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Introduction
CHAPTER 15 Cryosurgery
Carolyn Stull Clifford Perlis
SUMMARY
Cryosurgery is a versatile technique and a mainstay of the dermatologic
surgeonโs therapeutic armamentarium.
While used largely for actinic keratoses, cryotherapy may be used for an array of
dermatologic conditions.
Cryosurgery has become a well-established, safe treatment modality for a wide
range of conditions, and will likely remain a fixture in dermatologic surgery for years to come.
Beginner Pearls
It is always better to undertreat than overtreat an area. Warn patients that the areas
being treated may not resolve and that additional treatments may be needed.
Localize tissue treatment to the area of concern; it is best to avoid overly broad
treatment that only serves to cause more tissue damage.
Expert Pearls
Intralesional cryoneedles and other similar approaches may be used to treat larger or
more aggressive tumors.
In such cases, accurately gauging the temperature at the deepest section of the target
lesion may be helpful.
Donโt Forget!
Melanocytes are highly cold-sensitive, while malignant cells are most resistant to
cold-induced damage. Therefore, pigmentation changes are seen frequently with even moderately aggressive cryosurgery.
Cryosurgery induces tissue necrosis through several pathways, including direct
cellular injury, intra- and extracellular ice deposition, and damage to the microcirculatory vasculature.
Pitfalls and Cautions
Healing time after cryosurgery varies, and patients will almost always have significant
edema and erythema in the immediate postprocedure period.
On the scalp and legs, sites may take significantly longer to heal adequately.
Patient Education Points
When treating actinic keratoses, there is often a field of actinic damage where
incipient actinic keratoses are forming. Additional actinic keratoses in this area may be a result of this actinic field injury rather than a recurrence due to inadequate cryosurgery.
Patients should be told what to expect in the posttreatment period to minimize anxiety.
Billing Pearls
Cryosurgery coding depends on the lesion and anatomic site being treated. For actinic
keratoses, use code 17000 for the first lesion and 17003 for each additional (up to 14), and code 17004 if 15 or more are treated. For warts and other benign lesions, use code 17110 (a single code for up to 14 lesions) or 17111 (15 or more). For genital lesions, use code 54056 for the penis or 56501 for the vulva. For malignant
destruction, use the 172XX series.
CHAPTER 15 Cryosurgery
INTRODUCTION
Cryotherapy, the application of cold temperatures for therapeutic purposes, has been utilized for thousands of years. Historical records dating as far back as 2500 BC reveal that the Egyptians used cold to treat injuries and infected wounds.1 In the 5th century BC, Hippocrates documented the analgesic and anti-inflammatory properties of this modality.2 However, the technique of cryosurgery, which specifically denotes the use of extreme cold for cellular destruction, has its origin in more modern times. Around the turn of the 20th century, Dr. Campbell White, a dermatologist in New York, first pioneered the use of liquefied air for the treatment of warts, nevi, and malignancies. In subsequent years, cryogen delivery was enhanced with the development of handheld spray units and the availability of liquid nitrogen. Currently, cryosurgery exists as an extremely versatile treatment modality that is indicated for the treatment of numerous benign, premalignant, and malignant lesions.