array:23 [
  "pii" => "S1578219008702518"
  "issn" => "15782190"
  "doi" => "10.1016/S1578-2190(08)70251-8"
  "estado" => "S300"
  "fechaPublicacion" => "2008-05-01"
  "aid" => "70251"
  "copyright" => "Academia Española de Dermatología y Venereología and Elsevier España, S.L."
  "copyrightAnyo" => "2008"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "fla"
  "cita" => "Actas Dermosifiliogr. 2008;99:275-80"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 2329
    "formatos" => array:3 [
      "EPUB" => 32
      "HTML" => 1543
      "PDF" => 754
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S157821900870252X"
    "issn" => "15782190"
    "doi" => "10.1016/S1578-2190(08)70252-X"
    "estado" => "S300"
    "fechaPublicacion" => "2008-05-01"
    "aid" => "70252"
    "copyright" => "Academia Española de Dermatología y Venereología and Elsevier España, S.L."
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Actas Dermosifiliogr. 2008;99:281-90"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 7248
      "formatos" => array:3 [
        "EPUB" => 39
        "HTML" => 4309
        "PDF" => 2900
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original articles</span>"
      "titulo" => "Chemotherapy-Induced Acral Erythema&#58; A Clinical and Histopathologic Study of 44 Cases"
      "tienePdf" => "en"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "281"
          "paginaFinal" => "290"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Eritema Acral Inducido Por Quimioterapia&#58; Estudio Cl&#237;nico e Histopatol&#243;-Gico de 44 Casos"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "L&#46; Hueso, O&#46; Sanmart&#237;n, E&#46; Nagore, R&#46; Botella-Estrada, C&#46; Requena, B&#46; Llombart, C&#46; Serra-Guill&#233;n, A&#46; Alfaro-Rubio, C&#46; Guill&#233;n"
          "autores" => array:9 [
            0 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Hueso"
            ]
            1 => array:2 [
              "nombre" => "O&#46;"
              "apellidos" => "Sanmart&#237;n"
            ]
            2 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Nagore"
            ]
            3 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Botella-Estrada"
            ]
            4 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Requena"
            ]
            5 => array:2 [
              "nombre" => "B&#46;"
              "apellidos" => "Llombart"
            ]
            6 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Serra-Guill&#233;n"
            ]
            7 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Alfaro-Rubio"
            ]
            8 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Guill&#233;n"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821900870252X?idApp=UINPBA000044"
    "url" => "/15782190/0000009900000004/v1_201304241431/S157821900870252X/v1_201304241431/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S1578219008702506"
    "issn" => "15782190"
    "doi" => "10.1016/S1578-2190(08)70250-6"
    "estado" => "S300"
    "fechaPublicacion" => "2008-05-01"
    "aid" => "70250"
    "copyright" => "Academia Espa&#241;ola de Dermatolog&#237;a y Venereolog&#237;a and Elsevier Espa&#241;a&#44; S&#46;L&#46;"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Actas Dermosifiliogr. 2008;99:269-74"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2401
      "formatos" => array:3 [
        "EPUB" => 36
        "HTML" => 1439
        "PDF" => 926
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original articles</span>"
      "titulo" => "Epidermodysplasia Verruciformis-Like Cells as Histologic Markers of Immunosuppression&#58; Review of 229 Squamous Cell Carcinomas<a class="elsevierStyleCrossRef" href="#fn1"><span class="elsevierStyleSup">&#42;</span></a>"
      "tienePdf" => "en"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "269"
          "paginaFinal" => "274"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Las C&#233;lulas Tipo Epidermodisplasia Verruciforme Como Marcador Histol&#243;gico de Inmunodepresi&#243;n&#58; Revisi&#243;n de 229 Carcinomas Espinocelulares"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "R&#46; Corbal&#225;n-V&#233;lez, J&#46;A&#46; Ruiz-Maci&#225;, C&#46; Brufau, J&#46;M&#46; L&#243;pez-Lozano, E&#46; Mart&#237;nez-Barba, J&#46; Mart&#237;nez-Escribano, F&#46;J&#46; Carapeto"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Corbal&#225;n-V&#233;lez"
            ]
            1 => array:2 [
              "nombre" => "J&#46;A&#46;"
              "apellidos" => "Ruiz-Maci&#225;"
            ]
            2 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Brufau"
            ]
            3 => array:2 [
              "nombre" => "J&#46;M&#46;"
              "apellidos" => "L&#243;pez-Lozano"
            ]
            4 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Mart&#237;nez-Barba"
            ]
            5 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Mart&#237;nez-Escribano"
            ]
            6 => array:2 [
              "nombre" => "F&#46;J&#46;"
              "apellidos" => "Carapeto"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219008702506?idApp=UINPBA000044"
    "url" => "/15782190/0000009900000004/v1_201304241431/S1578219008702506/v1_201304241431/en/main.assets"
  ]
  "en" => array:14 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original articles</span>"
    "titulo" => "Mohs Micrographic Surgery&#58; Our First 100 Patients"
    "tieneTextoCompleto" => 0
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "275"
        "paginaFinal" => "280"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "T&#46; Alonso, P&#46; S&#225;nchez, A&#46; Gonz&#225;lez, J&#46; Ingelmo, I&#46; Ruiz, S&#46; Delgado, M&#46;A&#46; Rodr&#237;guez"
        "autores" => array:7 [
          0 => array:4 [
            "nombre" => "T&#46;"
            "apellidos" => "Alonso"
            "email" => array:1 [
              0 => "teresa&#64;aedv&#46;es"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">¿</span>"
                "identificador" => "cor1"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "P&#46;"
            "apellidos" => "S&#225;nchez"
          ]
          2 => array:2 [
            "nombre" => "A&#46;"
            "apellidos" => "Gonz&#225;lez"
          ]
          3 => array:2 [
            "nombre" => "J&#46;"
            "apellidos" => "Ingelmo"
          ]
          4 => array:2 [
            "nombre" => "I&#46;"
            "apellidos" => "Ruiz"
          ]
          5 => array:2 [
            "nombre" => "S&#46;"
            "apellidos" => "Delgado"
          ]
          6 => array:2 [
            "nombre" => "M&#46;A&#46;"
            "apellidos" => "Rodr&#237;guez"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:1 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital de Le&#243;n&#44; Le&#243;n&#44; Spain"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor1"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Correspondence&#58; Servicio de Dermatolog&#237;a&#46; Hospital de Le&#243;n&#44; C&#47; Altos de Nava&#44; s&#47;n&#44; 24280 Le&#243;n&#44; Spain&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Cirug&#237;a de Mohs&#58; Nuestros Primeros Cien Pacientes"
