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Characteristics and risk factors for recurrence of cutaneous squamous cell carcinoma with conventional surgery and surgery with delayed intraoperative margin assessment
Características del carcinoma epidermoide cutáneo y riesgo para el desarrollo de recidivas con cirugía convencional y cirugía con transoperatorio tardío
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Tel.: +52 55 54870900ext.4586." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Características del carcinoma epidermoide cutáneo y riesgo para el desarrollo de recidivas con cirugía convencional y cirugía con transoperatorio tardío" ] ] "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" => 1188 "Ancho" => 1583 "Tamanyo" => 317871 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Invasive squamous cell carcinoma at the base of the neck.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Non-melanoma skin cancer includes basal cell carcinoma and squamous cell carcinoma. Basal cell carcinoma (BCC) is the most common skin cancer; it is the least aggressive and generally has a good prognosis. A very low percentage of BCC behave aggressively with extensive local invasion, recurrences and metastases, despite extensive surgical treatment. However, squamous cell carcinoma (SCC) behaves more aggressively.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In general, a very small proportion of non melanoma skin cancers can behave aggressively, with extensive local invasion, multiple recurrences and occasionally, metastases, even after extensive surgery,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> and they have major functional, physical and social impact on the patient.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Statistics on white populations show an increase in incidence of 10% per year,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> predominating in males, at a ratio of 1.3–1.9:1. Predominance in females between the sixth and eighth decades of life has been observed in Mexico. When it presents in children, it is generally associated with a genodermatosis such as xeroderma pigmentosum, with a recurrence risk of up to 18%.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">4–6</span></a> However, it should be stressed that the age of presentation is changing and there is currently a greater incidence in young people,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> especially females and smokers.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The largest series of squamous cell carcinoma, conducted in Mexico, describes this tumour as more common in women, with an average age of 71, and predominating in the face. In this study the average size of the lesion was 3<span class="elsevierStyleHsp" style=""></span>cm and most had ulceration.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">There can be many treatment methods for squamous cell carcinoma; however, surgery is the treatment of choice. For low-grade tumours a surgical safety margin of between 4<span class="elsevierStyleHsp" style=""></span>mm and 6<span class="elsevierStyleHsp" style=""></span>mm is recommended and primary closure or reconstruction with flap or graft. The surgical specimen is sent to the pathology department and if positive in the margins or bed, the patient should be reoperated using a conventional procedure, micrographic Mohs micrographic surgery (MMS), or receive radiotherapy. For high-grade tumours, MMS is the standard of care or, if this technique is not available, resection with a margin of 1<span class="elsevierStyleHsp" style=""></span>cm. Tumours that are not candidates for surgery are sent directly for radiotherapy.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Because MMS was not available in our environment due to its high cost, when this technique was required, we excised the tumours with the margins indicated according to whether the grade was high or low. If primary closure was not feasible, the surgical defect was left open until the margins had been confirmed by histopathology: which we termed delayed closure. We used this technique because occasionally a flap would be required to close the surgical defect and re-excision would be more difficult if positive surgical margins had been found.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Objective</span><p id="par0035" class="elsevierStylePara elsevierViewall">To identify the characteristics of squamous cell carcinoma, its recurrence and the frequency of onset of new tumours, in our cases, and to identify those treated surgically with direct closure or closure delayed until receiving a tumour-free margin report (delayed closure), and thus determines optimal treatment behaviours.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Material and method</span><p id="par0040" class="elsevierStylePara elsevierViewall">The clinical records of patients diagnosed with squamous cell carcinoma who attended the dermatological surgery department of the <span class="elsevierStyleItalic">Hospital General Dr. Manuel Gea González</span> in a period of 10 days. The following variables were obtained from these patients: sex, age, time of onset, topography, morphology, histological characteristics, time between primary excision and recurrence, type of surgical treatment and follow-up time. We used descriptive statistics.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">One hundred and fourteen tumours were studied, from 103 patients with a diagnosis of squamous cell carcinoma. Of the total number of patients, 48 (46.6%) were male and 55 (53.4%) female. The age of diagnosis was between 19 and 91 years (mean<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>71.94; SD<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>13.34) with an onset time from 1 to 112 months (mean<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>12 months; SD<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2.65).