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CRYOSURGERY

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SUMMARY

  • Cryosurgery is a versatile technique and a mainstay of the dermatologic surgeon’s 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.

image 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.

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  • 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.

image Don’t 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.

image 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.

image 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.

image 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.

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 ...

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