Cryosurgery is the use of extreme cold in

surgery Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pa ...

to destroy abnormal or diseased tissue; thus, it is the surgical application of

cryoablation Cryoablation is a process that uses extreme cold to destroy tissue. Cryoablation is performed using hollow needles (cryoprobes) through which cooled, thermally conductive, fluids are circulated. Cryoprobes are positioned adjacent to the target in ...

. The term comes from the Greek words cryo (κρύο) ("icy cold") and surgery (''cheirourgiki'' – χειρουργική) meaning "hand work" or "handiwork". Cryosurgery has been historically used to treat a number of diseases and disorders, especially a variety of benign and malignant skin conditions.

Uses

Wart Warts are typically small, rough, hard growths that are similar in color to the rest of the skin. They typically do not result in other symptoms, except when on the bottom of the feet, where they may be painful. While they usually occur on the ...

moles Moles can refer to: * Moles de Xert, a mountain range in the Baix Maestrat comarca, Valencian Community, Spain *The Moles (Australian band) *The Moles, alter ego of Scottish band Simon Dupree and the Big Sound People * Abraham Moles, French engin ...

, skin tags,

solar keratoses Actinic keratosis (AK), sometimes called solar keratosis or senile keratosis, is a pre-cancerous area of thick, scaly, or crusty skin.Freedberg, et al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed.). McGraw-Hill. . Actinic k ...

, molluscum,

Morton's neuroma Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve, most commonly of the second and third intermetatarsal spaces (between the second/third and third/fourth metatarsal heads; the first is of the big toe), which results in th ...

and small

skin cancer Skin cancers are cancers that arise from the skin. They are due to the development of abnormal cells that have the ability to invade or spread to other parts of the body. There are three main types of skin cancers: basal-cell skin cancer (BCC) ...

s are candidates for cryosurgical treatment. Several internal disorders are also treated with cryosurgery, including

liver cancer Liver cancer (also known as hepatic cancer, primary hepatic cancer, or primary hepatic malignancy) is cancer that starts in the liver. Liver cancer can be primary (starts in liver) or secondary (meaning cancer which has spread from elsewhere to th ...

prostate cancer Prostate cancer is cancer of the prostate. Prostate cancer is the second most common cancerous tumor worldwide and is the fifth leading cause of cancer-related mortality among men. The prostate is a gland in the male reproductive system that su ...

, lung cancer, oral cancers, cervical disorders and, more commonly in the past,

hemorrhoids Hemorrhoids (or haemorrhoids), also known as piles, are vascular structures in the anal canal. In their normal state, they are cushions that help with stool control. They become a disease when swollen or inflamed; the unqualified term ''h ...

. Soft tissue conditions such as

plantar fasciitis Plantar fasciitis or plantar heel pain (PHP) is a disorder of the plantar fascia, which is the connective tissue which supports the arch of the foot. It results in pain in the heel and bottom of the foot that is usually most severe with the fi ...

(jogger's heel) and

fibroma Fibromas are benign tumors that are composed of fibrous or connective tissue. They can grow in all organs, arising from mesenchyme tissue. The term "fibroblastic" or "fibromatous" is used to describe tumors of the fibrous connective tissue. Whe ...

(benign excrescence of connective tissue) can be treated with cryosurgery. Cryosurgery works by taking advantage of the destructive force of freezing temperatures on

cells Cell most often refers to: * Cell (biology), the functional basic unit of life Cell may also refer to: Locations * Monastic cell, a small room, hut, or cave in which a religious recluse lives, alternatively the small precursor of a monastery w ...

. When their

temperature Temperature is a physical quantity that expresses quantitatively the perceptions of hotness and coldness. Temperature is measured with a thermometer. Thermometers are calibrated in various temperature scales that historically have relied o ...

sinks beyond a certain level

ice crystal Ice crystals are solid ice exhibiting atomic ordering on various length scales and include hexagonal columns, hexagonal plates, dendritic crystals, and diamond dust. Formation The hugely symmetric shapes are due to depositional growth, n ...

s begin forming inside the cells and, because of their lower

density Density (volumetric mass density or specific mass) is the substance's mass per unit of volume. The symbol most often used for density is ''ρ'' (the lower case Greek letter rho), although the Latin letter ''D'' can also be used. Mathematicall ...

, eventually tear apart those cells. Further harm to malignant growth will result once the

blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide awa ...

s supplying the affected tissue begin to freeze. Cryosurgery is used to treat a variety of benign skin lesions including: *

Acne Acne, also known as ''acne vulgaris'', is a long-term skin condition that occurs when dead skin cells and oil from the skin clog hair follicles. Typical features of the condition include blackheads or whiteheads, pimples, oily skin, and ...

Warts Warts are typically small, rough, hard growths that are similar in color to the rest of the skin. They typically do not result in other symptoms, except when on the bottom of the feet, where they may be painful. While they usually occur on the ...