</p><p id="par0050" class="elsevierStylePara elsevierViewall">The most common site was the cheek (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), with a histological variety of invasive SCC (54%), followed by SCC <span class="elsevierStyleItalic">in situ</span>. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the demographic characteristics of the case series (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Due to their topography, differentiation, invasion and size, 50% of the tumours in the series were included in the high-risk category.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Of the 103 patients with SCC, 14 had a second primary tumour (maximum 3). Of these, 6 (42.9%) were male and 8 (57.1%) female. There were no significant differences in the likelihood of developing a second SCC between the males and the females.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Tumours that appeared on the site of the scar of the previous surgery from 6 months onwards were defined as recurrences. There were only 4 recurrences (2.2%) that appeared between 1 and 4 years (mean 2.12 years; SD<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.31 years) after the primary tumour. With regard to topography, size and histology, no statistically significant differences were found in the recurrence rate. Of the 4 recurring tumours, 3 were treated with delayed closure, which showed no statistically significant association, since there were too few cases to show a tendency.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Of the 114 tumours, 30 (32.5%) were reconstructed with delayed closure until the margins were confirmed tumour-free and 79 (67.5%) had primary closure; we could not find the data in the clinical records of 5 cases.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The average margin in the tumours studied was 7.2<span class="elsevierStyleHsp" style=""></span>mm, with a minimum of 3<span class="elsevierStyleHsp" style=""></span>mm and a maximum of 5<span class="elsevierStyleHsp" style=""></span>cm (SD<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.473). Tumours <span class="elsevierStyleItalic">in situ</span> had the smallest margins and infiltrating tumours had the largest.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Most cutaneous squamous cell carcinomas are benign and can be cured with conventional surgery. However, high-risk squamous cell carcinoma has been identified that can metastasise in up to 5% and present local recurrence from 3% to 8%. High-risk spinocellular tumours measure more than 2<span class="elsevierStyleHsp" style=""></span>cm, present on the face, are histologically invasive if thicker than 2<span class="elsevierStyleHsp" style=""></span>mm with a Clark level greater than <span class="elsevierStyleSmallCaps">iv</span>, involve perineural invasion and are poorly differentiated.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> Moreover, these tumours have greater recurrence rates after surgical removal.</p><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">In situ</span> squamous cell carcinoma is limited to the epidermis and is the precursor to invasive squamous cell carcinoma, which must be treated aggressively and accurately to prevent its progression and worsen the patient's prognosis.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> Immunosuppression is a variable of poor prognosis in these types of tumours, since the condition and the use of immunosuppressant drugs increase the risk of squamous cell carcinoma by 65 times that of the normal population.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">There are many studies on the effectiveness of MMS and the low incidence of recurrence, some with insufficient evidence to compare effectiveness and the different treatments used for SCC. This prompted Dr Chren to analyse 2 university sites with a population of 1253 patients and 1585 tumours treated with different methods, including excision and MMS. She concluded that the recurrence rate of SCC with MMS was 2.1% and 3.5% after simple excision.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">It must be stressed that in our study, despite having tumours with high-risk factors for recurrence, a recurrence rate of 2.2% was found, similar to that of Mohs surgery, using delayed closure until confirmation of tumour-free margins (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). This finding is important, since it offers us the opportunity to provide optimal treatment for cutaneous squamous cell carcinoma at lower cost and in areas that lack the infrastructure to perform the aforementioned surgical technique.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">We must emphasise that one of the cases that recurred was an <span class="elsevierStyleItalic">in situ</span> squamous cell carcinoma, which was treated with the surgical margin indicated in the clinical guidelines. This leads us to the conclusion that it is likely that, rather than a recurrence, this was a new cancer in an area of field cancerisation with extensive photodamage. The other 3 tumours that recurred were invasive and of an aggressive histological type, which is a very important risk factor for recurrence and metastasis.</p><p id="par0105" class="elsevierStylePara elsevierViewall">We must suspect recurrence if a skin lesion appears on the scar or an area nearby; it can present as an erythemato-squamous plaque or a tumour ranging from millimetres to centimetres in size.</p><p id="par0110" class="elsevierStylePara elsevierViewall">We have learned in the past 2 years that a major recurrence factor for squamous cell carcinoma is the tumour depth in millimetres. Because this is a ten-year retrospective study, we do not have this data for all the tumours we studied, since in previous years this feature was not routinely assessed.