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaAceptado" => "2007-12-12"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Key words"
          "identificador" => "xpalclavsec84183"
          "palabras" => array:4 [
            0 => "Mohs surgery"
            1 => "cutaneous tumors"
            2 => "surgery"
            3 => "treatment"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec84184"
          "palabras" => array:4 [
            0 => "cirug&#237;a de Mohs"
            1 => "tumores cut&#225;neos"
            2 => "cirug&#237;a"
            3 => "tratamiento"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStyleSimplePara elsevierViewall">Mohs surgery was first described by Frederic Mohs in 1941 to eliminate high-risk cutaneous tumors&#46; The technique involves histological examination of the margins&#46;</p> <span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to describe the clinical findings and compare the grade and subclinical extension of the tumor&#8212;as measured by the number of Mohs stages needed for complete elimination&#8212;according to whether the tumor presented high-risk factors&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p class="elsevierStyleSimplePara elsevierViewall">We included 100 patients with 105 tumors&#46; In all cases&#44; age&#44; sex&#44; tumor site&#44; tumor type&#44; histological subtype in the case of basal cell carcinoma&#44; size&#44; recurrences&#44; number of Mohs stages&#44; and reconstruction technique were recorded&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">The study group comprised 44 men and 56 women aged between 28 and 88 years &#40;mean&#44; 72&#46;6 years&#41;&#46; Of the tumors&#44; 80&#37; corresponded to basal cell carcinoma&#44; 12&#46;38&#37; to squamous cell carcinoma&#44; 4&#46;76&#37; to dermatofibrosarcoma protuberans&#44; 0&#46;95&#37; to Merkel cell carcinoma&#44; 0&#46;95&#37; to microcystic adnexal carcinoma&#44; and 0&#46;95&#37; to lentigo maligna melanoma&#46; Most tumors were located on the head and 60&#37; required more than one Mohs stage for complete elimination&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p class="elsevierStyleSimplePara elsevierViewall">This series is characterized by a high percentage of high-risk cutaneous tumors&#46; After assessing the risk factors independently&#44; we found that the size of the tumor is the risk factor most closely related to grade and subclinical extension in the case of basal cell carcinoma&#44; although similar conclusions cannot be drawn for the other types of tumor studied&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Definici&#243;n</span><p class="elsevierStyleSimplePara elsevierViewall">Descrita por Frederic Mohs en 1941&#44; la cirug&#237;a de Mohs es una t&#233;cnica quir&#250;rgica con control histol&#243;gico de los bordes&#44; utilizada para eliminar tumores cut&#225;neos de alto riesgo&#46;</p> <span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">El objetivo de este art&#237;culo es informar de los hallazgos cl&#237;nicos y comparar la agresividad-extensi&#243;n subcl&#237;nica del tumor&#44; medida como n&#250;mero de estadios de Mohs necesarios para eliminar completamente el tumor&#44; en funci&#243;n de que el tumor presente o no factores de alto riesgo&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Se incluyen 100 pacientes con 105 tumores y en todos los casos se obtuvieron las variables de edad y sexo del paciente&#44; localizaci&#243;n&#44; tipo de tumor y subtipo histol&#243;gico en el caso del carcinoma basocelular&#44; tama&#241;o&#44; existencia de recurrencias&#44; n&#250;mero de estadios de Mohs y t&#233;cnica de reconstrucci&#243;n&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Se incluyen 44 hombres y 56 mujeres de edades comprendidas entre los 28 y 88 a&#241;os &#40;media 72&#44;6&#41;&#46; El 80&#37; eran carcinomas basocelulares&#44; el 12&#44;38&#37; carcinomas espinocelulares&#44; el 4&#44;76&#37; dermatofibrosarcomas <span class="elsevierStyleItalic">protuberans</span>&#44; el 0&#44;95&#37; carcinoma de c&#233;lulas de Merkel&#44; el 0&#44;9 5&#37; carcinoma anexial microqu&#237;stico y el 0&#44;95&#37; lentigo maligno melanoma&#46; La mayor&#237;a estaban localizados en la cabeza y el 60&#37; precis&#243; m&#225;s de un estadio de Mohs para ser eliminado&#46;</p> <span class="elsevierStyleSectionTitle">Conclusi&#243;n</span><p class="elsevierStyleSimplePara elsevierViewall">Esta serie se caracteriza por presentar un alto porcentaje de tumores cut&#225;neos de alto riesgo&#46; Valorando estos factores de riesgo de forma independiente podemos concluir que el tama&#241;o del tumor es el factor de riesgo que m&#225;s se relaciona con la agresividad y la extensi&#243;n subcl&#237;nica en el caso del carcinoma basocelular&#44; no pudiendo llegar a conclusiones similares para el resto de los tumores incluidos en este trabajo&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:32 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chemosurgery&#58; a microscopically controlled method of cancer excision"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "F&#46;E&#46; Mohs"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arch Surg"
                        "fecha" => "1941"
                        "volumen" => "42"
                        "paginaInicial" => "279"
                        "paginaFinal" => "295"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cirug&#237;a de Mohs"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46; R&#237;os-Buceta"
                            1 => "A&#46; Picoto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Actas Dermosifilogr"
                        "fecha" => "2003"
                        "volumen" => "94"
                        "paginaInicial" => "503"
                        "paginaFinal" => "523"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The cost of non-melanoma skin cancer management in the U&#46;S&#46; Medicare population"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;G&#46; Chen"
                            1 => "S&#46;R&#46; Feldman"
                            2 => "A&#46;B&#46; Fleischer"
                            3 => "G&#46; Yu"
                            4 => "E&#46;D&#46; Smith"
                            5 => "P&#46;M&#46; Willford"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2001"
                        "volumen" => "27"
                        "paginaInicial" => "1035"
                        "paginaFinal" => "1038"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11849266"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Basal cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;S&#46;M&#46; Wong"
                            1 => "R&#46;C&#46; Strange"