(including anogenital warts) *

Dermatofibroma A dermatofibroma, or benign fibrous histiocytomas, is a benign nodule in the skin, typically on the legs, elbows or chest of an adult. It is usually painless. It usually ranges from 0.2cm to 2cm in size but larger examples have been reported. It ...

Hemangioma A hemangioma or haemangioma is a usually benign vascular tumor derived from blood vessel cell types. The most common form, seen in infants, is an infantile hemangioma, known colloquially as a "strawberry mark", most commonly presenting on the ski ...

Keloid Keloid, also known as keloid disorder and keloidal scar, is the formation of a type of scar which, depending on its maturity, is composed mainly of either type III (early) or type I (late) collagen. It is a result of an overgrowth of granulation ...

(hypertrophic scar) * Molluscum contagiosum *

Myxoid cyst A myxoid cyst is a cutaneous condition often characterized by nail plate depression and grooves. See also * Scleroderma * List of cutaneous conditions * List of radiographic findings associated with cutaneous conditions Many conditions of o ...

Pyogenic granuloma A pyogenic granuloma or lobular capillary hemangioma is a vascular tumor that occurs on both mucosa and skin, and appears as an overgrowth of tissue due to irritation, physical trauma, or hormonal factors. It is often found to involve the gum ...

* Seborrheic keratoses * Skin tags Cryosurgery may also be used to treat low risk skin cancers such as

basal cell carcinoma Basal-cell carcinoma (BCC), also known as basal-cell cancer, is the most common type of skin cancer. It often appears as a painless raised area of skin, which may be shiny with small blood vessels running over it. It may also present as a raise ...

and

squamous cell carcinoma Squamous-cell carcinomas (SCCs), also known as epidermoid carcinomas, comprise a number of different types of cancer that begin in squamous cells. These cells form on the surface of the skin, on the lining of hollow organs in the body, and on the ...

but a biopsy should be obtained first to confirm the diagnosis, determine the depth of invasion and characterize other high risk histologic features.

Method

Liquid nitrogen

A common method of freezing lesions is by using

liquid nitrogen Liquid nitrogen—LN2—is nitrogen in a liquid state at low temperature. Liquid nitrogen has a boiling point of about . It is produced industrially by fractional distillation of liquid air. It is a colorless, low viscosity liquid that is wid ...

as the cryogen. The liquid nitrogen may be applied to lesions using a variety of methods; such as dipping a cotton or synthetic material tipped applicator in liquid nitrogen and then directly applying the cryogen onto the lesion. The liquid nitrogen can also be sprayed onto the lesion using a spray canister. The spray canister may utilize a variety of nozzles for different spray patterns. A cryoprobe, which is a metal applicator that has been cooled using liquid nitrogen, can also be directly applied onto lesions.

Carbon dioxide

Carbon dioxide is also available as a spray and is used to treat a variety of benign spots. Less frequently, doctors use

carbon dioxide Carbon dioxide ( chemical formula ) is a chemical compound made up of molecules that each have one carbon atom covalently double bonded to two oxygen atoms. It is found in the gas state at room temperature. In the air, carbon dioxide is t ...

"snow" formed into a cylinder or mixed with

acetone Acetone (2-propanone or dimethyl ketone), is an organic compound with the formula . It is the simplest and smallest ketone (). It is a colorless, highly volatile and flammable liquid with a characteristic pungent odour. Acetone is miscibl ...

to form a slush that is applied directly to the treated tissue.

Argon

Recent advances in technology have allowed for the use of

argon Argon is a chemical element with the symbol Ar and atomic number 18. It is in group 18 of the periodic table and is a noble gas. Argon is the third-most abundant gas in Earth's atmosphere, at 0.934% (9340 ppmv). It is more than twice a ...

gas to drive ice formation using a principle known as the Joule-Thomson effect. This gives physicians excellent control of the ice and minimizes complications using ultra-thin 17

gauge Gauge ( or ) may refer to: Measurement * Gauge (instrument), any of a variety of measuring instruments * Gauge (firearms) * Wire gauge, a measure of the size of a wire ** American wire gauge, a common measure of nonferrous wire diameter, es ...

cryoneedles.

Freeze sprays

A mixture of

dimethyl ether Dimethyl ether (DME; also known as methoxymethane) is the organic compound with the formula CH3OCH3, (sometimes ambiguously simplified to C2H6O as it is an isomer of ethanol). The simplest ether, it is a colorless gas that is a useful precursor ...

and

propane Propane () is a three-carbon alkane with the molecular formula . It is a gas at standard temperature and pressure, but compressible to a transportable liquid. A by-product of natural gas processing and petroleum refining, it is commonly used as ...

is used in some "

freeze spray Freeze spray (cold spray or vapocoolant) is a type of aerosol spray product containing a liquified gas used for rapidly cooling surfaces, in medical and industrial applications. It is usually sold in hand-held spray cans. It may consist of vario ...