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusion</span><p id="par0115" class="elsevierStylePara elsevierViewall">This study demonstrated that the delayed closure technique is economical and can be adapted to other hospitals, and contributes towards the low recurrence rate of cutaneous squamous cell carcinoma lesions, with results that are comparable to those of MMS.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Ethical disclosures</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Protection of human and animal subjects</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Confidentiality of data</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work centre on the publication of patient data.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Right to privacy and informed consent</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres987024" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and method" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec954576" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres987025" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y método" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec954575" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Objective" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Material and method" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusion" ] 10 => array:3 [ "identificador" => "sec0035" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Right to privacy and informed consent" ] ] ] 11 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-05-24" "fechaAceptado" => "2016-11-25" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec954576" "palabras" => array:4 [ 0 => "Non-melanoma skin cancer" 1 => "Squamous cell carcinoma" 2 => "Recurrence" 3 => "Modified Mohs" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec954575" "palabras" => array:4 [ 0 => "Cáncer de piel no melanoma" 1 => "Carcinoma epidermoide" 2 => "Recurrencia" 3 => "Mohs modificado" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Non-melanoma skin cancer includes basal cell carcinoma and squamous cell carcinoma (SCC). Basal cell carcinoma is the most common and least aggressive but in a low percentage of cases, despite appropriate wide surgical margins, it can be aggressive, producing local invasion, recurrences and distance metastasis. SCC has a more aggressive behaviour invading first the skin, the lymph nodes and less frequently produces distance metastasis.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To identify the characteristics of recurrent SCC and frequency of new SCC after conventional surgical and primary closure or closure delayed until a histological reporting of tumour-free surgical margins, in order to achieve a better surgical option, in our Mexican population.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Materials and method</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We reviewed clinical records from the last 10 years, and included those with a diagnosis of SCC.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">One hundred and fourteen tumours in 103 patients were included. The mean new tumour diagnosis was 32.2 per year; there were 46.6% men and 53.4% women. Age range 19–91, with mean 71.94 years (SD<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>13.34). The evolution time was from 1 to 112 months (mean<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>12 months, SD<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2.65). The most affected site was the cheek. In addition, an invasive tumour was reported in 54% in the histopathological study. At 10-year follow-up we found a second SCC in 14 patients and only 4 recurrences, between the 1st and 4th year and 3 were treated with delayed closure until margins were tumour-free.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">In this study we demonstrated that delayed closure technique is easy and adaptable in our population in the treatment of SCC, achieving good results with very low recurrences at 10-year follow-up.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and method" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Antecedentes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El carcinoma de piel no melanoma basocelular y el carcinoma epidermoide o espinocelular (CEC) son tumores frecuentes. El carcinoma basocelular es el cáncer más frecuente y el menos agresivo; en algunas ocasiones, a pesar del tratamiento quirúrgico con márgenes amplios, un porcentaje bajo tiene comportamiento agresivo, como invasión local extensa, recurrencias y metástasis. El CEC tiene un comportamiento más agresivo, primero en piel, después en ganglios linfáticos y, raramente, con metástasis a otros órganos.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Identificar las características de los CEC recurrentes y la frecuencia de aparición de nuevos tumores, tras el tratamiento quirúrgico con cirugía convencional y cierre diferido de herida hasta obtener el resultado histológico libre de tumor (transoperatorio tardío), esto con la finalidad de tener mejores opciones de tratamiento en la población mexicana.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material y método</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se revisaron los expedientes de 10 años y se incluyeron aquellos que tenían diagnóstico de CEC.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 114 tumores en 103 pacientes. Utilizando un análisis descriptivo, se encontró que la media de diagnóstico de casos nuevos por año fue 32,2. Pacientes masculinos 48 (46,6%) y 55 (53,4%) femeninos. La edad diagnóstica fue entre 19 y 91 años (media<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>71,94; DE<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>13,34) con un tiempo de evolución de 1 a 112 meses (media<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>12 meses; DE<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2,65). El más frecuente es en la mejilla y la variedad histológica invasiva se da en el 54%. En 14 pacientes se encontró un segundo CEC. Solo tuvimos 4 recurrencias, que aparecieron entre el primer y el cuarto año de seguimiento, y 3<span class="elsevierStyleHsp" style=""></span>de estos fueron tratados con cirugía con transoperatorio tardío.