question and answer
Skin cancer
April 2012
What’s the evidence on treating basal cell carcinoma with cryotherapy?
Marie-Clare Hopwood, MD, Cumberland, BC

Oncologist’s answer: Cryosurgery may be considered for patients with small, clinically well-defined primary tumours. It’s not commonly used except in patients for whom other types of surgery are contraindicated due to other medical conditions, as no tissue can be obtained that verifies clear margins. One has to be cautious in people who have abnormal cold tolerance such as those with cryoglobulinia or in areas where the skin is thin or risk of damage is high such as the ala nasi, nasolabial fold, tragus or areas where tumours sit near nerves or are fixed to bone or cartilage.

Localized edema is common following treatment, especially around the periorbital region, temple and forehead. Moreover, the surgical bed usually exudes necrotic material and then forms an eschar that persists for about 4 weeks. It should also be noted that melanocytes are permanently damaged and hypopigmentation occurs. Atrophy and hypertrophic scarring have been reported as well as instances of motor and sensory neuropathy.

A small 93-patient trial comparing cryosurgery to radiation therapy, with only 1 year of follow-up, showed a significantly higher recurrence rate with cryosurgery than radiation (39% vs 4%). Two small studies compared it to laser therapy with a photosensitizing agent — the laser was less effective in one and similar in the other but showed better cosmesis. In summary, it’s an option but often not the best, with several contraindications and poorer cosmetic results.

Dermatologist’s answer: The goal of treating any form of basal cell carcinoma is complete destruction of the lesion. Since there are several forms of basal cell carcinoma, it’s essential to select the proper modality. Basal cell carcinomas that show invasion into the dermis need to be surgically excised.

A superficial multifocal basal cell carcinoma is contained within the epidermis. Since the thickness of the epidermis is equivalent to one sheet of paper, there are other therapeutic treatments available. For example, curettage of the lesion is an effective form of treatment. Cryotherapy can also be used in this particular circumstance. However it tends to require aggressive treatment and multiple treatments are usually necessary to ensure complete removal.

If you’re using this type of therapy, it would be prudent for the patient to return every 3 to 4 months to examine the surgical site. You’ll be looking for patches on the margin of the tumour that resemble eczema. If in doubt, then a small biopsy is indicated.

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