" preparations such as Dr. Scholl's Freeze Away. The mixture is stored in an

aerosol spray Aerosol spray is a type of dispensing system which creates an aerosol mist of liquid particles. It comprises a can or bottle that contains a payload, and a propellant under pressure. When the container's valve is opened, the payload is forced out ...

type container at room temperature and drops to when dispensed. The mixture is often dispensed into a straw with a cotton-tipped swab. Similar products may use

tetrafluoroethane 1,1,1,2-Tetrafluoroethane (also known as norflurane (INN), R-134a, Freon 134a, Forane 134a, Genetron 134a, Green Gas, Florasol 134a, Suva 134a, or HFC-134a) is a hydrofluorocarbon (HFC) and haloalkane refrigerant with thermodynamic properties si ...

or other substances.

Products

;Cryosurgical systems A number of medical supply companies have developed cryogen delivery systems for cryosurgery. Most are based on the use of liquid nitrogen, although some employ the use of proprietary mixtures of gases that combine to form the cryogen.

In cancer treatment

Cryosurgery is also used to treat internal and external tumors as well as tumors in the bone. To cure internal tumors, a hollow instrument called a cryoprobe is used, which is placed in contact with the tumor. Liquid

nitrogen Nitrogen is the chemical element with the symbol N and atomic number 7. Nitrogen is a nonmetal and the lightest member of group 15 of the periodic table, often called the pnictogens. It is a common element in the universe, estimated at se ...

gas is passed through the cryoprobe.

Ultrasound Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies ...

or MRI is used to guide the cryoprobe and monitor the freezing of the cells. This helps in limiting damage to adjacent healthy tissues. A ball of ice crystals forms around the probe which results in freezing of nearby cells. When it is required to deliver gas to various parts of the tumor, more than one probe is used. After cryosurgery, the frozen tissue is either naturally absorbed by the body in the case of internal tumors, or it dissolves and forms a scab for external tumors.

Results

Cryosurgery is a minimally invasive procedure, and is often preferred to other types of surgery because of its safety, ease of use, minimal pain and scarring as well as low cost; however, as with any medical treatment, there are risks involved, primarily that of damage to nearby healthy tissue. Damage to nerve tissue is of particular concern but is rare. Cryosurgery cannot be used on lesions that would subsequently require biopsy as the technique destroys tissue and precludes the use of

histopathology Histopathology (compound of three Greek words: ''histos'' "tissue", πάθος ''pathos'' "suffering", and -λογία '' -logia'' "study of") refers to the microscopic examination of tissue in order to study the manifestations of disease. Sp ...

. More common complications of cryosurgery include blistering and edema which are transient. Cryosurgery may cause complications due to damage of underlying structures. Destruction of the

basement membrane The basement membrane is a thin, pliable sheet-like type of extracellular matrix that provides cell and tissue support and acts as a platform for complex signalling. The basement membrane sits between epithelial tissues including mesothelium an ...

may cause scarring and destruction of hair follicles can cause alopecia or hair loss. Occasionally, hypopigmentation may occur in the area of skin treated with cryosurgery, however, this complication is usually transient and often resolves as

melanocytes Melanocytes are melanin-producing neural crest-derived cells located in the bottom layer (the stratum basale) of the skin's epidermis, the middle layer of the eye (the uvea), the inner ear, vaginal epithelium, meninges, bones, and hear ...

migrate and repigment the area over several months. Bleeding can also occur, which can be delayed or immediate, due to damage of underlying arteries and arterioles. Tendon rupture and cartillage necrosis can occur, particularly if cryosurgery is done over bony prominences. These complications can be avoided or minimized if freeze times of less than 30 seconds are used during cryosurgery. Patients undergoing cryosurgery usually experience redness and minor-to-moderate localized pain, which most of the time can be alleviated sufficiently by oral administration of mild

analgesics An analgesic drug, also called simply an analgesic (American English), analgaesic (British English), pain reliever, or painkiller, is any member of the group of drugs used to achieve relief from pain (that is, analgesia or pain management). It ...

such as

ibuprofen Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that is used for treating pain, fever, and inflammation. This includes painful menstrual periods, migraines, and rheumatoid arthritis. It may also be used to close a patent ductus ar ...

codeine Codeine is an opiate and prodrug of morphine mainly used to treat pain, coughing, and diarrhea. It is also commonly used as a recreational drug. It is found naturally in the sap of the opium poppy, ''Papaver somniferum''. It is typically ...

acetaminophen Paracetamol, also known as acetaminophen, is a medication used to treat fever and mild to moderate pain. Common brand names include Tylenol and Panadol. At a standard dose, paracetamol only slightly decreases body temperature; it is inferior ...

(paracetamol).

Blister A blister is a small pocket of body fluid ( lymph, serum, plasma, blood, or pus) within the upper layers of the skin, usually caused by forceful rubbing ( friction), burning, freezing, chemical exposure or infection. Most blisters are filled ...

s may form as a result of cryosurgery, but these usually scab over and peel away within a few days.

References

{{reflist Dermatologic surgery Cryobiology Surgical procedures and techniques de:Kryotherapie#Kryochirurgie