Lesion selection and related contraindications

Cryosurgery is used commonly to treat both benign and malignant skin lesions: the medical professional treating the condition must select the best method from among the many available today. This chapter deals with selection of lesions that are best suited for cryosurgery. Though there are hardly strict confines to what can or cannot be treated this chapter will discuss lesions commonly treated by cryosurgery and general contraindications as well as some lesions where cryosurgery is not the best recommendation. General factors when considering cryosurgery as treatment for a lesion are site, cosmetic impact of treatment, and skin type. Those with more melanocytes are at higher risk of hypopigmentation following cryosurgical treatment as the freezing will damage pigment production often times, permanently. For skin cancers in particular one must consider size, depth, delineation, tumor type, and age and health of patient. The senior author has been using freezing in various ways since her residency days in 1961. Other contributing authors to this book are at Johns Hopkins and offer varied and current viewpoints. In this chapter we consider where cryosurgery is optimized, as in the treatment of actinic keratoses, and where it is relatively contraindicated, although may be used, with care, in small lesions such as patients with cryosurgery in cryourticaria. Confining what can and cannot be treated is relative to the medical professional's experience, knowledge, and comfort level in utilizing cryosurgery. What I may consider treatable, another may not. In this chapter I hope to generally clarify common encounters in the office that would be considered for treatment.