had lymph node involvement and 2 had metastatic disease&#46; Median time to inclusion of the tumor in the registry at the first visit was 11&#46;4 months &#40;IQR&#44; 23&#46;4 months&#41;&#44; and median time from this point to surgery was 1&#46;6 months &#40;IQR&#44; 1&#46;9 months&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Two-thirds of the tumors &#40;66&#46;9&#37;&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1200&#41; had not been previously treated&#44; 19&#46;2&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>345&#41; were recurrent and had been treated either medically or surgically&#44; and 13&#46;9&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>250&#41; were persistent tumors&#44; i&#46;e&#46;&#44; residual tumors at the margins following previous excision or tumors that had not responded to medical treatment&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Details of previous treatments and time to inclusion in the registry are shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46; The number of surgical treatments received by patients with persistent or recurrent tumors ranged from 1 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>358&#41; to 15 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46; Hedgehog inhibitors were used as adjunct therapy prior to MMS in 3 giant tumors&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Characteristics of Surgery</span><p id="par0075" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> shows the figures for use of anticoagulants and antiplatelet agents and their withdrawal prior to surgery&#44; comedication with corticosteroids&#44; concurrent diabetes mellitus&#44; and presurgical factors that can affect healing&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Surgery was performed on an outpatient basis or with a hospital admission time of under 24<span class="elsevierStyleHsp" style=""></span>hours in 71&#46;8&#37; of cases &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1420&#41;&#59; the remaining 21&#46;9&#37; of patients &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>376&#41; required hospitalization&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Local anesthesia was used in 86&#46;7&#37; of patients &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1554&#41;&#44; local anesthesia with oral premedication in 3&#46;7&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>67&#41;&#44; and sedation or general anesthesia in 9&#46;5&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>171&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The most common MMS technique was frozen-section Mohs &#40;89&#46;5&#37;&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1603&#41;&#44; followed by slow Mohs &#40;10&#37;&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>180&#41;&#44; and MMS with 3D-histology &#40;0&#46;5&#37;&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#41;&#46; MMS with intraoperative immunohistochemical staining was performed in just 7 cases &#40;0&#46;4&#37;&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Presurgical curettage was performed at the discretion of the dermatologist&#46; The stages required to achieve tumor-free margins are shown in <a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#46; Tumor-free margins were not achieved in 56 patients &#40;3&#46;2&#37;&#41; for reasons related to the characteristics of the tumor&#44; the poor general state of health of the patient&#44; or patient preferences&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The median sizes &#40;IQR&#41; of the initial tumor and the final surgical defect are shown in <a class="elsevierStyleCrossRef" href="#tbl0035">Table 7</a>&#46; The tumor extended into the dermis in 61&#37; of cases &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1059&#41;&#44; the hypodermis in 25&#46;7&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>445&#41;&#44; and the muscle in 7&#46;3&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>127&#41;&#46; Bone involvement was detected in 0&#46;9&#37; of cases &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41;&#46;</p><elsevierMultimedia ident="tbl0035"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Details of the specialist responsible for repairing the surgical defect are shown in <a class="elsevierStyleCrossRef" href="#tbl0040">Table 8</a>&#46;</p><elsevierMultimedia ident="tbl0040"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">No intraoperative complications were reported for the vast majority of patients &#40;98&#46;4&#37;&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1760&#41;&#46; Twenty-nine patients experienced significant intraoperative morbidity&#44; defined as a complication that required immediate intervention or modifications to the surgical procedure&#46; The most common complication was vasovagal syncope &#40;10 patients&#44; 0&#46;6&#37;&#41;&#44; followed by high blood pressure requiring treatment &#40;8 patients&#44; 0&#46;5&#37;&#41; and bleeding requiring intravenous treatment or interruption of surgery &#40;5 patients&#44; 0&#46;3&#37;&#41;&#46; There were also 2 episodes of hyperglycemia requiring treatment and unspecified arrhythmia in 1 patient &#40;0&#46;06&#37;&#41;&#46; All the complications were resolved immediately and surgery was completed in all cases but one&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Median duration of surgery was 75<span class="elsevierStyleHsp" style=""></span>minutes &#40;IQR&#44; 40<span class="elsevierStyleHsp" style=""></span>minutes&#59; range&#44; 15-438<span class="elsevierStyleHsp" style=""></span>minutes&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Postoperative adjuvant therapy included radiation therapy &#40;3 patients&#44; 0&#46;17&#37;&#41; and photodynamic therapy&#44; imiquimod&#44; radical surgery&#44; and bone drilling and radiation therapy &#40;1 case each&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">We have