Preoperative Care for Cryosurgery

Skin condition

Pretreatment

Macular (lentigines, lentigo simplex, lentigo solaris)

Retinoic acid/glycolic acid

Papular (molluscum)

In children with molluscum:

Hydrate skin

Indicate topical antibiotic in infected lesions

Topical anesthesia before procedure

Dermatofibroma

None

Verrucous warts

Immunomodulators/salicylic acid solution or patches with daily shaving

Shaving/wet before freeze

Topical anesthesia especially in younger patients

Condilomas

Immunomodulators

Seborrheic keratosis

Glycolic acid gel or cream

Keloids

None

Skin cancerization

Topical fluorouracil, tretinoin, isotretinoin, tazarotene, ingenol mebutate, diclofenac sodium, salycilic acid

Basal cell carcinomas

See Immunocryosurgery (Chap. 20)

What is the best technique?

Choose carefully the technique and ensure that you have all the necessary instruments to carry out the procedure. Do not treat some skin tags in the neck with the open (spraying) technique when the tweezer technique will work better, even if it is more time-consuming.

Will someone be available to attend to the patient if needed in case of an unexpected occurrence?

With any surgical procedure, doctors have a responsibility to ensure that the patient can be attended to in case of an unexpected event. In cryosurgery, the postoperative time can be of long duration; therefore, one has to mentally “draw” a timeline of the expected occurrences and the final healing time in order to make the necessary arrangements. The patient needs to have at hand the adequate staff to meet any eventuality. This is an important consideration to keep in mind: avoid extensive cryosurgical procedures (such as for large tumors) right before anticipated absences (physician, nurses, caretakers).

6.3 Patient’s Queries

Preoperative preparation

Make sure the patient understands the need for preoperative preparation in order to guarantee compliance. An example of such preparations can be the simple topical application of local anesthesia. However, others involve using immunomodulators for a long period, which in themselves have side effects.

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