Cryosurgery for Premalignant and Malignant Skin Conditions

Cryosurgery can be used to treat pre-malignant and malignant skin conditions. Actinic keratosis (AK) is a pre-malignant proliferation of keratinocytes manifesting as erythematous, scaly papules or plaques on sun-exposed skin. Two types of therapy are need for AK: lesion directed, to destroy individual AK and field, to destroy perilesional, microscopic changes. Lesion directed therapies include electrodessication and curettage, excision, and laser ablation. Field physical modalities include photodynamic therapy (PDT), peels, and laser resurfacing. Cryosurgery, a lesion directed therapy, is very successful and is one of the most commonly employed treatments for AK. Bowen’s disease presents as a well-defined, hyperkeratotic plaque; therapeutic options include PDT, curettage, topical 5-FU, excision, laser ablation, radiotherapy and cryosurgery. Malignant lesions treatable with cryosurgery include basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Excision is the most commonly used therapy for them. Alternatives include electrodessication and curettage, radiation, PDT, topical 5-FU and imiquimod. Cryosurgery for BCC and SCC shows success rates that rival excision when performed by a trained physician.