Intralesional cryosurgery for the treatment of basal cell carcinoma in an elderly patient

Subcutaneous emphysema after intralesional cryotherapy: An unusual complication

BACKGROUND

Intralesional cryotherapy (ILC) is a safe and well tolerated by the patient. Subcutaneous emphysema (SE) cases after spray and contact cryotherapy have been described; however, this complication has not been previously reported after ILC.

AIM

Our aim is to discuss the possible causes of SE development after ILC.

METHOD

We present a young patient that developed SE after ILC applying by insertion of an open-ended needle to the tip of the cryotherapy gun.

RESULTS

The development of SE following ILC may have been caused by inward clefting from the ear hole, the usage of an open-ended needle and a lack of safety system.

CONCLUSION

It will be safer to apply special methods involving the usage of sealed distal type to prevent SE development.

Intralesional cryosurgery for the treatment of basal cell carcinoma of the lower extremities in elderly subjects: a feasibility study

BACKGROUND

Incidences of basal cell carcinoma (BCC) on the lower extremities in elderly patients are rising. Surgical approaches to the treatment of BCC are subject to possible difficulties in healing, failure of skin grafts, and wound infection. This study assessed the efficacy of intralesional cryosurgery in the treatment of BCC of the lower limbs in elderly patients.

METHODS

This study included eight patients aged >60 years in whom a total of 10 nodular or superficial BCCs of the lower limbs were confirmed by biopsy. The patients' medical histories revealed comorbidities including hypertension, diabetes, hypercholesterolemia, venous insufficiency, and deep vein thrombosis of the legs, congestive heart failure, chronic renal failure, and ischemic heart disease. Using liquid nitrogen, an intralesional cryosurgery needle (CryoShape) was inserted into the tumor to facilitate its complete freezing. Treatment success was confirmed by biopsy taken approximately 3 months after complete healing of the cryo-wound.

RESULTS

The average size of the lesions treated was 2.49 cm(2) (16.4 × 15.2 mm). Mean recovery time was 79.9 days. Biopsies were obtained at a mean of 85.3 days after the wound had healed. All 10 biopsies verified the complete destruction of the tumor. There was no evidence of wound infection or tumor recurrence over a follow-up period of 28 months.

CONCLUSIONS

This study demonstrates that a single intralesional cryosurgery session can completely eradicate BCC on the lower extremities in elderly patients. This technique is associated with relatively minor complications, is well tolerated, and represents a safe and effective therapeutic modality for BCC of the lower limbs.

Intralesional cryosurgery combined with topical silicone gel sheeting for the treatment of refractory keloids

BACKGROUND

A variety of therapeutic procedures for treating keloids have been previously reported, with varying success and recurrence rates. As a monotherapy, intralesional cryosurgery has yielded convincing clinical results.

OBJECTIVE

We combined intralesional cryosurgery with the application of topical silicone gel sheeting.

MATERIALS AND METHODS

In this retrospective study, which was conducted between 2008 and 2012, 21 patients with 32 keloids were enrolled. Twenty-five lesions were treated with intralesional cryotherapy combined with postoperative silicone gel sheeting (the cryotherapy + silicone group), and 7 keloids were treated with intralesional cryotherapy alone (the cryotherapy group). The scar volume reduction was assessed, and the patients' subjective and objective parameters were evaluated. Additionally, patient satisfaction was estimated using a modified Gorney Gram scale (0-3).

RESULTS

In all cases (n = 32 for both groups), a significant keloid volume reduction was observed. The patients' subjective complaints were significantly improved, whereas the combined therapy showed slightly better results in hardness (p < .0012), pain (p < .0233), and discomfort (p < .0029), whereas monotherapy achieved higher satisfaction scores in redness (p < .0220) and pruritus (p < .0206), although these differences were not significant between the treatment modalities.

CONCLUSION

The results of this study support the use of combined intralesional cryosurgery followed by the application of silicone gel sheeting to treat refractory keloids.