Dermatological Cryosurgery and Cryotherapy

696 Pages·2016·26.7 MB·English

by  William Abramovits

Dermatologic
Cryosurgery
William Abramovits
Gloria Graham
Yaron Har-Shai
Renata Strumia
Editors
123
Dermatological Cryosurgery
and Cryotherapy

William Abramovits • Gloria Graham
Yaron Har-Shai • Renata Strumia
Editors
Dermatological
Cryosurgery
and Cryotherapy
Editors
William Abramovits Yaron Har-Shai
Dermatology Treatment The Unit of Plastic Surgery
and Research Center Carmel Medical Center
Dallas , TX Haifa
USA Israel
Gloria Graham Renata Strumia
Eastern Dermatology and Pathology St Anna Hospital
Morehead City , NC University of Ferrara
USA Ferrara
Italy
ISBN 978-1-4471-6764-8 ISBN 978-1-4471-6765-5 (eBook)
DOI 10.1007/978-1-4471-6765-5
Library of Congress Control Number: 2015960385
© Springer-Verlag London 2016
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Pref ace
In dermatologic cryotherapy and cryosurgery, localized cold is used to
improve some skin conditions or destroy and remove abnormal tissue. It uti-
lizes cryogens to treat various benign non-cancerous, pre-cancerous, and can-
cerous lesions.
The advantages of cryosurgery include high success rates, few side effects
of signifi cance, relatively short recovery times, ease of performance, and rea-
sonable cost. The disadvantages include frequent morbidity, lack of accurate
margin of destruction control, and operator dependency.
Solid scientifi c grounds nowadays support the indications for cryosurgical
and cryotherapeutic procedures, starting with understanding the mechanisms
of action, the cellular and vascular events that occur during the processes of
cooling and freezing, thawing and recovery, and ending with the statistical
evidence of cure or relief.
T his book is titled Cryosurgery and Cryotherapy for Skin Diseases and
Conditions because in this way we address from the start semantic issues with
the word cryotherapy, which we consider to be misused interchangeably with
cryosurgery. For our purpose, the term “cryosurgery” is used to denote a pri-
marily destructive procedure involving temperature reduction (such as for
skin cancer), while “cryotherapy” is used to denote a therapeutic procedure
where the tissues are taken to low temperature but are expected to survive
(such as in pain reduction). A terminology compromise was accepted for
those procedures where mechanisms of action where destruction and the
involvement of immunity overlapped. We often respected the choice of words
by the chapter authors.
An example of cryosurgery is the treatment of epithelial skin neoplasms
by lowering them to temperatures that selectively destroy the cancer cells
within them, while their surrounding tissue is spared lethal damage. Examples
of cryotherapy include lowering skin temperature to induce anesthesia, pre-
serving a severed fi nger for reattachment, or cooling a wart for a few seconds
just to induce an immune response that hopefully will get rid of it.
It was 3 years ago that Mr. Grant Weston from Springer Publishers
approached me after my almost yearly lecture on cutaneous cryosurgery at an
Annual Meeting of the American Academy of Dermatology to suggest that I
write the “defi nitive textbook” on the subject. That year another textbook
(albeit not the defi nitive) on the same topic was just published, so I felt that
the timing was suboptimal; the seed had been placed in nourishing ground.
For the daunting task, it was tremendously gratifying to obtain the support of
v
vi Preface
luminaries like Gloria Graham, MD; Renata Strumia, MD; and Yaron Har-
Shai, MD, who became my co-editors.
Gloria needs no introduction in the world of dermatology, and she is with-
out a doubt the Doyenne of Cryosurgery, having written many articles, edited
textbooks, lectured innumerable times all over the world, treated many, and
mentored a large cadre of practitioners of the trade. Dr. Graham kept motivat-
ing us by example; although she struggled with health issues, she never quit
pressing us to edit and her many friends in the fi eld to contribute.
Renata was introduced to me by Grant. He suggested that I read a book on
cryosurgery she had just published in Italian. Dr. Strumia wrote that book
pretty much all by herself, and it was very much to my liking. I contacted her,
met her at congresses, learned fi rsthand of her competence, and asked her to
join us as editor and contributor; she did so with remarkable eagerness and
effi ciency.
Yaron’s name I kept running into while reviewing cryosurgery on PubMed;
Dr. Har-Shai is a plastic surgeon in Israel who has a keen interest in the reduc-
tion of keloids and has developed innovative techniques. He was also a most
effi cient deliverer of contributions to our text, and he helped us recruiting
erudite authors for several chapters. I would also want to give a special thanks
to Dr. Robert Schwartz for his help in the fi nal stretch of this book. He dedi-
cated a lot of his time and his team’s effort to complete chapters for which we
had diffi culties fi nding willing contributors.
I am in great debt to my co-editors for their efforts and collaboration. They
all actively participated in the development of the content, wrote a great num-
ber of the chapters, and helped me greatly in the selection of contributors of
the highest quality, expertise, and recognition in their respective fi elds.
Finally, I must acknowledge the valuable participation and intense dedica-
tion and efforts of the team Alba Quiñones, MD (from Dermatology Treatment
and Research Center) and Michael D. Sova (Developmental Editor for
Springer Science) to whom this text owes its crystallization.
H opefully the readers will fi nd this book to be of value, as complete as
