Case and Research Letters
Our Experience With Strain Elastography in 2 Cases of Suspected Malignant Subcutaneous Lesions
Experiencia de elastografía strain en 2 casos de lesiones subcutáneas sospechosas de malignidad
a Servicio de Dermatología, Complejo Hospitalario Universitario de Ferrol, Ferrol, A Coruña, España
b Servicio de Dermatología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
c Servicio de Anatomía Patológica, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
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Vilas-Sueiro, F. Alfageme-Roldán, P. Nájera, G. Roustán" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Vilas-Sueiro" "email" => array:1 [ 0 => "avilassueiro@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "F." "apellidos" => "Alfageme-Roldán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "P." "apellidos" => "Nájera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "G." "apellidos" => "Roustán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario Universitario de Ferrol, Ferrol, A Coruña, España" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Experiencia de elastografía <span class="elsevierStyleItalic">strain</span> en 2 casos de lesiones subcutáneas sospechosas de malignidad" ] ] "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" => 1175 "Ancho" => 3000 "Tamanyo" => 253722 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Color Doppler skin ultrasound scan showing an oval, hypoechoic lesion in the dermis-hyopdermis associated with slight peripheral hypervascularization. B, Strain elastogram showing the mean percentage of stiffness within the lesion.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The appearance of subcutaneous lesions in patients with a history of malignancy nearly always raises diagnostic uncertainty. We present 2 such cases in which ultrasound elastography showed significant differences between one lesion and the other.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 55-year-old woman presented with a mildly painful subcutaneous lesion in the periumbilical region that had been present for 10 days. Approximately 4 months earlier, she had been diagnosed with peritoneal carcinomatosis. The neoplastic cells analyzed in the different locations were consistent with adenocarcinoma. Considering the patient's history and the possibility that the mass could be a cutaneous metastasis, we decided to perform an ultrasound examination prior to histologic evaluation. The ultrasound image, captured with a variable-frequency linear probe (8-18<span class="elsevierStyleHsp" style=""></span>MHz), showed a hypoechoic, structurally asymmetric lesion with a well-defined border in the dermis and hypodermis. Doppler color imaging showed slight peripheral hypervascularization. Because these findings were consistent with a possible diagnosis of cutaneous metastasis, we decided to perform strain elastography. The results of the elastogram showed a mean intralesional stiffness of 44.9% (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The corresponding strain ratio was 0.79 and the elasticity score was 2 (of a total of 5). Histopathologic examination ruled out the tentative diagnosis of cutaneous metastasis and showed features consistent with an abscessed retention cyst. The patient was prescribed oral antibiotics, which led to full resolution of the lesion.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">A 45-year-old woman presented with a nodular lesion on the neck measuring approximately 1<span class="elsevierStyleHsp" style=""></span>cm at its widest diameter. Four years earlier, she had undergone surgery to excise a stage T4b superficial spreading melanoma on her right cheek. The staging study showed no evidence of local recurrence or distant spread. Cutaneous ultrasound with an 18-MHz linear probe showed an irregular, hypoechoic structure in the hypodermis. Color Doppler imaging revealed intense intralesional hypervascularization. Although this is a nonspecific finding, it is suggestive of malignancy. According to the strain elastogram, there was a mean stiffness of 84.6% (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The strain ratio was 2.21 and the elasticity score was 3. Unlike in the previous case (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A), excision of the lesion and subsequent histopathologic examination with hematoxylin-eosin and immunohistochemical staining confirmed the diagnosis of metastatic melanoma (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The introduction of ultrasound imaging for dermatologic applications has led to considerable improvements in the diagnosis, treatment, and monitoring of inflammatory and neoplastic diseases in recent years. Ultrasound is a very important tool for the investigation of melanoma as it can assess tumor thickness and vascularization and rule out subcutaneous and lymph node metastases.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Cutaneous ultrasound can provide key diagnostic information in such cases and also in cases where there is a strong suspicion of melanoma metastasis.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Irregular hypoechoic nodules with more intense acoustic shadowing in the subcutaneous tissue are highly suggestive of malignancy. These nodules typically have an oval, lobulated, or on occasions, potato-shaped appearance. The above findings, however, are nonspecific and can give rise to false negatives.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Elastography can help when ultrasound does not provide the full diagnostic picture. It has been used to assess liver, breast, and thyroid tissue, but its use in dermatology is relatively new.