described the current use of MMS in Spain based on information entered into REGESMOHS between July 2013 and January 2016&#46; The data correspond to 1796 patients who underwent at least 1 MMS operation at one of the 18 participating hospitals&#46; Our results provide insights into the use and technical complexity of MMS in Spain&#44; as well as use of resources and short-term outcomes&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The strengths of the study lie in its prospective design and the analysis of data that are strongly representative of the state of MMS in Spain&#44; as the participating hospitals account for a large proportion of all hospitals that perform this procedure in Spain&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">12</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">One limitation is related to the progressive inclusion of patients and recording of data&#44; as some hospitals appear to have fewer patients than recorded in the initial report&#44; indicating that they have either not operated on some patients or not entered the data into the online system&#46; Minor changes to outcomes due to random variations can probably be expected in future publications&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The incidence of nonmelanoma skin cancer has increased exponentially in recent decades&#44; and annual increases of between 3&#37; and 8&#37; have been reported in Europe&#44; the USA&#44; Canada&#44; and Australia since 1960&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">14&#8211;16</span></a> MMS is the current gold standard for the treatment of high-risk BCC and SCC and it has also shown superior results to other techniques for other cutaneous cancers&#46; A priori&#44; however&#44; the technique may not seem very cost-effective due to the infrastructure requirements&#44; the need for trained personnel&#44; and the time it takes&#46; Data on these aspects of MMS can vary from country to country and accurate assessment is important for benchmarking purposes&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The use of MMS has been reported in several important studies&#44; including prospective studies of a large Australian registry of patients treated with MMS between 1993 and 2002<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">17&#8211;19</span></a> and a series of prospective studies and randomized clinical trials comparing MMS and conventional surgery in the Netherlands&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">20&#8211;22</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Our results for tumor location and patient sex are similar to those described in the initial report of REGESMOHS<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a> and other series&#46; The only difference between our study and others that have included tumors other than BCC and SCC is the higher proportion of LM and DFSP cases&#46; In our study&#44; for example&#44; these tumors accounted for 2&#46;81&#37; and 1&#46;97&#37; of cases&#44; respectively&#44; contrasting with rates of 0&#37; and 0&#46;5&#37; in a recent study from the United Kingdom&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">22</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Patients who had undergone solid organ transplantation represented the largest group of patients with immunosuppression in REGESMOHS &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#41;&#46; Transplant patients have a higher incidence of nonmelanoma skin cancer&#44; and SCC in particular&#44; and may be candidates for MMS&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">23&#44;24</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">The proportion of patients who received antiplatelet or anticoagulant treatment &#40;18&#37;&#41; is lower than that reported in other dermatologic surgery studies &#40;29&#37; for MMS patients<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">25</span></a> and 35&#37; for dermatologic surgery patients in general&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">26</span></a> The perioperative use of these treatments&#44; however&#44; was similar to that reported elsewhere&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">27&#44;28</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">In our series&#44; 33&#46;1&#37; of tumors were recurrent or persistent&#59; this rate is identical to that reported for the Australian study of BCCs treated with MMS<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">17</span></a> and very similar to the rate of 29&#46;3&#37; described by Hoorens et al&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">29</span></a> in the most recent study from the Netherlands&#46; Like in our study&#44; the most common previous treatment in these studies was surgery&#46; It is noteworthy that&#44; with the exception of cryotherapy&#44; nonsurgical treatment was uncommon &#40;&#60;&#160;3&#37; for each treatment&#41;&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">A mean of 1&#46;6 stages &#40;median&#44; 1&#59; range&#44; 1-12&#41; was required to achieve tumor-free margins&#46; This figure is slightly lower than that of 1&#46;7 &#40;median&#44; 2&#59; range&#44; 1-9&#41; <span class="elsevierStyleSup">17</span>reported in Australia for BCC<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">17</span></a> and identical to that of 1&#46;6 &#40;median&#44; 1&#59; range&#44; 1-7&#41; reported for SCC&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">19</span></a> In Europe&#44; Flohil et al&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">20</span></a> reported a clearance rate of 43&#46;5&#37; with 1 stage &#40;vs&#46; 56&#46;5&#37; with &#8805;&#160;2 stages&#41;&#46; In a series of 737 BCCs treated with MMS&#44; Smeets et al&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">21</span></a> reported clearance rates of 25&#37; and 46&#37; for 1 and 2 stages&#44; respectively&#46; The corresponding