\nAd<\/em><\/p>\n<\/span>Skin cancer<\/span><\/h4>\nApplication to facilitate skin self-examination and early detection<\/strong>. read more<\/span>.<\/strong><\/p>\n<\/blockquote>\n<\/section>\n<\/div>\n<\/div>\n
Text: Miiskin.<\/div>\n<\/div>\n
These guidelines were provided to DermNet New Zealand by ProCare Health Limited, July 2014.<\/p>\n
<\/span>Disclaimer<\/span><\/h3>\nThese guidelines have been written for the use of ProCare member practices. No set of guidelines can cover all the variations required for specific patient circumstances. It is the responsibility of healthcare professionals to use these guidelines to adapt them for safe use within their institutions and for the individual needs of patients.<\/p>\n
<\/span>Definition<\/span><\/h2>\nCryotherapy<\/span> is a minimum invader<\/span> A procedure that uses an extremely cold liquid or instrument to freeze and destroy abnormal tissue that requires removal. Also known as cryosurgery or cryoablation.<\/p>\n<\/span>Scope<\/span><\/h2>\nRegistered doctors and nurses who have been trained to perform the procedure.<\/p>\n
Treatment of evil one<\/span> Cryotherapy skin lesions are not covered by this document.<\/p>\n<\/div>\n
<\/span>Indications for cryotherapy.<\/span><\/h2>\n\n- Viral warts in older children and adults<\/li>\n
- \nSeborrheic<\/span> keratosis<\/span>\n<\/li>\n
- Actinic keratosis<\/span><\/li>\n
- Molluscum contagiosum in adults<\/li>\n
- Skin tags *<\/li>\n<\/ul>\n
* Diathermy may be more effective for skin tags<\/span> \/ \/ fibroepithelial<\/span> polyps<\/p>\nThe following skin cancers may be suitable for cryotherapy if performed by a properly trained doctor and where injury<\/span> has been identified by biopsy<\/span>:<\/p>\n\n- Small, thin, typical, superficial. basal<\/span> cell carcinoma<\/span> on trunk and limbs<\/li>\n
- Small typical intraepithelial scaly<\/span> Trunk and Limb Cell Carcinoma<\/li>\n<\/ul>\n
<\/span>\nContraindications<\/span> to cryotherapy<\/span><\/h2>\n\n- Undiagnosed skin lesions<\/li>\n
- Injury for what tissue pathology<\/span> it is required<\/li>\n
- Injury within a compromised circulation area<\/li>\n
- Melanoma<\/span><\/li>\n
- Previous sensitivity or adverse reaction<\/span> to cryosurgery<\/li>\n
- The patient cannot accept the side effects.<\/li>\n
- Patients with poor circulation.<\/li>\n
- Unconscious patients<\/li>\n
- Small children<\/li>\n
- Dark-skinned patients<\/li>\n<\/ul>\n
<\/span>Precautions when using cryotherapy<\/span><\/h2>\n\n- Areas not recommended for the application of liquid nitrogen: corners of the eyes, skin fold between the nose and lips, the skin around the nostrils and the skin that covers nerves<\/span>eg sides of digits<\/span>, below the knee in certain groups (eg, diabetics, the elderly)<\/li>\n
- The reappearance of a lesion previously treated with cryotherapy should be referred to a doctor for review.<\/li>\n
- \nRecurrent<\/span> Skin cancers after cryotherapy may be more difficult to treat.<\/li>\n
- Take care in patients with a history of slow healing or skin. infection<\/span>\n<\/li>\n
- Prolonged freezing can cause scarring; light freezing is best and the patient returns to freeze again if response is inadequate<\/li>\n
- Cryotherapy leaves permanent white marks that can be very unpleasant, especially in patients with dark skin.<\/li>\n
- Cryotherapy can sometimes cause nerve damage and ongoing pain in some dangerous areas where the nerves meet superficially (for example, sides of the fingers)<\/li>\n<\/ul>\n
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<\/span>Cryotherapy checklist<\/span><\/h2>\n<\/span>Pre-procedure<\/span><\/h3>\n\n- The general practitioner should review any injury where there is uncertainty about the diagnosis or suitability for cryotherapy.<\/li>\n
- Obtain informed consent<\/li>\n<\/ul>\n
<\/span>Prepare team \/ environment<\/span><\/h3>\n\n- Apply goggles and protective gloves.<\/li>\n
- Decant liquid nitrogen in the cryospray or if a cotton-tipped applicator is used in apermeable<\/span> container<\/li>\n
- Cotton-tipped applicators have been commonly used, but should only be used for benign<\/span> injuries due to lower<\/span> tissue freezing compared to spray<\/span> techniques<\/li>\n<\/ul>\n\n
<\/span>Cryosurgery devices: cotton tipped applicator (left), liquid nitrogen spray (right)<\/span><\/h5>\n<\/section>\n\n\n
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Large cotton buds used for cryotherapy<\/p>\n
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Liquid nitrogen dispenser for cryotherapy<\/p>\n<\/p><\/div>\n<\/section>\n
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<\/span>Liquid nitrogen application<\/span><\/h3>\n\n- Hand hygiene<\/li>\n
- Select the A to D spray tip of the appropriate size for the diameter and thickness of the lesion.<\/li>\n
- Apply liquid nitrogen to the lesion for a few seconds, depending on the diameter required and the depth of freezing.<\/li>\n
- A margin of 1\u20132 mm is recommended for benign lesions.<\/li>\n
- A disposable plastic ear speculum (trimmed if necessary) can be used to limit the treatment area<\/li>\n
- Freezing times range from about five seconds (after the freeze ball appears) for actinic keratoses to 10 or 20 seconds for thicker lesions such as plant<\/span> warts or seborrheic keratosis<\/span>\n<\/li>\n
- Two freeze \/ thaw cycles (with a shorter freeze time) are more effective for thicker lesions such as seborrheic keratosis and warts.<\/li>\n
- For warts (especially plantar warts) removal of curb<\/span> by using a scalpel blade or before keratolytic<\/span> Treatment (eg salicylic acid) may improve response to subsequent cryotherapy<\/li>\n
- Cotton tipped applicators should not be submerged in the flask; new swabs should be used if more liquid nitrogen is required<\/li>\n<\/ul>\n
<\/span>Post-procedure<\/span><\/h2>\n\n- Periodic cleaning and sterilization of cryospray nozzles should be performed in accordance with the manufacturer's recommendations.<\/li>\n
- If the mouthpiece comes in contact with the patient's skin, autoclaving is required (see Practice Infection Control<\/span> politics)<\/li>\n
- Clean the flask<\/li>\n
- Document the injury and treatment in the patient management system. This includes (but is not limited to)\n