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> When tissue is subject to pressure applied either mechanically or through an ultrasound beam, it deforms before generally returning to its original shape. Resistance to deformation is a reflection of the hardness or stiffness of a tissue.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Elastography systems can be classified as strain imaging (based on tissue deformation calculations) or shear wave imaging (based on the characterization of shear wave speed). The 2 main measures used in elastography are stiffness of the target lesion in relation to that of the adjacent parenchyma (strain ratio) and percentage of tissue hardness or stiffness within a lesion.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7–9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">On analyzing the use of elastography for the diagnosis of primary tumors and lymph node metastases in patients with malignant melanoma, Hinz et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> found that elastography combined with ultrasound had greater sensitivity for the detection of lymph node metastases than ultrasound alone. For the elastography study, they correlated findings with patterns of different degrees of elasticity.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In our series, elastography showed evident differences between the 2 lesions (for both strain ratio and percentage of intralesional stiffness), and in addition, the technique was more sensitive than B-mode and Doppler color ultrasound, supporting the findings of Hinz et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Based on the Tsukaba Elasticity Score system, the first lesion, with an elasticity score of 2, had a greater likelihood of being benign than the second lesion (score of 3)</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, we have provided comparative data from an elastography study of 2 cutaneous lesions in patients with a high risk of malignancy. The differences observed suggest that elastography could provide key diagnostic information when clinical examination and skin ultrasound findings are inconclusive. With the current technology, however, histopathologic confirmation is still required. More studies are needed to determine whether elastography could become a key diagnostic tool for dermatologists.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Vilas-Sueiro A, Alfageme-Roldán F, Nájera P, Roustán G. Experiencia de elastografía <span class="elsevierStyleItalic">strain</span> en 2 casos de lesiones subcutáneas sospechosas de malignidad. Actas Dermosifiliogr. 2018;109:274–276.</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" => 1175 "Ancho" => 3000 "Tamanyo" => 253722 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Color Doppler skin ultrasound scan showing an oval, hypoechoic lesion in the dermis-hyopdermis associated with slight peripheral hypervascularization. B, Strain elastogram showing the mean percentage of stiffness within the lesion.</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" => 1111 "Ancho" => 3000 "Tamanyo" => 272692 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Color Doppler ultrasound scan showing a hypoechoic lesion in the hypodermis with intralesional hypervascularization. B, Strain elastogram showing a considerable percentage of mean stiffness.</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" => 1125 "Ancho" => 1500 "Tamanyo" => 564631 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A, Histopathologic image showing abundant macrophages, polymorphonuclear leukocytes, and traces of keratin consistent with a retention cyst (hematoxylin-eosin, original magnification ×40). B, Histopathologic image showing a proliferation of melanocytes with abundant mitotic figures in relation to melanoma metastasis (hematoxylin-eosin, original magnification ×100).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of ultrasound imaging in dermatology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B. Echeverría-García" 1 => "J. Borbujo" 2 => "F. Alfageme" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2014.03.007" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2014" "volumen" => "105" "paginaInicial" => "887" "paginaFinal" => "890" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24997744" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of lymph node ultrasound evaluation in melanoma - review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Ungureanu" 1 => "C. Botar Jid" 2 => "E. Candrea" 3 => "R. Cosgarea" 4 => "S.C. Senila" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Med Ultrason" "fecha" => "2016" "volumen" => "18" "paginaInicial" => "224" "paginaFinal" => "230" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27239659" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for Performing Dermatologic Ultrasound Examinations by the DERMUS Group" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "X. Wortsman" 1 => "F. Alfageme" 2 => "G. Roustan" 3 => "S. Arias-Santiago" 4 => "A. Martorell" 5 => "O. Catalano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7863/ultra.15.06046" "Revista" => array:7 [ "tituloSerie" => "J Ultrasound Med" "fecha" => "2016" "volumen" => "35" "paginaInicial" => "577" "paginaFinal" => "580" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26887446" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0920996415001760" "estado" => "S300" "issn" => "09209964" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High-resolution ultrasonography assists the differential diagnosis of blue naevi and cutaneous metastases of melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Samimi" 1 => "A. Perrinaud" 2 => "M. Naouri" 3 => "A. Maruani" 4 => "E. Perrodeau" 5 => "L. Vaillant" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2010.09903.