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Cryosurgery of benign skin tumors.
Guidelines
On the basis of the clinical diagnosis was made cryogenic removal of tumors of the skin. Cryodestruction effect achieved by the contact method using repeated freezing cycles.
The diameter of the nozzle of the applicator picked up, respectively tumors with overlapping it on 2-3 mm.
The exposure time depends on the size of the tumor, its localization and histological structure.
In the treatment of tumors with a predominance of phenomena of Hyper and parakeratosis and the presence in the basis of fibrous tissue the procedure had to be repeated 2-3 times with a total time dosage to 7-10 minutes.
If the tumor was localized in the region of the mucous membranes with a predominance of symptoms of papillomatosis, often was enough for 1 session of cryotherapy with total time at a dosage of 1-2 min.
The area of cryotherapy after the procedure is recommended to treat alcoholic solution of brilliant green, and in the stage of formation of a scab - buckthorn oil. Need combination allowance during cryoablation was not.
Clinically, immediately after cryosurgery, was observed by the formation of ice-fields greater than the diameter of the nozzle of the applicator for 1-2 mm.
As the thaw developed hyperemia. After 40-60 sec. after cryosurgery has developed swelling, more pronounced reaction was observed in areas with abundant subcutaneous fat; then, after 2-5 h formed papule with serous or serous-hemorrhagic content, which were opened on day 2-5, forming the wound surface.
Swelling within the first 5 days gradually regress.
For 3-7 day formed a dense crust, the healing is under the scab from the periphery to the center.
By the end of 3-4 weeks, the scab is torn away, leaving a tender pink scar that 2-3 months after treatment invisible. The efficacy of treatment in benign formations tomade in 98% of cases.
Cryosurgery for basal cell carcinoma skin cancer.
Clinical diagnosis of basal cell carcinoma was verified histologically or cytologically. The principal difference in the method of cryodestruction of skin cancer from benign masses was that:
1) the diameter of the nozzle of the applicator was selected with the overlap of the tumor to 0.5 cm;
2) the total time of one session of cryotherapy was 3-5 min with 2-fold freezing (single freezing-thawing can be lethal not all the cells of a malignant tumor, if the entire volume of the tumor was not created by temperatures below -50 deg.C). Time of cryotherapy to various skin tumors are presented in table. 1.
3) the number of cycles of treatment depends on the size of the tumor (table. 2).
Time of cryotherapy to various skin tumors.
| The name of the tumor | Exposure time (sec.) |
|---|---|
| 1. Pigmented tumors | |
| intradermal nevus | 180 |
| boundary nevus | 180 |
| the compound nevus | - |
| 2. Warts | |
| plantar | 180 |
| common | 240-300 |
| genital warts | 40-60 |
| other | -d> |
| 3. Papilloma | 120-180 |
| 4. Leukoplakia | 60-120 |
| 5. Basal cell carcinoma 1-2 tbsp. | |
| surface shape | 180-240 |
| nodular form | 240-300 |
| ulcerative form | 240-300 |
| other | 240-300 |
The number of sessions of cryosurgery depending on the size of the tumor.
| Tumor size (cm.) | The number of sessions |
|---|---|
| 1. to 1 | 1 |
| 2. 1-2 | 2 with inter. in 10-15 days. |
| 1. 2-3 | 2-3 with inter. in 10-15 days. |
Control of efficacy was performed as follows: in the process of healing from the field of cryoablation for 3, day 10 took the scrapings for Cytology to detect tumor cells.
The area of cryolysis after the procedure is recommended to treat alcoholic solution of brilliant green, and in the stage of formation of a scab - buckthorn oil. When cryotherapy anesthetic is necessary was not.
Since the formation of eschar, patients in most cases, be able to work.
Long-term results, patients are traced in a period of 4 months. up to 5 years.
Relapses ofthe tumor occur in 2% of cases. Occurrence of relapses is associated with errors in the methodology of cryoablation, as both observations have in the initial stage of the work.
Complications.
Complications include abscess under a scab. It occurs in 2-3 of 100 patients.
When suppuration must remove the crust, the surface of the wound treated with hydrogen peroxide and make a bandage with a hypertonic solution.
As the cleansing of the wound and the granulation should go to ointment dressings.
In this complication is noted the length of time the reparations and the appearance of rough scarring.
The method of cryogenic effect on benign and malignant tumors of the skin is simple, effective, gives good cosmetic results, cost-effective and can be used with simple equipment in a clinic, district, and local hospitals.
