Five–year results of curettage–cryosurgery of selected large primary basal cell carcinomas on the nose: an alternative treatment in a geographical area underserved by Mohs' surgery

[Cryosurgery in dermatology]

This article provides information on the clinical development of skin reactions after cryosurgery/cryotherapy and the indications, complications and contraindications of skin cryosurgery. Successful skin cryosurgery requires rapid freezing and slow thawing, minimum tissue temperature of -25 to -60℃ and, in malignant lesions, repetition of the freeze-thaw cycle. Frozen tissue reacts with peripheral erythema immediately after thawing, followed by edema, bulla formation, exudation and mumification. Lesions usually heal with a fine atrophic scar after approximately 4 weeks. Nowadays, cryosurgery is considered the treatment of choice in hypertrophic scars and keloids, granuloma annulare, small capillary infantile hemangioma and isolated actinic keratoses. It is also a valuable alternative therapy for various other skin diseases, including common warts, solar lentigo, superficial basal cell carcinoma and Kaposi's sarcoma. Cryosurgery is a safe regimen with relatively few adverse effects and contraindications. Pain during and/or shortly after treatment, bulla formation and local edema are the major temporary adverse effects; lesional hypopigmentation and/or peripheral hyperpigmentation is the most common long-term complication.

The efficacy of intralesional cryosurgery in the treatment of small- and medium-sized basal cell carcinoma: A pilot study

BACKGROUND

Cryotherapy has been used in treatment of basal cell carcinoma (BCC). In 1993, Weshahy described his technique for applying cryotherapy in depth, i.e. intralesional cryosurgery (ILC), using Weshahy's cryoneedles.

OBJECTIVE

To assess the clinical efficacy of ILC using Weshahy cryoneedles in the treatment of small- and medium-sized BCC with >5-year follow-up.

PATIENTS AND METHODS

This pilot study included 43 patients with histopathologically proven BCCs of the nodular and superficial type. All BCCs were treated by Intralesional cryosurgery (Weshahy's technique) using specially designed angled or hook shaped needles.

RESULTS

The study included 22 men (51.2%) and 21 women (48.8%). Out of 46 lesions, 45 lesions (97.8%) showed a cure in one session, and only 1 nodular lesion showed a small recurrence in a marginal region of the site treated. In relation to the cosmetic outcome, 32 (69.6%) lesions showed a good to excellent outcome, 11 (23.9%) a moderate to good outcome and 3 (6.5%) a poor cosmetic outcome. The cosmetic outcome was better in females (p = 0.578), with small lesions (p = 0.048), and between 40 and 70 years old (p = 0.046).

CONCLUSION

Cryotherapy is an alternative treatment for a small- to medium-sized BCC in selected patients.

The efficacy of facial skin cancer treatment with high-energy pulsed neodymium and Nd:YAG lasers

OBJECTIVE

The aim of this study was to assess the curative and cosmetic efficacy of treatment for facial skin cancer using neodymium laser irradiation.

BACKGROUND DATA

Due to the complex anatomy of the area, therapy for facial skin cancer is difficult.

MATERIALS AND METHODS

Laser irradiation was used for the treatment of 3461 patients with 3624 facial skin cancer lesions of stages T(1-2)N(0)M(0:) 3346 basal cell skin cancers, 188 limited basal cell skin cancer recurrences, and 90 squamous cell skin cancers. Pulsed neodymium (Nd) and Nd:YAG lasers were used as the energy sources. The patients were followed-up from 3 mo to 5 y or more.

RESULTS

Patients with basal cell skin cancer treated by irradiation with the Nd laser developed recurrences in 1.8% of cases, and patients treated with the Nd:YAG laser had a recurrence rate of 2.5%. Recurrences following treatment for basal cell skin cancer, and those of squamous cell skin cancer, after irradiation with the Nd laser appeared in 3.7% and 4.4% of patients, respectively. Overall, the frequency of facial skin cancer recurrences after treatment with laser irradiation was 2.1% of all the irradiated tumors.

CONCLUSION

Neodymium laser irradiation is an effective method to treat facial skin cancer of stages T(1-2)N(0)M(0), and results in acceptable cosmetic results.

Prospective follow-up after curettage-cryosurgery for scalp and face skin cancers

BACKGROUND

Cryosurgery (CS) in the treatment of nonmelanoma skin cancers (NMSCs), especially in the face and on the scalp, has several advantages vs. other methods. Prospectively gathered long-term results after CS are, however, scarce.

OBJECTIVES

To establish long-term results after curettage and CS (CCS) of NMSCs in the face and on the scalp considering complication rate, patient tolerance, cosmetic outcome and rate of recurrence.

