|Year : 1999 | Volume
| Issue : 1 | Page : 18-19
Cryotherapy in basal cell carcinoma
A Sandra, C Balachandran, SD Shenoi, L Sabitha, Pa
Cryotherapy has proved to be an effective tool in the management of various dermatoses. We report 6 patients with histopathologically proven basal cell carcinoma of variable sizes treated with liquid nitrogen cryotherapy by the open spray technique. Lesions tended to heal with depigmentation and scar formation. However depigmented areas often repigmented over a period of time.
Keywords: Basal cell carcinoma, Cryotherapy
|How to cite this article:|
Sandra A, Balachandran C, Shenoi S D, Sabitha L, Pa. Cryotherapy in basal cell carcinoma. Indian J Dermatol Venereol Leprol 1999;65:18-9
|How to cite this URL:|
Sandra A, Balachandran C, Shenoi S D, Sabitha L, Pa. Cryotherapy in basal cell carcinoma. Indian J Dermatol Venereol Leprol [serial online] 1999 [cited 2013 May 18];65:18-9. Available from: http://www.ijdvl.com/text.asp?1999/65/1/18/4743
| Introduction|| |
Basal cell carcinoma (BCC) is the commonest cancer occurring in man. Although its incidence is much higher in Caucasians, it is not uncommon in India. Treatment modalities available include curettage and electrodessication, excision, Moh's surgery, radiation, cryosurgery, CO2 lasers, 5-fluorouracil etc. Treatment is selected on the basis of number, size, site and type of lesion and the experience of the treating physician. Cryotherapy is being increasingly used in the management of basal cell carcinomas.
| Materials and Methods|| |
Six patients, 4 males and 2 females with histologically proven basal cell carcinoma were chosen for the study. Clinical details of the patients are given in [Table - 1] All had nodulo-ulcerative type of BCC with well-defined margins. H & E in all patients showed tumour islands composed of basalioma cells with peripheral palisading arrangement. The patient with the presternal lesion had a sclerotic component in addition and differential diagnosis of syphilitic gumma was considered as the first biopsy revealed an intense infiltration of plasma cells and no tumor islands; however a repeat biopsy revealed the classical features of BCC and his VDRL, TPHA, HIV Elisa tests were negative. One patient with lesion on the back showed few areas of cells with squamoid features in addition.
Under local anaesthesia, liquid nitrogen cryotherapy was given using a hand held cryocan (CRY-AC) by the open spray technique with the wide bore spray-tip held 1-2 cms away from the lesion until a hard ice ball had formed under the lesion. Two freeze-thaw cycles were given. Freeze time ranged between 30 seconds to 3 minutes depending on the size of the lesion and the lateral spread of frost measured 3-5 mm beyond margins of the tumour. Thaw time varied between one to ten minutes.
Thermocouples were used only in 1 patient and temperature achieved at the base was -50°c to -60°c. In all others the ice ball formation, lateral spread of frost, time and size of lesion were used as guidelines for freeze duration. In the patient with BCC on scalp the lesion was first debulked by a shave technique and the cryogen was administered. All were treated with dry gauze dressings, analgesics and a course of antibiotics.
| Results|| |
Twenty-four hours following treatment patients developed oedema, oozing and blister formation. A dry crust formed in 2-4 weeks and complete wound healing occurred within 4-6 weeks with scarring and depigmentation. In two patients the wound had got secondarily infected and patient had to be put on a second course of antibiotics. Over the course of the next few months depigmented areas slowly repigmented.
| Discussion|| |
High cure rates have been achieved with cryotherapy in BCCs. Zacainn reported a cure rate of 97% and Kuflik and Gage reported a 5 year cure rate of 99%. The cryogen produces cellular damage by intra and extra cellular ice crystal formation, vascular stasis and local electrolyte imbalanceCollagen fibres, cartilage and bone are resistant to damage by cryogen which enables healing and allows selective destruction of tumors overlying bone or cartilage as was seen in 3 of our patients.
The advantages are it is a simple office procedure, cost effective and can be used in those with medical risk for surgery. Disadvantages include prolonged healing time, depigmentation and scarring. Depigmentation results due to the susceptibility of melanocytes to damage from freezing. Although cryotherapy is usually employed for smaller lesions (< 2 cms), we found it effective in the larger ones too. Recurrences usually occur during first 2 years after treatment. In a recent study Kuflik and Gage treated recurrent BCCs ranging in size from 0.6 to 4.4 cms with cryotherapy and found it to be effective and the results comparable with other methods of treatment. Our follow-up time has varied from 4 months to 2 years and all patients are doing well.
| References|| |
|1.||Lang PG, Maize JC. Basal cell carcinoma. In: Friedman RJ, Rigel SD, Kopf AW, Harris MN, Baker D.Cancer of the Skin. Philadelphia. WB Saunders 991;35-73. |
|2.||Zacarian SA . Cryosurgery of cutaneous carcinomas : an 18 year study of 3022 patients with 4228 carcinomas. J Am Acad Dermatol 1983;9:947-956. [PUBMED] [FULLTEXT]|
|3.||Kuflik EG, Gage AA. The five year cure rate achieved by cryosurgery for skin cancer. Am Acad Dermatol 1991;24:1002-1004. [PUBMED] [FULLTEXT]|
|4.||Kuflik EG. Cryosurgery updated. J Am Acad Dermatol 1994;31:924-944. [PUBMED] [FULLTEXT]|
|5.||Kuflik EG, Gage AA. Recurrent basal cell carcinoma treated with cryosurgery. J Am Acad Dermatol 1997;37:82-84. [PUBMED] [FULLTEXT]|
[Figure - 1], [Figure - 2]
[Table - 1]