</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusión</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Este estudio demostró que la técnica de cirugía con transoperatorio tardío es adaptable para el tratamiento de CEC con buenos resultados y bajo porcentaje de recurrencia en un seguimiento a 10 años.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y método" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Domínguez-Cherit J, Rodríguez-Gutiérrez G, Narváez Rosales V, Toussaint Caire S, Fonte Avalos V. Características del carcinoma epidermoide cutáneo y riesgo para el desarrollo de recidivas con cirugía convencional y cirugía con transoperatorio tardío. Cir Cir. 2017;85:499–503.</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" => 1188 "Ancho" => 1583 "Tamanyo" => 317871 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Invasive squamous cell carcinoma at the base of the neck.</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" => 1188 "Ancho" => 1583 "Tamanyo" => 215772 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Surgical defect after SCC excision with margin, left open until the histopathological report. When this returns tumour-free, the wound will be closed.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Total \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">117 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Males \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Females \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Topography</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cheek \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nose \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Upper limb \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Scalp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hand \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Trunk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lower limb \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Forehead \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lip \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pinna \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Eyelid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Genitals \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Temporal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Second spinocellular carcinoma</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1676383.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">General characteristics of squamous cell carcinoma in the sample studied.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Basal cell carcinoma treated with Mohs surgery in Australia I. Experience over 10 years" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I. Leibovitch" 1 => "S. Huilgol" 2 => "D. Selva" 3 => "S. Richards" 4 => "R. Paver" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2005.04.089" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2005" "volumen" => "53" "paginaInicial" => "458" "paginaFinal" => "463" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16112353" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0065" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of skin-related quality of life after treatment of cutaneous basal cell carcinoma and squamous cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T. Chen" 1 => "D.L. Bertentha" 2 => "A. Sahay" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.143.11.1386" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2007" "volumen" => "143" "paginaInicial" => "1386" "paginaFinal" => "1392" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18025362" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0070" "etiqueta" => "3" "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 => "J. Roewert-Huber" 1 => "B. Lange-Asschenfeldt" 2 => "E. Stockfleth" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2007.08273.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2007" "volumen" => "157" "paginaInicial" => "47" "paginaFinal" => "51" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18067632" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0075" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Basal cell carcinoma in childhood: case report and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Griffin" 1 => "P. Cohen" 2 => "J. Tschen" 3 => "E. Mullans" 4 => "K. Schulze" 5 => "P. Martinelli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2006.09.032" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2007" "volumen" => "57" "paginaInicial" => "S97" "paginaFinal" => "S102" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17938034" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0080" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence of basal cell and squamous cell carcinomas in a population younger than 40 years" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Christenson" 1 => "T. Borrowman" 2 => "C. Vachon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.294.6.681" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2005" "volumen" => "294" "paginaInicial" => "681" "paginaFinal" => "690" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16091570" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0085" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carcinoma epidermoide de piel en la población mexicana. Estudio epidemiológico y clínico de 508 tumores" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T. Barrón-Tapia" 1 => "J. Peniche-Rosado" 2 => "A. Peniche-Castellanos" 3 => "I. Arellano-Mendoza" 4 => "G. León-Dorantes" 5 => "P. Mercadillo-Pérez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Rev