64), although patient satisfaction was higher with cryosurgery.
Multiple skin tags on neck trial#
21 A randomized controlled trial (n = 240) found no difference in clearance rates in the treatment of warts comparing repeat cryosurgery with daily salicylic acid (34% vs. 21 Also, the Cochrane review did not demonstrate significant difference between salicylic acid and cryotherapy or difference between cryotherapy and placebo. A Cochrane review found no significant difference in cure rates between cryotherapy administered at two-, three-, and four-week intervals for the treatment of warts. 20 For deep plantar warts, improved cure rates can be achieved by pretreatment with keratolytics (i.e., salicylic acid) followed by shaving the hyperkeratotic tissue and subsequent cryotherapy treatment. Several treatment sessions may be required therefore, expectations should be discussed with the patient. Clearance rates following cryosurgery range from 39% to 84% at three months. 17Ĭlearance of verrucous lesions is variable, depending on the size of the lesion and the degree of hyperkeratosis. 4 A systematic review of 118 observational studies found that the recurrence of squamous cell carcinoma was lowest after cryotherapy however, the lesions were small and low risk. 1 Clinical monitoring after treatment for recurrence is recommended because recurrence typically occurs within the first two years following cryotherapy. Significantly raised lesions can benefit from curettage and debulking before cryotherapy. The need for repeat treatment sessions is dependent on clinical response. Although expert opinion varies on the number of required freeze–thaw cycles, all of the opinions support multiple cycles in the treatment of malignant lesions. 4 A surrounding ice ball of 3 to 5 mm greater than the lesion is recommended with use of any of the cryosurgical techniques. The goal of treatment with cryosurgery is to destroy the same amount of tissue that would otherwise be removed via local excision. Cryotherapy is not indicated for basal cell carcinoma lesions that are larger than 3 mm in depth, for recurrent lesions, or in areas of the body with a high risk of occurrence 14, 15 (low-risk features of basal and squamous cell carcinoma amenable to cryotherapy are summarized in Table 2 1, 15 – 18). Cryosurgery is not a first-line treatment for malignant lesions however, it remains a treatment option for low-risk lesions. When a malignant skin lesion is suspected, biopsy should be performed to confirm the diagnosis and to establish the depth of tumor invasion. Ensure that the cap to the container remains loose, allowing gas to escape, because building pressure from the nitrogen gas expansion can result in explosion and injury. Ordinary steel hot/cold liquid containers may be used to transport liquid nitrogen when using the dipstick method 8 ( Figure 3). 2, 4 The choice of treatment technique is based on physician preference, available clinical resources, and the size and location of the lesions. 6 If greater application accuracy is required, the tip of the applicator may be rolled to a point or a “hard tail.” 7 This method creates sufficient depth of freezing to treat nonmalignant skin lesions, such as actinic keratoses, angiomas, molluscum contagiosum, verrucae, and lentigo simplex. Applicators may be created using synthetic material balls and rolling on the end of an applicator stick similarly, nonsterile 8-inch rayon-tipped swabs may be used. The dipstick technique involves dipping a cotton- or synthetic-tipped applicator into liquid nitrogen and applying it directly to the lesion. Potential adverse effects include bleeding, blistering, edema, paresthesia, and pain and less commonly include tendon rupture, scarring, alopecia, atrophy, and hypopigmentation. Contraindications to cryosurgery include neoplasms with indefinite margins or when pathology is desired, basal cell or squamous cell carcinomas with high-risk features, and prior adverse local reaction or hypersensitivity to cryosurgery. Basal and squamous cell carcinomas with low-risk features may be treated with cryosurgery. Benign lesions such as common and plantar warts, anogenital condylomas, molluscum contagiosum, and seborrheic keratoses can be treated with cryotherapy. Cryosurgery may be performed in the outpatient setting using dipstick, spray, or cryoprobe techniques to treat a variety of benign, premalignant, and malignant skin lesions with high cure rates. Cutaneous cryosurgery has become a commonly performed outpatient procedure because of the combination of its safety, effectiveness, low cost, ease of use, lack of need for injectable anesthetic, and good cosmetic results. Cryosurgery is the application of freezing temperatures to achieve the destruction of tissue.
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