                            2 => "J&#46;T&#46; Lear"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.327.7418.794"
                      "Revista" => array:6 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2003"
                        "volumen" => "327"
                        "paginaInicial" => "794"
                        "paginaFinal" => "798"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14525881"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tumors of the epidermis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46; Weedon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "titulo" => "Skin pathology"
                        "fecha" => "1997"
                        "editorial" => "Churchill-Livingstone"
                        "editorialLocalizacion" => "London"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6&#46;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Bastiaens MT&#44; Hoefnagel JJ&#44; Bruijn JA&#44; Westendorp RG&#44; Vermeer BJ&#44; Bouwes Bavinck JN&#46; Differences in age&#44; site distribution and sex between nodular and superficial basal cell carcinomas indicate different type of tumors&#46; J Invest Dermatol&#46; 998&#59;110&#58;880-4&#46;"
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology and aetiology of basal cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46; Tran"
                            1 => "K&#46; Chen"
                            2 => "S&#46; Shumack"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2003"
                        "volumen" => "149"
                        "numero" => "Suppl 66"
                        "paginaInicial" => "50"
                        "paginaFinal" => "52"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14616351"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Variations of basal cell carcinomas according to gender&#44; age&#44; location and histopathological subtype"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Y&#46; Scrivener"
                            1 => "E&#46; Grosshans"
                            2 => "B&#46; Cribier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2002"
                        "volumen" => "147"
                        "paginaInicial" => "41"
                        "paginaFinal" => "47"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12100183"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0016508508009694"
                          "estado" => "S300"
                          "issn" => "00165085"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "HA&#46; Mohs&#8217; micrographic surgery for treatment of basal cell carcinoma of the face&#8211;results of a retrospective study and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46;W&#46; Smeets"
                            1 => "D&#46;I&#46; Kuijpers"
                            2 => "P&#46; Nelemans"
                            3 => "J&#46;U&#46; Ostertag"
                            4 => "M&#46;E&#46; Verhaegh"
                            5 => "G&#46;A&#46; Krekels"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2004.06047.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2004"
                        "volumen" => "151"
                        "paginaInicial" => "141"
                        "paginaFinal" => "147"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15270883"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of extensive subclinical spread in nonmelanoma skin cancer treated with Mohs micrographic surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;S&#46; Batra"
                            1 => "L&#46;C&#46; Kelley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "2002"
                        "volumen" => "138"
                        "paginaInicial" => "1043"
                        "paginaFinal" => "1051"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12164742"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0016510709026868"
                          "estado" => "S300"
                          "issn" => "00165107"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Correlation of histologic subtypes of primary basal cell carcinoma and number of Mohs stages required to achieve a tumor-free plane"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "I&#46;F&#46; Orengo"
                            1 => "S&#46;J&#46; Salasche"
                            2 => "J&#46; Fewkes"
                            3 => "J&#46; Khan"
                            4 => "J&#46; Thornby"
                            5 => "F&#46; Rubin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:8 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "1997"
                        "volumen" => "37"
                        "numero" => "Pt 1"
                        "paginaInicial" => "385"
                        "paginaFinal" => "387"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9308550"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1542356509006697"
                          "estado" => "S300"
                          "issn" => "15423565"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Basal cell carcinoma treated with Mohs surgery in Australia I&#46; Experience over 10 years"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "I&#46; Leibovitch"
                            1 => "S&#46;C&#46; Huilgol"
                            2 => "D&#46; Selva"
                            3 => "S&#46; Richards"
                            4 => "R&#46; Paver"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2005.04.083"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2005"
                        "volumen" => "53"
                        "paginaInicial" => "445"
                        "paginaFinal" => "451"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16112351"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The use of Mohs micrographic surgery for determination of residual tumor in incompletely excised basal cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46;C&#46; Bieley"
                            1 => "R&#46;S&#46; Kirsner"
                            2 => "B&#46;A&#46; Reyes"
                            3 => "L&#46;D&#46; Garland"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:8 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "1992"
                        "volumen" => "26"
                        "numero" => "Pt 1"
                        "paginaInicial" => "754"
                        "paginaFinal" => "756"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1583176"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0016510711000071"
                          "estado" => "S300"
                          "issn" => "00165107"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of methods for checking surgical margins"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;P&#46; Rapini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "1990"
                        "volumen" => "23"
