From the Guidelines
I strongly recommend using a comprehensive cryotherapy consent form for skin lesions that includes documentation of verbal consent, as suggested by the British Association of Dermatologists' guidelines 1. This consent form should clearly outline the procedure, risks, benefits, and alternatives, and should be provided to the patient along with a patient information leaflet on cryotherapy, as recommended in the guidelines 1. The consent form should begin with a description of cryotherapy as a procedure that uses extreme cold (typically liquid nitrogen at -196°C) to destroy abnormal tissue. It should explain that the treatment involves applying liquid nitrogen directly to the skin lesion for a few seconds, which may be repeated in the same session. The form should specify potential side effects including:
- pain during and after the procedure
- redness
- swelling
- blistering
- scabbing that typically resolves within 1-3 weeks More serious but less common risks to include are:
- infection
- scarring (which may be permanent)
- changes in skin pigmentation (hypopigmentation or hyperpigmentation)
- damage to underlying structures
- incomplete removal requiring additional treatments The consent should note that multiple treatments may be necessary for complete resolution, typically spaced 2-4 weeks apart. Alternative treatments should be listed, such as:
- surgical excision
- electrodesiccation and curettage
- topical medications
- observation The form should conclude with a statement confirming the patient understands the information provided, has had questions answered, and voluntarily consents to treatment, as recommended by the guidelines 1. This comprehensive consent form protects both the provider and patient by ensuring informed decision-making before proceeding with cryotherapy for skin lesions. It is also essential to record the dose, duration, and number of cycles of cryotherapy, as well as documentation of verbal consent, as recommended in the guidelines 1.
From the Research
Cryotherapy Consent for Skin Lesions
The following information is provided to inform you about the cryotherapy procedure for skin lesions:
- Cryosurgery is a highly effective treatment for a broad range of benign skin problems, including actinic keratosis, solar lentigo, seborrheic keratosis, viral wart, molluscum contagiosum, and dermatofibroma 2.
- The procedure involves the application of freezing temperatures to achieve the destruction of tissue, and can be performed in the outpatient setting using dipstick, spray, or cryoprobe techniques 3.
- Potential benefits of cryosurgery include a short preparation time, low risk of infection, and minimal wound care, with advantages such as no expensive supplies or injectable anesthesia required, and no need for suture removal 2.
Potential Risks and Complications
- Potential side effects of cryosurgery include bleeding, blister formation, headache, hair loss, and hypopigmentation, but rarely scarring 2.
- Other possible adverse effects include pain, edema, paresthesia, and less commonly, tendon rupture, scarring, alopecia, atrophy, and hypopigmentation 3.
- Lesional hypopigmentation and/or peripheral hyperpigmentation is the most common long-term complication of cryosurgery 4.
Contraindications and Precautions
- Contraindications to cryosurgery include neoplasms with indefinite margins or when pathology is desired, basal cell or squamous cell carcinomas with high-risk features, and prior adverse local reaction or hypersensitivity to cryosurgery 3.
- It is essential to have a clinical diagnosis before proceeding with cryosurgery, and if clinical diagnosis is not possible, either a skin biopsy or referral to a dermatologist is recommended 5.
Procedure and Aftercare
- The procedure typically involves rapid freezing and slow thawing, with a minimum tissue temperature of -25 to -60℃, and in malignant lesions, repetition of the freeze-thaw cycle 4.
- After the procedure, frozen tissue reacts with peripheral erythema, followed by edema, bulla formation, exudation, and mumification, and lesions usually heal with a fine atrophic scar after approximately 4 weeks 4.