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Cryosurgery (cryotherapy) of the skin involves the use of extreme cold to remove both benign and malignant lesions of the skin. The technique involves the application of liquid nitrogen, chemical refrigerants, or cold cryoprobes to the skin. Liquid nitrogen can be applied using cotton-tipped applicators or cryoguns. Cryoprobes with nitrous oxide cryoguns can also deliver the cold directly to the lesions to be frozen. Cryosurgery has wide applicability to a variety of skin lesions and has the advantages of ease of use, low cost, and acceptable cosmetic results. With these techniques, the physician is able to treat multiple lesions rapidly.
Cryotherapy selectively destroys cells, leaving the fibroblast tissue matrix intact. Because fibroblasts do not usually form extensive scar tissue during the healing process, healing occurs with little to no scar formation.
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| Advantages |
- For the physician
- Procedure can be performed with little time
- Technique is easy to learn
- Multiple lesions can be treated at one time
- An assistant is not needed
- For the patient
- No injections of local anesthetic needed
- Pain is tolerable (less so for children)
- No sutures to remove
- Wound care is usually simple
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| Disadvantages |
- For the physician
- Equipment cost
- Arranging for delivery and storage of liquid nitrogen or nitrous oxide (Verruca-Freeze has a small canister so delivery and storage are not problems)
- There is an art to mastering these techniques
- For the patient
- Postoperative pain
- Lesion recurrence
- Hypopigmentation may result
- Area may be more prone to sunburn
- Multiple visits may be necessary
- Blisters may be tense and painful
- Numbness in area may last for months
- Scarring may occur
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| Complications of Cryosurgery |
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Immediate and Routinely Expected (not true complications)
- Pain during the freezing and thawing period
- Blister formation
- Intradermal hemorrhage
- Edema
Immediate and Less Common
- Headache affecting forehead, temples, and scalp
- Syncope
Delayed and Rare
- Postoperative infection
- Hemorrhage from the wound site
- Pyogenic granuloma
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Prolonged and Rare
- Hyperpigmentation
- Milia
- Hypertrophic scars
- Neuropathy
Permanent
- Hypopigmentation (common)
- Ectropion and notching of eyelids
- Notching and atrophy of tumors overlying cartilage
- Tenting or notching of the vermilion border of the upper lip
- Atrophy
- Alopecia
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Usatine R, Moy R, Tobinick E, Siegel D. Skin Surgery: A Practical Guide. Mosby-Year Book, Inc., St. Louis, 1998
Modified from Zacarian S: Cryosurgery for skin cancer and cutaneous disorders, St. Louis, 1985, Mosby.
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