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CRYOSURGERY (CRYOTHERAPY)

Cryosurgery is used frequently by skin care physicians to treat many skin problems. Liquid nitrogen is sprayed on the area of skin, freezing it. A light freezing causes a peeling, a moderate freezing causes a blistering, and a hard freezing causes a scabbing. It is used for acne, various scars, growths, and some skin cancers. Some physicians still use a swab to apply it, but the results are the same.

Medicare Now Covers Removal of Precancerous Sun-Induced Skin Lesions

Medicare now provides beneficiaries with universal coverage for the removal of actinic keratoses - precancerous skin lesions caused by sun exposure - according to the Center for Medicare & Medicaid Services (CMS). Prior to this ruling, Medicare had no national policy with regard to treating or removing actinic keratoses.

Up to 60 percent of Americans will develop at least one of these lesions, with fair-skinned individuals who have a significant history of sun exposure carrying the greatest risk.

Actinic keratoses appear as rounded, rough, scaly patches on the skin that range from flesh-colored to reddish-brown. Left untreated, actinic keratoses can lead to invasive squamous cell carcinoma, a potentially fatal form of skin cancer. To prevent this progression, physicians can remove actinic keratoses using a variety of treatments.

Based on an extensive analysis of previously completed studies and expert testimony, CMS concluded that Medicare will cover routine treatment of actinic keratoses to prevent diagnosed lesions from developing into invasive squamous cell carcinoma.

Covered treatments include cryosurgery (destruction of lesion by freezing) with liquid nitrogen, excision (cutting the lesion out of skin), curettage (scraping the lesion away) and photodynamic therapy (photosensitizing cells and destroying them by exposing them to a light source).

Cryosurgery Post-operative Care

For simple and noncomplex lesions, no specific care other than washing with soap and water is needed. For malignancies and deeper lesions, various combinations of care are optional and may include the following:

(1) Washing treated site with soap and water.
(2) Application of alcohol or hydrogen peroxide to eschar.
(3) Wet compresses.
(4) Systemic steroids (as an anti-inflammatory agent for lesions around the eyes in selected cases).
(5) Systemic antibiotics (rarely needed, but may be used prophylactically in patients with certain medical conditions).
(6) Antibiotic ophthalmic solution may be used.
(7) Drainage of vesicles or blisters may be done.
(8) Keeping treated site clean.
(9) Gauze or other dressing may be applied but this is usually not necessary).

Other items to consider:

(1) Usual and expected postoperative tissue response varies in degree but may include the following:

(a) Pain
(b) Tenderness
(c) Erythema, local edema, exudation, and crusting
(d) Vesicles or bullae including hemorrhagic bullae
(e) Sloughing or necrotic tissue
(f) Eschar (Scab) formation

(2) Occasional temporary postoperative occurrences:

(a) Local or more generalized edema, especially periorbital
(b) Early hemorrhage
(c) Delayed hemorrhage
(d) Syncope
(e) Pain and tenderness
(f) Nail dystrophy
(g) Hypertrophic scarring
(h) Infection
(i) Nerve injury (rare)
(j) Milia
(k) Hyperpigmentation or hypopigmentation (this can be fairly common)
(l) Febrile response (rare)

(3) Permanent postoperative complications:

(a) Hypopigmentation (loss of pigmentation)
(b) Retraction or scarring 
    (1) Atrophic
    (2) Hypertrophic
(c) Tissue defects
    (1) Notching of the ear
    (2) Notching of ala of nose
(d) Recurrence of lesion
(e) Alopecia
(f) Nail dystrophy (rare)

Adherence to these guidelines will not ensure successful treatment in every situation. Further, these guidelines should not be deemed inclusive of all proper methods of care or exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate clinical judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient.

Call our office at (913) 962-1869 to make an appointment to see the physician for consultation about your health care needs.

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