                        "paginaInicial" => "288"
                        "paginaFinal" => "294"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2212126"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical margins for excision of primary cutaneous squamous cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;G&#46; Brodland"
                            1 => "J&#46;A&#46; Zitelli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "1992"
                        "volumen" => "27"
                        "paginaInicial" => "241"
                        "paginaFinal" => "248"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1430364"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous squamous cell carcinoma treated with Mohs micrographic surgery in Australia I&#46; Experience over 10 years"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "I&#46; Leibovitch"
                            1 => "S&#46;C&#46; Huilgol"
                            2 => "D&#46; Selva"
                            3 => "D&#46; Hill"
                            4 => "S&#46; Richards"
                            5 => "R&#46; Paver"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2005.02.059"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2005"
                        "volumen" => "53"
                        "paginaInicial" => "253"
                        "paginaFinal" => "260"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16021120"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Squamous-cell carcinoma treated by Mohs&#8217; surgery&#58; an experience with 414 cases in a period of 15 years"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; Robins"
                            1 => "L&#46;M&#46; Dzubow"
                            2 => "D&#46;S&#46; Rigel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Dermatol Surg Oncol"
                        "fecha" => "1981"
                        "volumen" => "7"
                        "paginaInicial" => "800"
                        "paginaFinal" => "801"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7298979"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermatofibrosarcoma protuberans&#46; Experience with 14 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "F&#46; D&#8217;Andrea"
                            1 => "A&#46; Vozza"
                            2 => "S&#46; Brongo"
                            3 => "F&#46; Di Girolano"
                            4 => "G&#46; Vozza"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JEADV"
                        "fecha" => "2001"
                        "volumen" => "15"
                        "paginaInicial" => "427"
                        "paginaFinal" => "429"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11763383"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermatofibrosarcoma protuberans"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;T&#46; Vidimos"
                            1 => "T&#46;N&#46; Helm"
                            2 => "F&#46;A&#46; Papay"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "titulo" => "Cutaneous oncology"
                        "fecha" => "1998"
                        "editorial" => "Blackwell Science"
                        "editorialLocalizacion" => "Malden"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mohs micrographic surgery for the treatment of dermatofibrosarcoma protuberans&#46; Results of a multiinstitutional series with an analysis of the extent of microscopic spread"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Ratner"
                            1 => "C&#46;O&#46; Thomas"
                            2 => "T&#46;M&#46; Johnson"
                            3 => "V&#46;K&#46; Sondak"
                            4 => "T&#46;A&#46; Hamilton"
                            5 => "B&#46;R&#46; Nelson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "1997"
                        "volumen" => "37"
                        "paginaInicial" => "600"
                        "paginaFinal" => "613"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9344201"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0016510711001209"
                          "estado" => "S300"
                          "issn" => "00165107"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermatofibrosarcoma protuberans treated by micrographic surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Ah-Weng"
                            1 => "J&#46;R&#46; Marsden"
                            2 => "D&#46;S&#46; Sanders"
                            3 => "R&#46; Waters"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/sj.bjc.6600643"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Cancer"
                        "fecha" => "2002"
                        "volumen" => "87"
                        "paginaInicial" => "1386"
                        "paginaFinal" => "1389"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12454766"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mohs micrographic surgery for dermatofibrosarcoma protuberans&#58; University of Miami and NYU Experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46; Nouri"
                            1 => "R&#46; Lodha"
                            2 => "G&#46; Jim&#233;nez"
                            3 => "P&#46; Robins"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2002"
                        "volumen" => "28"
                        "paginaInicial" => "1060"
                        "paginaFinal" => "1064"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12460303"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Microcystic adnexal carcinoma&#58; forty-eight cases&#44; their treatment&#44; and their outcome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46; Chiller"
                            1 => "D&#46; Passaro"
                            2 => "M&#46; Scheuller"
                            3 => "M&#46; Singer"
                            4 => "T&#46; McCalmont"
                            5 => "R&#46;C&#46; Grekin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "2000"
                        "volumen" => "136"
                        "paginaInicial" => "1355"
                        "paginaFinal" => "1359"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11074698"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S001651071001895X"
                          "estado" => "S300"
                          "issn" => "00165107"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sclerosing sweat duct &#40;syringomatous&#41; carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;H&#46; Cooper"
                            1 => "S&#46;E&#46; Mills"
                            2 => "D&#46;D&#46; Leonard"
                            3 => "D&#46;J&#46; Santa Cruz"
                            4 => "J&#46;T&#46; Headington"
                            5 => "R&#46;J&#46; Barr"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Surg Pathol"
                        "fecha" => "1985"