possible, and enjoyable to read; it may not be the “defi nitive textbook” on the
subject, but hopefully that is because the fi eld continues to expand and
progress.
Dallas, TX, USA William Abramovits
Contents
Part I History
1 The History of Dermatologic Cryosurgery . . . . . . . . . . . . . . . . 3
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Part II Physics
2 Principles of Cryoablation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
John G. Baust , Andrew A. Gage , and John M. Baust
3 Cryogens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
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4 The Effect of Cold Temperatures on Biological Systems. . . . . 19
Jeunghwan Choi, Saravana B. Kumar,
Silvia Jiang-Hughes, and John C. Bischof
5 Mechanism of Cellular Damage from Cryosurgery. . . . . . . . . 37
Carlos Horacio Gonzalez Rojas
6 Effects of Cold Temperature on the Skin. . . . . . . . . . . . . . . . . . 39
Kenneth R. Diller , Sepideh Khoshnevis ,
and Matthew Brothers
Part III Immunology
7 Immunology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Michael Scott Sabel
Part IV Equipment
8 Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
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9 In-Offi ce Generators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
C. Lee Asplund
10 Storage Units/Dewars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
William Abramovits and Ana M. Prato-Guia
11 Withdrawal Devices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Carmen I. Hernandez Lara
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12 Stands/Roller Bases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Alba G. Quiñones
13 Gloves and Aprons. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
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14 Delivery Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
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15 Dispensing Units (Carbon Dioxide,
Nitrous Oxide, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
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16 Thermos/Vacuum-Insulated Bottles/Flasks. . . . . . . . . . . . . . . . 95
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17 Cups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
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18 Tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
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19 Cotton/Rayon Tipped Applicators . . . . . . . . . . . . . . . . . . . . . . . 105
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20 Sprayers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
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21 Open Cones. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Carmen I. Hernandez Lara
22 Closed Probes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
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23 Cryochambers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
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24 Cryoneedles (for Extra and Intra-lesional Use) . . . . . . . . . . . . 121
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25 Miscellaneous (Adaptors, Extensions,
Protectors, Tubing, etc.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
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26 Cryotweezers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
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27 Other Delivery Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
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28 Tissue Temperature Monitors. . . . . . . . . . . . . . . . . . . . . . . . . . . 135
William Abramovits
29 Monitorization Instrumentation with Ultrasound . . . . . . . . . . 137
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Contents ix
30 MRI/CAT Scanners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
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31 Confocal Microscopes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
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Part V Therapeutic Principles and Techniques
32 Therapeutic Principles and Techniques. . . . . . . . . . . . . . . . . . . 147
Gloria F. Graham and Sara Moradi Tuchayi
33 Patient Selection and Related Contraindications . . . . . . . . . . . 151
Gloria F. Graham and Sara Moradi Tuchayi
34 Lesion Selection and Related Contraindications . . . . . . . . . . . 157
Manisha J. Patel , Alice He , and Gloria F. Graham
35 Method and Equipment Selection . . . . . . . . . . . . . . . . . . . . . . . 163
Gloria F. Graham and Sara Moradi Tuchayi
36 Cryosurgeon Selection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Gloria F. Graham
Part VI Methods
37 Spray . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Gloria F. Graham
38 Cotton Tipped Application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Renata Strumia
39 Segmental and Fractional Cryotherapy. . . . . . . . . . . . . . . . . . . 183
Renata Strumia
40 Cryopeeling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Janyana M. D. Deonizio
41 Cryo-massage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Renata Strumia
42 Controlled Cold Induced Lipolysis. . . . . . . . . . . . . . . . . . . . . . . 193
Jennifer Peterson and Suzanne Bruce
43 Solid Carbon Dioxide: Usage in Slush or Block
Form as Therapeutic Agent in Dermatology. . . . . . . . . . . . . . . 201
Harold J. Brody
Part VII Results
44 Expected Events. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Christopher M. Scott , Gloria F. Graham ,
and Ronald R. Lubritz
45 Evolution of the Cryo-lesion . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Christopher M. Scott , Gloria F. Graham ,
and Ronald R. Lubritz