rates for the UK series were 58&#37; for 1 stage&#44; 34&#37; for 2 stages&#44; 6&#37; for 3 stages&#44; 1&#37; for 4 stages&#44; and 0&#46;5&#37; for 5 or more stages&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">22</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">The surgical defect was repaired by a dermatologist in a very high proportion of patients in REGESMOHS &#40;98&#46;4&#37; in total&#41;&#46; On the whole&#44; this rate is higher than previously reported rates&#46; In a series of 12<span class="elsevierStyleHsp" style=""></span>344 MMS operations performed in the United States &#40;Brown University&#44; Rhode Island&#41; between 2005 and 2012&#44; 17&#37; of surgical defects in women and 8&#37; of those in men were reconstructed by a plastic surgeon&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">30</span></a> In the Dutch series described by Hoorens et al&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">29</span></a> most of the surgical defects were repaired by dermatologists &#40;84&#37;&#41;&#44; followed by head and neck surgeons &#40;8&#46;5&#37;&#41;&#44; plastic surgeons &#40;6&#46;2&#37;&#41;&#44; and other specialists&#44; such as oculoplastic surgeons &#40;1&#37;-3&#37;&#41;&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Flap closure&#44; used in 47&#46;2&#37; of cases in our series&#44; was the most common repair method used&#44; coinciding with previous reports&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">31&#44;32</span></a> Several decades ago&#44; skin grafts used to be considered the most useful closure method in MMS&#44; as they permitted earlier detection of possible recurrence&#46; Now&#44; however&#44; flaps are more common than either grafting or healing by secondary intention due to the increased confidence in outcomes&#44; improved surgical skills&#44; smaller postsurgical defects&#44; and the younger age of patients&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">All the intraoperative complications reported in our series involved high blood pressure and&#47;or intraoperative bleeding&#46; Just 1 patient required hospitalization due to intraoperative- and postoperative bleeding&#44; which is considered a major surgery-related complication&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">33&#44;34</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">The median duration of surgery&#44; 75<span class="elsevierStyleHsp" style=""></span>minutes&#44; indicates that&#44; overall&#44; MMS operations do not take much longer than conventional surgery of facial skin tumors that require reconstructive surgery with flap closure or grafts&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusions</span><p id="par0195" class="elsevierStylePara elsevierViewall">The characteristics of the patients and tumors treated by MMS in Spain are similar to those reported in similar studies from other geographic areas&#46; The findings for short-term outcomes were also similar&#46; The main differences in our series were the higher percentage of DFSP and LM cases treated and the higher proportion of surgical defects repaired by a dermatologist&#46; Major intraoperative complications were very rare and median duration of surgery was only slightly higher than that reported for conventional surgery&#46; Our data are useful for evaluating whether findings from other settings can be applied to Spain for hospitals planning to introduce MMS or for those already using MMS wishing to use benchmarking to identify areas for improvement&#46; Our results may also be useful for effectiveness studies and should interest dermatologists and other health care specialists and managers&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Ethical Disclosures</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Protection of humans and animals</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors declare that no tests were carried out in humans or animals for the purpose of this study&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Confidentiality of data</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors declare that they have followed their hospital&#39;s protocol on the publication of data concerning patients&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Right to privacy and informed consent</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors obtained informed consent from the patients and&#47;or subjects referred to in this article&#46; This document is held by the corresponding author&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Funding</span><p id="par0215" class="elsevierStylePara elsevierViewall">REGESMOHS is funded by FAEDV with the collaboration of Roche Farma&#46; Roche Farma had no involvement in the preparation of this manuscript&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicts of Interest</span><p id="par0220" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest regarding the content of this article&#46;</p></span></span>"
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            0 => "Cirug&#237;a microgr&#225;fica de Mohs"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The Spanish Mohs Surgery Registry is used to collect data on the use and outcomes of Mohs micrographic surgery &#40;MMS&#41; in Spain&#46; The aim of this study was to describe perioperative and intraoperative data recorded for MMS procedures performed between July 2013 &#40;when the registry started&#41; and January 2016&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Prospective cohort study of data from 18 hospitals&#46; The data collected included type of anesthesia&#44; surgical technique&#44; hospital admission&#44; number of Mohs stages&#44; management of preoperative risk factors&#44; additional treatments&#44; previous treatments&#44; type of tumor&#44; operating time&#44; and complications&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Data were available for 1796 operations&#46; The most common tumor