                        "volumen" => "9"
                        "paginaInicial" => "422"
                        "paginaFinal" => "433"
                        "itemHostRev" => array:3 [
                          "pii" => "S1542356509000500"
                          "estado" => "S300"
                          "issn" => "15423565"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Microcystic adnexal carcinoma&#58; Collaborative series review and update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "P&#46;M&#46; Friedman"
                            1 => "R&#46;H&#46; Friedman"
                            2 => "S&#46;B&#46; Jiang"
                            3 => "K&#46; Nouri"
                            4 => "R&#46; Amonette"
                            5 => "P&#46; Robins"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "1999"
                        "volumen" => "41"
                        "paginaInicial" => "225"
                        "paginaFinal" => "231"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10426893"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Microcystic adnexal carcinoma&#58; treatment with Mohs micrographic surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "I&#46; Leibovitchet"
                            1 => "S&#46;C&#46; Huilgol"
                            2 => "D&#46; Selva"
                            3 => "K&#46; Lun"
                            4 => "S&#46; Richards"
                            5 => "R&#46; Paver"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2004.10.868"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2005"
                        "volumen" => "52"
                        "paginaInicial" => "295"
                        "paginaFinal" => "300"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15692477"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1542356509001372"
                          "estado" => "S300"
                          "issn" => "15423565"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous malignant melanoma treated by Mohs surgery&#46; Review of the treatment results of 179 cases from the Mohs Melanoma Registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;N&#46; Snow"
                            1 => "F&#46;E&#46; Mohs"
                            2 => "H&#46;A&#46; Oriba"
                            3 => "C&#46;M&#46; Dudley"
                            4 => "G&#46; Leverson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "1997"
                        "volumen" => "23"
                        "paginaInicial" => "1055"
                        "paginaFinal" => "1060"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9391564"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mohs micrographic surgery for lentigo maligna melanoma&#58; a follow-up study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46;M&#46; Cohen"
                            1 => "M&#46;W&#46; McCall"
                            2 => "R&#46;H&#46; Zax"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "1998"
                        "volumen" => "24"
                        "paginaInicial" => "673"
                        "paginaFinal" => "677"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9648576"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mohs micrographic surgery in the treatment of lentigo maligna and melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;L&#46; Temple"
                            1 => "J&#46;P&#46; Arlette"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/jso.20305"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Surg Oncol"
                        "fecha" => "2006"
                        "volumen" => "94"
                        "paginaInicial" => "287"
                        "paginaFinal" => "292"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16917877"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S001651070703180X"
                          "estado" => "S300"
                          "issn" => "00165107"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multimodality treatment of Merkel cell carcinoma&#58; case series and literature review of 1024 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "H&#46; Medina-Franco"
                            1 => "M&#46;M&#46; Urist"
                            2 => "J&#46; Fieras"
                            3 => "M&#46;J&#46; Heslin"
                            4 => "K&#46;I&#46; Bland"
                            5 => "S&#46;W&#46; Beenken"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Surg Oncol"
                        "fecha" => "2001"
                        "volumen" => "8"
                        "paginaInicial" => "204"
                        "paginaFinal" => "208"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11314935"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0016508510009613"
                          "estado" => "S300"
                          "issn" => "00165085"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Merkel cell carcinoma&#46; Comparison of Mohs micrographic surgery and wide excision in eighty-six patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "W&#46;J&#46; O&#8217;Connor"
                            1 => "R&#46;K&#46; Roenigk"
                            2 => "D&#46;G&#46; Brodland"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "1997"
                        "volumen" => "23"
                        "paginaInicial" => "929"
                        "paginaFinal" => "933"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9357504"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mohs micrographic surgery in the treatment of rare aggressive cutaneous tumors&#58; the Geisinger experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;J&#46; Thomas"
                            1 => "G&#46;C&#46; Wood"
                            2 => "V&#46;J&#46; Marks"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2007.33069.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2007"
                        "volumen" => "33"
                        "paginaInicial" => "333"
                        "paginaFinal" => "339"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17338692"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000009900000004/v1_201304241431/S1578219008702518/v1_201304241431/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "6155"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15782190/0000009900000004/v1_201304241431/S1578219008702518/v1_201304241431/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219008702518?idApp=UINPBA000044"
]
Compartir
Información de la revista
Vol. 99. Núm. 4.
Páginas 275-280 (mayo 2008)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 99. Núm. 4.
Páginas 275-280 (mayo 2008)
Original articles
Acceso a texto completo
Mohs Micrographic Surgery: Our First 100 Patients
Cirugía de Mohs: Nuestros Primeros Cien Pacientes
Visitas
6708
T. Alonso
Autor para correspondencia
teresa@aedv.es

