Cryosurgery

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS
  • Benign skin lesions
  • Malignant and premalignant skin lesions such as basal cell carcinoma
  • Scars
  • Benign pigmented skin lesions
CONTRAINDICATIONS

Absolute Contraindications

  • Excessive reaction to previous cryosurgery
  • Unwillingness of patient to accept the possibility of skin pigment changes
  • Malignant melanoma
  • Compromised circulation
  • Lesions in which identification of tissue pathology is required
  • Sclerosing (morpheaform) or recurrent basal cell or squamous cell carcinoma

Relative Contraindications

  • Basal cell or squamous cell carcinomas larger than 1 cm in diameter
  • Any condition with high levels of cryoglobulins
  • Current high-dose steroid therapy
EQUIPMENT

The equipment needed varies with the type of cryosurgery planned.

Liquid Nitrogen

  • Cryogen spray unit and storage dewar
  • Assorted nozzles of various sizes
  • Protective plastic shield with openings of assorted sizes
  • Styrofoam cup or vacuum-insulated bottle
  • Cotton-tipped applicators (small and large) or metal pickups

Nitrous Oxide (N2O)

  • 20-lb tank and cart
  • Cryoprobe regulator with gun and cryoprobe tip assortment
  • K-Y Jelly or cryogen gel

Canister Gas Refrigerants

  • Can of Verruca-Freeze (CryoSurgery, Inc., Nashville TN) or Medi-Frig (Ellman International, Inc., Oceanside, NY) with plastic limiting cones and buds of various sizes
  • Can of Histofreezer (OraSure Technologies, Inc., Reeuwijk, The Netherlands) with applicators
ANATOMY

Tissue Effects: Principles for Treatment

  • Tissue destruction begins only when the temperature of the tissue is between −10°C and −20°C. A deeper freeze with temperatures between −40°C and −50°C ensures that malignant cells are completely destroyed.
  • The lethal zone (tissue temperature lower than −20°C) is 2 to 3 mm inside the outer margin of the ice ball.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Bandages usually are not necessary.
  • Occasionally, a profuse watery discharge may persist; debridement of the wound often alleviates the discharge.

Post-Procedure Patient Education

  • Inform the patient of the anticipated healing time, expected results, and follow-up.
  • Advise the patient on care of blistered lesions.
  • Document the information given to the patient.
  • See Related Procedure Posttreatment Physiologic Effects.
COMPLICATIONS
  • Pigment and hair changes
  • Lesions may recur and require retreatment.
  • Ulcer formation
  • Pretreatment biopsy is recommended for all lesions suspicious for malignancy.
  • Cryosurgery in the periorbital area may cause excessive swelling.
  • Peripheral neuropathy
  • Excessive reaction to freezing
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