Cryosurgery of malignant and premalignant diseases of the skin: A simple approach

Cryosurgical treatment of skin cancer and premalignant conditions of the skin has been in widespread use for 20 years. Data accumulated over this period suggest that if attention is paid to the treatment technique and to lesion selection, then cure rates equivalent to radiotherapy, simple surgical excision, and curettage and cautery can be achieved reliably. Moh's micrographic surgery offers a higher cure rate for skin cancer, but is not suitable for the vast majority of lesions seen in clinical practice. The decision to use cryosurgery to treat any particular lesion will therefore be influenced by a number of other considerations. Cryosurgery competes well on morbidity and cosmetic outcome and is the quickest, easiest, cheapest and most readily available of the treatment options. As such it has earned its place among the recognized treatment modalities for skin cancers as well as premalignant conditions of the skin. Cryosurgery is commonly delivered empirically without record of the dose delivered and without audit of the outcome. The aim of this review is to describe in detail one standard technique of therapy that is easily reproduced and has been audited; the timed spot freeze technique. This technique can be used, even by those inexperienced in cryosurgery, to achieve predictable success rates. Many other techniques do exist, but either have not been audited or are unnecessarily cumbersome.