Correspondence: Servicio de Dermatología. Hospital de León, C/ Altos de Nava, s/n, 24280 León, Spain.
, P. Sánchez, A. González, J. Ingelmo, I. Ruiz, S. Delgado, M.A. Rodríguez
Servicio de Dermatología, Hospital de León, León, Spain
Este artículo ha recibido
Información del artículo
Resumen
Bibliografía
Descargar PDF
Estadísticas
Abstract
Introduction

Mohs surgery was first described by Frederic Mohs in 1941 to eliminate high-risk cutaneous tumors. The technique involves histological examination of the margins.

Objective

The aim of this study was to describe the clinical findings and compare the grade and subclinical extension of the tumor—as measured by the number of Mohs stages needed for complete elimination—according to whether the tumor presented high-risk factors.

Methods

We included 100 patients with 105 tumors. In all cases, age, sex, tumor site, tumor type, histological subtype in the case of basal cell carcinoma, size, recurrences, number of Mohs stages, and reconstruction technique were recorded.

Results

The study group comprised 44 men and 56 women aged between 28 and 88 years (mean, 72.6 years). Of the tumors, 80% corresponded to basal cell carcinoma, 12.38% to squamous cell carcinoma, 4.76% to dermatofibrosarcoma protuberans, 0.95% to Merkel cell carcinoma, 0.95% to microcystic adnexal carcinoma, and 0.95% to lentigo maligna melanoma. Most tumors were located on the head and 60% required more than one Mohs stage for complete elimination.

Conclusion

This series is characterized by a high percentage of high-risk cutaneous tumors. After assessing the risk factors independently, we found that the size of the tumor is the risk factor most closely related to grade and subclinical extension in the case of basal cell carcinoma, although similar conclusions cannot be drawn for the other types of tumor studied.

Key words:
Mohs surgery
cutaneous tumors
surgery
treatment
Resumen
Definición

Descrita por Frederic Mohs en 1941, la cirugía de Mohs es una técnica quirúrgica con control histológico de los bordes, utilizada para eliminar tumores cutáneos de alto riesgo.

Objetivo

El objetivo de este artículo es informar de los hallazgos clínicos y comparar la agresividad-extensión subclínica del tumor, medida como número de estadios de Mohs necesarios para eliminar completamente el tumor, en función de que el tumor presente o no factores de alto riesgo.