METHODS

Seven hundred and twenty-six patients with 962 face and scalp NMSCs were prospectively followed after CCS (1 week, 3 months, and then annually) during the time period December 1994-September 2008.

RESULTS

Mean/median follow-up time was 42/34 months (range 1 month-14 years). Forty-two of 962 (4.4%) received antibiotics due to clinical, superficial infections. No serious complications were recorded. Ninety-nine per cent of the women and 100% of the men graded the cosmetic outcome as 'good' on a three-level scale, follow-up rate 99%. Fifty-six (14%) women and 78 (23%) men (P = 0.001) developed one or more new NMSCs during the study period. Fourteen of 962 (1.5%) recurrences were recorded, in nine women and five men. An expected recurrence-free rate/cure rate of > 97% after 14 years was calculated (Kaplan-Meier).

CONCLUSIONS

CCS in the treatment of NMSCs is expedient and well tolerated, with no major and few minor complications. When performed as in the present study it produces good cosmetic results in virtually all cases, with an anticipated 97% cure rate after 14 years. CCS is thus a highly viable alternative in the treatment of NMSCs in the face and on the scalp.

Different inflammatory mediators induce inflammation and pain after application of liquid nitrogen to the skin

The application of liquid nitrogen to the skin induces inflammation and pain. However, there is little data on the role of inflammatory mediators in the production of these symptoms. We have developed an experimental model to study some aspects of the inflammatory response and its mediators following the application of cold. We have applied liquid nitrogen jets to subcutaneous air pouches in the dorsal skin of rats to study the kinetics of the migration of inflammatory cells; also to the ear for histopathological analysis and on the paws for edema and pain. Inflammatory mediators were identified by pharmacological means. The results showed that the cellular inflammatory response was characterized by persistent cell migration, mainly of granulocytes. Histopathology of the ears confirmed these findings. Histamine and sympathomimetic mediators were mainly responsible for the resultant swelling. However, the hypernociception that resulted involved other mediators including IL-1 and eicosanoids. These data suggest that interference with the release of inflammatory mediators might reduce the side effects of cryosurgery and prevent hyperalgesia and inflammation at the site of application of cold.

Nevoid basal cell carcinoma syndrome: a review of the literature

The nevoid basal cell carcinoma syndrome (NBCCS) or Gorlin-Goltz Syndrome is an autosomal dominant disorder principally characterized by cutaneous basal cell carcinomas, multiple keratocysts, and skeletal anomalies. The present report reviews current knowledge of this disorder that has profound relevance to specialists in Oral and Maxillo-Facial Surgery, Oral Medicine and Radiology.

Basal cell carcinoma: treatment options and prognosis, a scientific approach to a common malignancy

The incidence of basal cell carcinoma is rapidly increasing and a number of treatment modalities are available. Treatment of basal cell carcinoma includes both surgical and nonsurgical approaches, some of which are traditional, and others experimental. The treatment modality utilized is dependent on both the tumor type and the patient. In order to choose between therapies, evidence-based research is necessary. In an extensive review of the literature concerning treatment options for patients with basal cell carcinoma, we found that there are a limited number of comparative, prospective, randomized, long-term follow-up studies. Based on the results of the available studies, surgical excision, Mohs surgery and cryosurgery are the three standard therapies of choice. Other treatment modalities should be considered secondary choices. There are also promising new treatment options, such as photodynamic therapy, which need further investigation. Special attention is needed when treating the more aggressive subtypes of the disease, such as the micronodular, infiltrative, adenoid and morpheic forms of basal cell carcinoma, as well as bigger basal cell carcinomas and basal cell carcinoma recurrences.

Curettage-cryosurgery for non-melanoma skin cancer of the external ear: excellent 5-year results

In this 5-year follow-up study, 60 auricular non-melanoma skin cancers, selected at a skin tumour clinic, were treated by a thorough curettage with different sized curettes followed by cryosurgery in a double freeze-thaw cycle. Tumours of the external auditory canal were excluded. Forty-seven basal cell carcinomas (BCCs), nine squamous cell carcinomas (SCCs), three Bowen's disease and one basisquamous cancer were included. The mean diameter of the malignancies was 18 mm (range 5-70). Morphoeiform BCCs, recurrent BCCs with fibrotic component and most of the SCCs were selected for Mohs' micrographic surgery. Forty-two patients with 47 tumours were followed-up for at least 5 years with only one recurrence. Thirteen patients, followed-up for 2-4 years, died from other causes with no sign of recurrence at their last visit. No major problems after treatment were registered and the cosmetic result was good or acceptable in all patients.