treated by MMS was basal cell carcinoma &#40;85&#46;96&#37;&#41;&#44; followed by squamous cell carcinoma &#40;6&#46;18&#37;&#41;&#44; lentigo maligna &#40;2&#46;81&#37;&#41;&#44; and dermatofibrosarcoma protuberans &#40;1&#46;97&#37;&#41;&#46; Primary tumors accounted for 66&#46;9&#37; of all tumors operated on&#59; 19&#46;2&#37; of tumors were recurrent and 13&#46;9&#37; were persistent&#46; The most common previous treatment was surgical&#46; MMS was mostly performed under local anesthesia &#40;86&#46;7&#37; of cases&#41; and as an outpatient procedure &#40;71&#46;8&#37;&#41;&#46; The frozen section technique was used in 89&#46;5&#37; of cases&#46; One stage was needed to achieve tumor-free margins in 56&#46;45&#37; of patients&#59; 2 stages were required in 32&#46;1&#37; of patients&#44; 3 in 7&#46;1&#37;&#37;&#44; 4 in 2&#46;7&#37;&#44; and 5 or more in 1&#46;8&#37;&#46; The defect was reconstructed by the dermatologist in 98&#37; of patients and the most common technique was flap closure &#40;47&#46;2&#37;&#41;&#46; Intraoperative complications were recorded for just 1&#46;62&#37; of patients and the median &#40;interquartile range&#41; duration of surgery was 75 &#40;60-100&#41; minutes&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The characteristics of the patients and tumors treated by MMS are similar to those reported for similar studies in other geographic areas&#46; Lentigo maligna and dermatofibrosarcoma protuberans accounted for a higher proportion of cases in our series&#44; and repair of the surgical defect by a dermatologist was also more common&#46; Operating times in MMS are not much longer than those reported for other procedures and the rate of intraoperative complications is very low&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El Registro Espa&#241;ol de Cirug&#237;a de Mohs recoge los datos de aplicaci&#243;n y resultados de esta t&#233;cnica en Espa&#241;a&#46; Se describen los datos de las intervenciones realizadas desde el inicio del Registro en julio de 2013 a enero de 2016&#46; Se analizan los datos de las cirug&#237;as tanto perioperatorios como intraoperatorios&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohortes prospectivo en el que participan 18 centros&#46; Se recogen los datos de las intervenciones quir&#250;rgicas como tipo de anestesia&#44; t&#233;cnica quir&#250;rgica&#44; ingreso hospitalario&#44; n&#250;mero de estadios&#44; manejo de factores de riesgo preoperatorios&#44; tratamientos complementarios&#44; tratamientos previos&#44; tipo de tumor&#44; tiempo empleado en la cirug&#237;a y complicaciones&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se analizan 1&#46;796 intervenciones quir&#250;rgicas&#46; El tumor intervenido con m&#225;s frecuencia es el carcinoma basocelular &#40;85&#44;96&#37;&#41;&#44; seguido del carcinoma epidermoide &#40;6&#44;18&#37;&#41;&#44; lentigo maligno &#40;2&#44;81&#37;&#41; y dermatofibrosarcoma protuberans &#40;1&#44;97&#37;&#41;&#46; El 66&#44;9&#37; de los tumores eran primarios&#44; el 19&#44;2&#37; recurrentes y el 13&#44;9&#37; persistentes&#46; El tratamiento previo m&#225;s frecuente fue quir&#250;rgico&#46; La cirug&#237;a de Mohs se realiz&#243; con m&#225;s frecuencia bajo anestesia local &#40;86&#44;7&#37;&#41; y de forma ambulatoria &#40;71&#44;8&#37;&#41;&#46; En el 89&#44;5&#37; de los casos se utiliz&#243; la t&#233;cnica de Mohs en congelaci&#243;n&#46; El n&#250;mero de etapas requerido para alcanzar m&#225;rgenes libres de tumor fue una en 56&#44;45&#37; de los pacientes&#44; 2 en 32&#44;1&#37;&#44; 3 en 7&#44;1&#37;&#44; 4 en 2&#44;7&#37; y 5 o m&#225;s en 1&#44;8&#37;&#46; El propio dermat&#243;logo reconstruy&#243; el defecto en el 98&#37; de los pacientes y la t&#233;cnica reconstructiva m&#225;s utilizada fue el colgajo &#40;47&#44;2&#37;&#41;&#46; Solo el 1&#44;62&#37; de los pacientes present&#243; alguna complicaci&#243;n intraoperatoria y la mediana de la duraci&#243;n de la cirug&#237;a fue 75 &#40;p25&#58;60-p75&#58;100&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las caracter&#237;sticas de los pacientes y tumores tratados son similares a las descritas en estudios de las mismas caracter&#237;sticas en otras &#225;reas geogr&#225;ficas&#46; Existe un porcentaje mayor de lentigo maligno y dermatofibrosarcoma protuberans&#46; La reconstrucci&#243;n la realiza el dermat&#243;logo con m&#225;s frecuencia que en otras series&#46; El tiempo de utilizaci&#243;n de quir&#243;fano no es mucho mayor que para otras t&#233;cnicas y la tasa de complicaciones intraoperatorias es muy reducida&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; de Eusebio Murillo E&#44; Mart&#237;n Fuentes A&#44; Ruiz-Salas V&#44; Garc&#233;s JR&#44; Mi&#241;ano Medrano R&#44; L&#243;pez-Estebaranz JL&#44; et al&#46; Descripci&#243;n de las intervenciones quir&#250;rgicas recogidas en el registro espa&#241;ol de cirug&#237;a de Mohs &#40;REGESMOHS&#41; &#40;2013-2015&#41;&#46; Actas Dermosifiliogr&#46; 2017&#59;108&#58;836&#8211;843&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; &#40;&#37;&#41; of Patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital Santa Creu i Sant Pau&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">345 &#40;19&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fundaci&#243;n Hospital Alcorc&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">235 &#40;13&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Complejo Hospital Universitario de Guadalajara&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">214 &#40;11&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Complejo Hospitalario de Le&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">197 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cl&#237;nica Universidad de Navarra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">109 &#40;6&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cl&#237;nica Teknon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84 &#40;4&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cl&#237;nica Zarzuela&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82 &#40;4&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cl&#237;nica Quir&#243;n Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78 &#40;4&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital del Mar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69 &#40;3&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital La Princesa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68 &#40;3&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital Galdakao&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60 &#40;3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital de Cruces&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital de Manises&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Complexo Hospitalario Universitario de Santiago&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital San Roque&#44; Las Palmas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital La Paz&#44; Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;796&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Number of Patients From Each Participating Hospital and Percentage of Total&#46;</p>"
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at2"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Demographic Characteristics</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">No&#46; &#40;&#37;&#41; of Patients</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">919 &#40;51&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">876 &#40;48&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Place of residence</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Same health district as treating hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">405 &#40;22&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other health district&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1391 &#40;77&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mean &#40;SD&#41; age&#44; y</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68&#46;5 &#40;14&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Clinical characteristics prior to surgery</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">No&#46; &#40;&#37;&#41; of Patients</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Immunosuppression</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Transplantation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Immunosuppressive treatment &#40;&#62;<span class="elsevierStyleHsp" style=""></span>3 mo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hematologic tumor &#60;<span class="elsevierStyleHsp" style=""></span>5 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Human immunodeficiency virus positivity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Multiple tumor syndromes</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>History of multiple tumors without a diagnosis of Gorlin syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Gorlin syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;0&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other syndromes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;0&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Diabetes mellitus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">179 &#40;10&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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      2 => array:8 [
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        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
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            "identificador" => "at3"
            "detalle" => "Table "
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        "tabla" => array:1 [
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Histologic Type&#47;Subtype&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Basal cell carcinoma</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1544&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Infiltrative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">734&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Histologically nonaggressive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">429&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Morpheaform&#47;sclerosing&#47;fibrosing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">220&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Micronodular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">113&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Metatypical&#47;keratinization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Perineural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Squamous cell carcinoma</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">111</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">6&#46;18</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Infiltrative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Histologically nonaggressive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Basosquamous &#40;not including metatypical basal cell carcinoma&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Undifferentiated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sclerosing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Perineural&#47;perivascular infiltration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Spindle-cell&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Clear-cell&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Small-cell&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Keratoacanthoma &#40;centrofacial&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Breslow<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62; Clark level IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Lentigo maligna</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Dermatofibrosarcoma protuberans</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Microcystic