Métodos

Se incluyen 100 pacientes con 105 tumores y en todos los casos se obtuvieron las variables de edad y sexo del paciente, localización, tipo de tumor y subtipo histológico en el caso del carcinoma basocelular, tamaño, existencia de recurrencias, número de estadios de Mohs y técnica de reconstrucción.

Resultados

Se incluyen 44 hombres y 56 mujeres de edades comprendidas entre los 28 y 88 años (media 72,6). El 80% eran carcinomas basocelulares, el 12,38% carcinomas espinocelulares, el 4,76% dermatofibrosarcomas protuberans, el 0,95% carcinoma de células de Merkel, el 0,9 5% carcinoma anexial microquístico y el 0,95% lentigo maligno melanoma. La mayoría estaban localizados en la cabeza y el 60% precisó más de un estadio de Mohs para ser eliminado.

Conclusión

Esta serie se caracteriza por presentar un alto porcentaje de tumores cutáneos de alto riesgo. Valorando estos factores de riesgo de forma independiente podemos concluir que el tamaño del tumor es el factor de riesgo que más se relaciona con la agresividad y la extensión subclínica en el caso del carcinoma basocelular, no pudiendo llegar a conclusiones similares para el resto de los tumores incluidos en este trabajo.

Palabras clave:
cirugía de Mohs
tumores cutáneos
cirugía
tratamiento
El Texto completo está disponible en PDF
References
[1.]
F.E. Mohs.
Chemosurgery: a microscopically controlled method of cancer excision.
Arch Surg, 42 (1941), pp. 279-295
[2.]
L. Ríos-Buceta, A. Picoto.
Cirugía de Mohs.
Actas Dermosifilogr, 94 (2003), pp. 503-523
[3.]
J.G. Chen, S.R. Feldman, A.B. Fleischer, G. Yu, E.D. Smith, P.M. Willford.
The cost of non-melanoma skin cancer management in the U.S. Medicare population.
Dermatol Surg, 27 (2001), pp. 1035-1038
[4.]
C.S.M. Wong, R.C. Strange, J.T. Lear.
Basal cell carcinoma.
[5.]
D. Weedon.
Tumors of the epidermis.
Skin pathology, Churchill-Livingstone, (1997),
[6.]
Bastiaens MT, Hoefnagel JJ, Bruijn JA, Westendorp RG, Vermeer BJ, Bouwes Bavinck JN. Differences in age, site distribution and sex between nodular and superficial basal cell carcinomas indicate different type of tumors. J Invest Dermatol. 998;110:880-4.
[7.]
H. Tran, K. Chen, S. Shumack.
Epidemiology and aetiology of basal cell carcinoma.
Br J Dermatol, 149 (2003), pp. 50-52
[8.]
Y. Scrivener, E. Grosshans, B. Cribier.
Variations of basal cell carcinomas according to gender, age, location and histopathological subtype.
Br J Dermatol, 147 (2002), pp. 41-47
[9.]
N.W. Smeets, D.I. Kuijpers, P. Nelemans, J.U. Ostertag, M.E. Verhaegh, G.A. Krekels, et al.
HA. Mohs’ micrographic surgery for treatment of basal cell carcinoma of the face–results of a retrospective study and review of the literature.
Br J Dermatol, 151 (2004), pp. 141-147
[10.]
R.S. Batra, L.C. Kelley.
Predictors of extensive subclinical spread in nonmelanoma skin cancer treated with Mohs micrographic surgery.
Arch Dermatol, 138 (2002), pp. 1043-1051
[11.]
I.F. Orengo, S.J. Salasche, J. Fewkes, J. Khan, J. Thornby, F. Rubin.
Correlation of histologic subtypes of primary basal cell carcinoma and number of Mohs stages required to achieve a tumor-free plane.
J Am Acad Dermatol, 37 (1997), pp. 385-387
[12.]
I. Leibovitch, S.C. Huilgol, D. Selva, S. Richards, R. Paver.
Basal cell carcinoma treated with Mohs surgery in Australia I. Experience over 10 years.
J Am Acad Dermatol, 53 (2005), pp. 445-451
[13.]
H.C. Bieley, R.S. Kirsner, B.A. Reyes, L.D. Garland.
The use of Mohs micrographic surgery for determination of residual tumor in incompletely excised basal cell carcinoma.
J Am Acad Dermatol, 26 (1992), pp. 754-756
[14.]
R.P. Rapini.
Comparison of methods for checking surgical margins.
J Am Acad Dermatol, 23 (1990), pp. 288-294
[15.]
