In a previous article about actinic keratoses, I mentioned cryosurgery as a potential treatment. Cryosurgery is a surgical procedure that uses the application of liquid nitrogen to kill affected skin cells. The treatment will cause the patient to feel cold at and around the point of contact. The low temperature of liquid nitrogen (around -300 degrees Fahrenheit), can cause a stinging or burning sensation. The pain may last shortly after the treatment, but is rarely permanent or severe.
Several studies on the effect of cryosurgery on actinic keratoses show the procedure as very promising. A research group composed of Drs. Zouboulis and Rohrs from Klinik und Hochschulambulanz fur Dermatologie demonstrated that the procedure was 97 percent effective at removing actinic keratoses legions. The trial, which tested a variety of patients over a two month period, showed a low recurrence rate of 2.1 percent in the first year, and 11.5 percent following three years. Most patients did not experience pain from the procedure (only 15 percent of the patients experienced pain during or after the treatment). A pigmentation change occurred in five percent of the patients, and was the most common side effect. The treatment was reviewed an alternative treatment to phototherapy, however, the results were dependent on the physician performing the operation.
Another study, performed at the Brandeis University, confirmed the previous results. The study cautioned that cryosurgery can cause scarring, infection, pigmentation changes, and textural changes. Cryosurgery was found more effective in removing legions than fluorouracil, electrodessication and curettage, and nonsteroidal anti-inflammatory preparations.
Following cryosurgery, patients may expect to feel irritation around the area, depending on the site of treatment. The treated area can appear red following the procedure, which may be followed by swelling and blistering. The blister should form a scab in several days; the scab should then peel of within a week. During this period, the affected area may ooze fluid (either bloody or clear) and this is perfectly normal. The site should heal two to four weeks. During this time, the skin may have a different (or lack of) pigment. The pigment should return, but it is possible that the pigment will not return or not return completely.
It is important following treatment to keep the area clean. Wash the affected site gently with soap and water 12 and 24 hours after treatment, avoiding the application of lotions, creams, or make-up until the area is healed. If the blister breaks, clean the area with antibacterial soap and water, and keep covered with a bandage. If you experience severe pain following surgery, unusual discoloration, or unusual drainage of fluid or fluid volume contact your physician immediately.
Chris Gromisch is a Junior Chemistry major at Trinity College.