Med Hosp Gen Mex" "fecha" => "2004" "volumen" => "67" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0090" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carcinoma epidermoide cutáneo: definiendo la variante de alto riesgo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Martorell-Calatayud" 1 => "O. Sanmartín Jimenez" 2 => "J. Cruz Mojarrieta" 3 => "C. Guillén Barona" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.adengl.2011.12.012" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2013" "volumen" => "104" "paginaInicial" => "367" "paginaFinal" => "379" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23683506" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0095" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical and histological prognostic factors for local recurrence and metastasis of cutaneous squamous cell carcinoma: analysis of a defined population" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Roozeboom" 1 => "B. Lohman" 2 => "A. Westers-Attema" 3 => "M.H. Roozeboom" 4 => "B.G. Lohman" 5 => "A. Westers-Attema" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Acta Derm Venereol" "fecha" => "2013" "volumen" => "6" "paginaInicial" => "417" "paginaFinal" => "421" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0100" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Bishakjian CK, Olencki T, Aasi SZ, Alam M, Andersen JS, Berg D, et al. NCCN Guidelines Version 1.2016 Panel Members Squamous Cell Skin Cancer. Available from: <a href="https://es.scribd.com/doc/295173447/squamous-Cell-Skin-Cancer-NCCN-Guidelines">https://es.scribd.com/doc/295173447/squamous-Cell-Skin-Cancer-NCCN-Guidelines</a>." ] ] ] 9 => array:3 [ "identificador" => "bib0105" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumor recurrences, five years after treatment of cutaneous basal cell carcinoma and squamous cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.M. Chren" 1 => "E. Linos" 2 => "J.S. Torres" 3 => "S.E. Stuart" 4 => "M.S. Rupa Parvataneni" 5 => "W.J. Boscardin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/jid.2012.403" "Revista" => array:6 [ "tituloSerie" => "J Invest Dermatol" "fecha" => "2013" "volumen" => "133" "paginaInicial" => "1188" "paginaFinal" => "1196" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23190903" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0110" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk factors for cutaneous squamous cell carcinoma recurrence, metastasis and disease-specific death: a systemic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.K. Thompson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamadermatol.2015.4994" "Revista" => array:6 [ "tituloSerie" => "JAMA Dermatol" "fecha" => "2016" "volumen" => "152" "paginaInicial" => "419" "paginaFinal" => "428" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26762219" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24440507/0000008500000006/v1_201802220438/S2444050718300160/v1_201802220438/en/main.assets" "Apartado" => array:4 [ "identificador" => "44603" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24440507/0000008500000006/v1_201802220438/S2444050718300160/v1_201802220438/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444050718300160?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 45 | 0 | 45 |
| 2024 October | 258 | 9 | 267 |
| 2024 September | 354 | 18 | 372 |
| 2024 August | 366 | 16 | 382 |
| 2024 July | 421 | 11 | 432 |
| 2024 June | 331 | 9 | 340 |
| 2024 May | 428 | 14 | 442 |
| 2024 April | 286 | 12 | 298 |
| 2024 March | 268 | 12 | 280 |
| 2024 February | 287 | 12 | 299 |
| 2024 January | 329 | 16 | 345 |
| 2023 December | 227 | 11 | 238 |
| 2023 November | 280 | 13 | 293 |
| 2023 October | 385 | 25 | 410 |
| 2023 September | 253 | 17 | 270 |
| 2023 August | 194 | 14 | 208 |
| 2023 July | 251 | 3 | 254 |
| 2023 June | 219 | 7 | 226 |
| 2023 May | 236 | 15 | 251 |
| 2023 April | 211 | 5 | 216 |
| 2023 March | 169 | 2 | 171 |
| 2023 February | 120 | 11 | 131 |
| 2023 January | 120 | 4 | 124 |
| 2022 December | 107 | 14 | 121 |
| 2022 November | 78 | 18 | 96 |
| 2022 October | 98 | 13 | 111 |
| 2022 September | 96 | 13 | 109 |
| 2022 August | 106 | 24 | 130 |
| 2022 July | 56 | 6 | 62 |
| 2022 June | 80 | 22 | 102 |
| 2022 May | 74 | 11 | 85 |
| 2022 April | 95 | 11 | 106 |
| 2022 March | 242 | 27 | 269 |
| 2022 February | 189 | 24 | 213 |
| 2022 January | 131 | 11 | 142 |
| 2021 December | 101 | 21 | 122 |
| 2021 November | 109 | 15 | 124 |
| 2021 October | 123 | 20 | 143 |
| 2021 September | 108 | 19 | 127 |
| 2021 August | 151 | 10 | 161 |
| 2021 July | 110 | 15 | 125 |
| 2021 June | 67 | 8 | 75 |
| 2021 May | 95 | 10 | 105 |
| 2021 April | 232 | 36 | 268 |
| 2021 March | 128 | 13 | 141 |
| 2021 February | 67 | 9 | 76 |
| 2021 January | 100 | 17 | 117 |
| 2020 December | 92 | 15 | 107 |
| 2020 November | 95 | 14 | 109 |
| 2020 October | 65 | 11 | 76 |
| 2020 September | 63 | 15 | 78 |
| 2020 August | 55 | 13 | 68 |
| 2020 July | 53 | 11 | 64 |
| 2020 June | 63 | 12 | 75 |
| 2020 May | 102 | 15 | 117 |
| 2020 April | 78 | 15 | 93 |
| 2020 March | 59 | 6 | 65 |
| 2020 February | 68 | 13 | 81 |
| 2020 January | 63 | 11 | 74 |
| 2019 December | 57 | 10 | 67 |
| 2019 November | 36 | 7 | 43 |
| 2019 October | 42 | 9 | 51 |
| 2019 September | 29 | 10 | 39 |
| 2019 August | 22 | 5 | 27 |
| 2019 July | 38 | 10 | 48 |
| 2019 June | 68 | 8 | 76 |
| 2019 May | 137 | 40 | 177 |
| 2019 April | 49 | 34 | 83 |
| 2019 March | 15 | 9 | 24 |
| 2019 February | 29 | 6 | 35 |
| 2019 January | 15 | 2 | 17 |
| 2018 December | 14 | 8 | 22 |
| 2018 November | 21 | 4 | 25 |
| 2018 October | 42 | 5 | 47 |
| 2018 September | 61 | 27 | 88 |
| 2018 August | 24 | 5 | 29 |
| 2018 July | 27 | 8 | 35 |
| 2018 June | 54 | 6 | 60 |
| 2018 May | 21 | 5 | 26 |
| 2018 April | 23 | 4 | 27 |
| 2018 March | 33 | 5 | 38 |
| 2018 February | 4 | 3 | 7 |
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