What is Cryosurgery?
Cryosurgery is a highly effective treatment for a broad range of benign skin problems. Cryosurgery is best suited for use in patients with light skin and for treatment of lesions in most non–hair-bearing areas of the body. Spray methods include the timed spot freeze technique, the rotary or spiral pattern, and the paintbrush method. Benign skin lesions that are suitable for freezing include actinic keratosis, solar lentigo, seborrheic keratosis, viral wart, molluscum contagiosum, and dermatofibroma. Cryosurgery requires little time. Advantages of this treatment include a short preparation time, low risk of infection, and minimal wound care. In addition, cryosurgery requires no expensive supplies or injectable anesthesia, and the patient does not have to return for suture removal. Potential side effects include bleeding, blister formation, headache, hair loss, and hypopigmentation, but rarely scarring. Skin lesions often can be treated in a single session, although some require several treatments.
Cryosurgery has been used to treat skin lesions for approximately 100 years. The first cryogens were liquid air and compressed carbon dioxide snow. Liquid nitrogen became available in the 1940s and currently is the most widely used cryogen.
Over the past 50 years, much experience has been gained in the use of cryosurgery to treat skin lesions. The cotton-tipped dipstick method of liquid nitrogen application has been popular in the management of common benign lesions. However, this method is being supplanted by liquid nitrogen spray techniques. Liquid nitrogen spray equipment is easy to use, and similar techniques can be employed to manage benign, premalignant, and malignant lesions.
Sun-damaged skin and related lesions are highly amenable to intervention with cryosurgical treatment. Localized small actinic keratosis, which is one of the most common solar-related skin abnormalities, usually requires only five to seven seconds of freeze time beyond initial appearance of a halo around the target lesion. Treatment requires only one freeze-thaw cycle and a margin of less than 1 mm.
Seborrheic keratosis, the most common benign neoplasm, is best treated with cryosurgery or shave excision/curettage. Cryosurgery is especially effective in patients with multiple lesions.11Thin, flat lesions usually require only one five- to 10-second freeze-thaw cycle; larger, thicker lesions may need longer treatment times or, occasionally, two freeze-thaw cycles.
In treating seborrheic keratosis, the physician should consider the potential for hair loss in treated areas when choosing a therapeutic modality. The other major side effect of cryosurgery for this lesion is hypopigmentation. This side effect is more likely to occur in patients with dark skin.
VIRAL SKIN INFECTIONS
Warts that are resistant to over-the-counter topical agents commonly are treated with cryosurgery. However, response is variable and often depends on the size of the wart and the degree of hyperkeratosis. Several treatment sessions typically are required, and the overall success rate is approximately 75 percent.
To avoid hypopigmentation, small flat warts may be treated with a light spray technique. Digital warts respond favorably to the timed spot freeze spray technique. Deep plantar or palmar warts present challenges, because pain may limit the patient’s tolerance of freezing.
Cryosurgery has been found to be effective in the management of condyloma acuminatum, particularly when treatment with podophyllin (Podocon-25) has failed or the lesion is located in an area where use of this agent is undesirable.
Molluscum contagiosum, a common dermatologic problem in younger persons, is caused by a poxvirus. This lesion is amenable to cryosurgery, Applying liquid nitrogen spray for a few seconds until the surface of the umbilicated papule turns white usually is adequate.
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