Cutaneous Cryosurgery for Common Skin Conditions
Am Fam Physician. 2020 Apr 1;101(7):399-406.
Related letter: Is Cutaneous Cryosurgery the Best Treatment Option for Cutaneous Warts?
Author disclosure: No relevant financial affiliations.
Cryosurgery is the application of freezing temperatures to achieve the destruction of tissue. 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 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. Benign lesions such as common and plantar warts, anogenital condylomas, molluscum contagiosum, and seborrheic keratoses can be treated with cryotherapy. Basal and squamous cell carcinomas with low-risk features may be treated with cryosurgery. 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. Potential adverse effects include bleeding, blistering, edema, paresthesia, and pain and less commonly include tendon rupture, scarring, alopecia, atrophy, and hypopigmentation.
Cryosurgery is the application of freezing temperatures to achieve the destruction of tissue.1 Cryosurgery is an effective and efficient method for treating a wide range of cardiac, dermatologic, ophthalmic, gynecologic, oncologic, neurologic, and urologic conditions. Cutaneous cryosurgery has become a commonly performed outpatient procedure because of its safety, effectiveness, low cost, ease of use, lack of need for injectable anesthetic, and good cosmetic results.1
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
Cryosurgery is useful in the treatment of actinic keratoses with cure rates reported between 69% for freeze times of more than five seconds and 83% for freeze times of more than 20 seconds.18 | B | Limited evidence from single randomized controlled trial |
Warts may be treated with cryotherapy administered at two-, three-, or four-week intervals without differences in cure rates.21 | A | Cochrane review with clear recommendation |
Cryosurgery is as effective as daily treatment with salicylic acid in the treatment of plantar warts, with higher reported patient satisfaction.22 | B | Limited evidence from single randomized controlled trial |
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
Cryosurgery is useful in the treatment of actinic keratoses with cure rates reported between 69% for freeze times of more than five seconds and 83% for freeze times of more than 20 seconds.18 | B | Limited evidence from single randomized controlled trial |
Warts may be treated with cryotherapy administered at two-, three-, or four-week intervals without differences in cure rates.21 | A | Cochrane review with clear recommendation |
Cryosurgery is as effective as daily treatment with salicylic acid in the treatment of plantar warts, with higher reported patient satisfaction.22 | B | Limited evidence from single randomized controlled trial |
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
Mechanism of Action
Commonly available cryogens include Freon 12, Freon 22, solid carbon dioxide, liquid nitrous oxide, liquid nitrogen, and liquid helium.2 The freons are typically used for skin anesthesia. Liquid nitrous oxide is effective in treating benign skin lesions; however, it is more commonly used for ophthalmic and gynecologic lesions. Liquid nitrogen has become the cryogen of choice in most clinical situations.3
Temperatures of −13°F to −58°F (−25°C to −50°C) can be achieved with liquid nitrogen within 30 seconds when using a spray or probe. Effective removal of malignant lesions typically requires lower temperatures (−40°F to −58°F [−40°C to −50°C]) achieved with the application of spray or probe. Liquid nitrogen used with the applicator method is useful in treating premalignant and benign lesions, requiring slightly higher temperatures of −4°F to −22°F (−20°C to −30°C).3
The mechanism of injury includes the direct effects of freezing on the cells, osmolarity
References
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