adnexal carcinoma</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Merkel cell tumor</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Extramammary Paget disease</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Atypical fibroxanthoma&#47;malignant fibrous histiocytoma</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Angiosarcoma</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Acral lentiginous melanoma</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sebaceous carcinoma</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Eccrine&#47;mucinous carcinoma</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Desmoplastic trichoepithelioma</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatments Before Mohs Micrographic Surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; &#40;&#37;&#41; of Patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Median &#40;IQR&#41; Time Since Previous Treatment median&#44; mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Direct closure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">441 &#40;24&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;2 &#40;4&#46;4-60&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Surgery with plasty repair&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">123 &#40;6&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;1 &#40;2&#46;6-59&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cryotherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#46;1 &#40;8&#46;6-55&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Surgery with grafting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60 &#40;3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#46;4 &#40;9&#46;5-81&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Curettage&#47;electrocoagulation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49 &#40;2&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#46;6 &#40;2&#46;4-70&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MMS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42 &#40;2&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#46;6 &#40;18&#46;9-69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Radiation therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55&#46;8 &#40;12&#46;4-149&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Photodynamic therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;1&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;8 &#40;8-19&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Imiquimod&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 &#40;2&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46;1 &#40;8&#46;8-42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fluoropyrimidines&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">197&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hedgehog inhibitors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;3 &#40;8-25&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Perioperative risk factors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; &#40;&#37;&#41; of Patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Antiplatelet treatment</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">191 &#40;10&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Withdrawal</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">No</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">133 &#40;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Yes</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Anticoagulant treatment</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">130 &#40;7&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Withdrawal</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46 &#40;35&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83 &#40;64&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Corticosteroid treatment &#62;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">3 mo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;1&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Diabetes mellitus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">179 &#40;10&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of Stages&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; &#40;&#37;&#41; of Patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1002 &#40;56&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">569 &#40;32&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">126 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47 &#40;2&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8805; 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 &#40;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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        "texto" => "<p id="par0225" class="elsevierStylePara elsevierViewall">The following members of REGESMOH participated in the data collection stage of the study&#58; Luc&#237;a Ascanio Armada and Dolores Caro Guti&#233;rrez &#40;Hospital Universitario Fundaci&#243;n Alcorc&#243;n&#41;&#59; Carlos Serra Guill&#233;n&#44; Eduardo Nagore Enguidanos&#44; Beatriz Llombart Cussac&#44; and Celia Requena Caballero &#40;Instituto Valenciano de Oncolog&#237;a&#41;&#59; Luis Hueso Gabriel and Antonio Martorell &#40;Hospital de Manises&#41;&#59; M&#46; Jos&#233; Seoane Pose &#40;CHU Santiago&#41;&#59; Ricardo Su&#225;rez and Celia Horcajada &#40;Hospital Gregorio Mara&#241;&#243;n&#41;&#59; Francisco Alc&#225;ntara Nicol&#225;s&#44; Patricia Gonz&#225;lez Mu&#241;oz&#44; and Consuelo S&#225;nchez Herreros &#40;Hospital de Guadalajara&#41;&#59; Carolina Medina Gil&#44; Elena Castro Gonz&#225;lez&#44; and Jaime Vilar Alejo &#40;Hospital San Roque&#44; Las Palmas&#41;&#59; Mar&#237;a Luisa Alonso Pacheco and Mat&#237;as Mayor Arenal &#40;Hospital La Paz&#44; Madrid&#41;&#46; We also thank all the staff from the departments involved in REGESMOHS&#46;</p>"
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