D.G. Brodland, J.A. Zitelli.
Surgical margins for excision of primary cutaneous squamous cell carcinoma.
J Am Acad Dermatol, 27 (1992), pp. 241-248
[16.]
I. Leibovitch, S.C. Huilgol, D. Selva, D. Hill, S. Richards, R. Paver.
Cutaneous squamous cell carcinoma treated with Mohs micrographic surgery in Australia I. Experience over 10 years.
J Am Acad Dermatol, 53 (2005), pp. 253-260
[17.]
P. Robins, L.M. Dzubow, D.S. Rigel.
Squamous-cell carcinoma treated by Mohs’ surgery: an experience with 414 cases in a period of 15 years.
J Dermatol Surg Oncol, 7 (1981), pp. 800-801
[18.]
F. D’Andrea, A. Vozza, S. Brongo, F. Di Girolano, G. Vozza.
Dermatofibrosarcoma protuberans. Experience with 14 cases.
JEADV, 15 (2001), pp. 427-429
[19.]
A.T. Vidimos, T.N. Helm, F.A. Papay.
Dermatofibrosarcoma protuberans.
Cutaneous oncology, Blackwell Science, (1998),
[20.]
D. Ratner, C.O. Thomas, T.M. Johnson, V.K. Sondak, T.A. Hamilton, B.R. Nelson, et al.
Mohs micrographic surgery for the treatment of dermatofibrosarcoma protuberans. Results of a multiinstitutional series with an analysis of the extent of microscopic spread.
J Am Acad Dermatol, 37 (1997), pp. 600-613
[21.]
A. Ah-Weng, J.R. Marsden, D.S. Sanders, R. Waters.
Dermatofibrosarcoma protuberans treated by micrographic surgery.
Br J Cancer, 87 (2002), pp. 1386-1389
[22.]
K. Nouri, R. Lodha, G. Jiménez, P. Robins.
Mohs micrographic surgery for dermatofibrosarcoma protuberans: University of Miami and NYU Experience.
Dermatol Surg, 28 (2002), pp. 1060-1064
[23.]
K. Chiller, D. Passaro, M. Scheuller, M. Singer, T. McCalmont, R.C. Grekin.
Microcystic adnexal carcinoma: forty-eight cases, their treatment, and their outcome.
Arch Dermatol, 136 (2000), pp. 1355-1359
[24.]
P.H. Cooper, S.E. Mills, D.D. Leonard, D.J. Santa Cruz, J.T. Headington, R.J. Barr, et al.
Sclerosing sweat duct (syringomatous) carcinoma.
Am Surg Pathol, 9 (1985), pp. 422-433
[25.]
P.M. Friedman, R.H. Friedman, S.B. Jiang, K. Nouri, R. Amonette, P. Robins.
Microcystic adnexal carcinoma: Collaborative series review and update.
J Am Acad Dermatol, 41 (1999), pp. 225-231
[26.]
I. Leibovitchet, S.C. Huilgol, D. Selva, K. Lun, S. Richards, R. Paver.
Microcystic adnexal carcinoma: treatment with Mohs micrographic surgery.
J Am Acad Dermatol, 52 (2005), pp. 295-300
[27.]
S.N. Snow, F.E. Mohs, H.A. Oriba, C.M. Dudley, G. Leverson.
Cutaneous malignant melanoma treated by Mohs surgery. Review of the treatment results of 179 cases from the Mohs Melanoma Registry.
Dermatol Surg, 23 (1997), pp. 1055-1060
[28.]
L.M. Cohen, M.W. McCall, R.H. Zax.
Mohs micrographic surgery for lentigo maligna melanoma: a follow-up study.
Dermatol Surg, 24 (1998), pp. 673-677
[29.]
C.L. Temple, J.P. Arlette.
Mohs micrographic surgery in the treatment of lentigo maligna and melanoma.
J Surg Oncol, 94 (2006), pp. 287-292
[30.]
H. Medina-Franco, M.M. Urist, J. Fieras, M.J. Heslin, K.I. Bland, S.W. Beenken.
Multimodality treatment of Merkel cell carcinoma: case series and literature review of 1024 cases.
Ann Surg Oncol, 8 (2001), pp. 204-208
[31.]
W.J. O’Connor, R.K. Roenigk, D.G. Brodland.
Merkel cell carcinoma. Comparison of Mohs micrographic surgery and wide excision in eighty-six patients.
Dermatol Surg, 23 (1997), pp. 929-933
[32.]
C.J. Thomas, G.C. Wood, V.J. Marks.
Mohs micrographic surgery in the treatment of rare aggressive cutaneous tumors: the Geisinger experience.
Dermatol Surg, 33 (2007), pp. 333-339
Copyright © 2008. Academia Española de Dermatología y Venereología and Elsevier España, S.L.
Descargar PDF
Idiomas
Actas Dermo-Sifiliográficas
Opciones de artículo
Herramientas
es en

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

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