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2010" "volumen" => "163" "paginaInicial" => "550" "paginaFinal" => "556" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20545694" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EFSUMB. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Cosgrove" 1 => "F. Piscaglia" 2 => "J. Bamber" 3 => "J. Bojunga" 4 => "J.M. Correas" 5 => "O.H. Gilja" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-0033-1335375" "Revista" => array:6 [ "tituloSerie" => "Ultraschall Med" "fecha" => "2013" "volumen" => "34" "paginaInicial" => "238" "paginaFinal" => "253" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23605169" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medical ultrasound: Imaging of soft tissue strain and elasticity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P.N. Wells" 1 => "H.D. Liang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1098/rsif.2011.0054" "Revista" => array:6 [ "tituloSerie" => "J R Soc Interface" "fecha" => "2011" "volumen" => "8" "paginaInicial" => "1521" "paginaFinal" => "1549" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21680780" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography Part 1: Basic principles and technology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Bamber" 1 => "D. Cosgrove" 2 => "C.F. Dietrich" 3 => "J. Fromageau" 4 => "J. Bojunga" 5 => "F. Calliada" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-0033-1335205" "Revista" => array:6 [ "tituloSerie" => "Ultraschall Med" "fecha" => "2013" "volumen" => "34" "paginaInicial" => "169" "paginaFinal" => "184" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23558397" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Elastography in Dermatology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F. Alfageme-Roldán" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2016.05.004" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2016" "volumen" => "107" "paginaInicial" => "652" "paginaFinal" => "660" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27352999" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound of the sentinel node in melanoma patients: Echo-free island is a discriminatory morphologic feature for node positivity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.A. Voit" 1 => "C.M. Oude Ophuis" 2 => "J. Ulrich" 3 => "A.C. van Akkooi" 4 => "A.M. Eggermont" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CMR.0000000000000223" "Revista" => array:7 [ "tituloSerie" => "Melanoma Res" "fecha" => "2016" "volumen" => "26" "paginaInicial" => "267" "paginaFinal" => "271" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26881876" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0920996414005192" "estado" => "S300" "issn" => "09209964" ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Real-time tissue elastography as promising diagnostic tool for diagnosis of lymph node metastases in patients with malignant melanoma: A prospective single-center experience" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. Hinz" 1 => "T. Hoeller" 2 => "J. Wenzel" 3 => "T. Bieber" 4 => "M.H. Schmid-Wendtner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000346942" "Revista" => array:6 [ "tituloSerie" => "Dermatology" "fecha" => "2013" "volumen" => "226" "paginaInicial" => "81" "paginaFinal" => "90" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23548643" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010900000003/v1_201804020430/S1578219018300143/v1_201804020430/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/15782190/0000010900000003/v1_201804020430/S1578219018300143/v1_201804020430/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018300143?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 10 | 5 | 15 |
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| 2023 Noviembre | 71 | 37 | 108 |
| 2023 Octubre | 58 | 17 | 75 |
| 2023 Septiembre | 69 | 32 | 101 |
| 2023 Agosto | 51 | 10 | 61 |
| 2023 Julio | 67 | 32 | 99 |
| 2023 Junio | 65 | 19 | 84 |
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| 2023 Abril | 36 | 28 | 64 |
| 2023 Marzo | 78 | 34 | 112 |
| 2023 Febrero | 275 | 33 | 308 |
| 2023 Enero | 41 | 34 | 75 |
| 2022 Diciembre | 68 | 42 | 110 |
| 2022 Noviembre | 24 | 32 | 56 |
| 2022 Octubre | 36 | 18 | 54 |
| 2022 Septiembre | 22 | 44 | 66 |
| 2022 Agosto | 35 | 39 | 74 |
| 2022 Julio | 20 | 37 | 57 |
| 2022 Junio | 29 | 20 | 49 |
| 2022 Mayo | 50 | 46 | 96 |
| 2022 Abril | 69 | 45 | 114 |
| 2022 Marzo | 77 | 78 | 155 |
| 2022 Febrero | 59 | 44 | 103 |
| 2022 Enero | 62 | 44 | 106 |
| 2021 Diciembre | 53 | 55 | 108 |
| 2021 Noviembre | 44 | 54 | 98 |
| 2021 Octubre | 51 | 66 | 117 |
| 2021 Septiembre | 29 | 40 | 69 |
| 2021 Agosto | 30 | 37 | 67 |
| 2021 Julio | 32 | 41 | 73 |
| 2021 Junio | 25 | 39 | 64 |
| 2021 Mayo | 46 | 61 | 107 |
| 2021 Abril | 98 | 78 | 176 |
| 2021 Marzo | 66 | 36 | 102 |
| 2021 Febrero | 54 | 44 | 98 |
| 2021 Enero | 41 | 45 | 86 |
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| 2020 Noviembre | 37 | 39 | 76 |
| 2020 Octubre | 27 | 22 | 49 |
| 2020 Septiembre | 48 | 21 | 69 |
| 2020 Agosto | 24 | 30 | 54 |
| 2020 Julio | 30 | 24 | 54 |
| 2020 Junio | 32 | 36 | 68 |
| 2020 Mayo | 16 | 17 | 33 |
| 2020 Abril | 26 | 22 | 48 |
| 2020 Marzo | 21 | 17 | 38 |
| 2020 Febrero | 6 | 1 | 7 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 18 | 2 | 20 |
| 2019 Noviembre | 2 | 0 | 2 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 10 | 0 | 10 |
| 2019 Junio | 4 | 0 | 4 |
| 2019 Mayo | 7 | 0 | 7 |
| 2019 Abril | 4 | 0 | 4 |
| 2019 Febrero | 4 | 0 | 4 |
| 2018 Noviembre | 4 | 0 | 4 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Abril | 1 | 0 | 1 |
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