From the Guidelines
Cryotherapy can be used to treat basal cell carcinoma, particularly for low-risk lesions, with cure rates ranging from 85-99%. This treatment involves freezing the cancerous tissue with liquid nitrogen, which destroys the abnormal cells by forming ice crystals within them and disrupting cellular metabolism 1. The procedure is typically performed in a dermatologist's office and involves applying liquid nitrogen directly to the lesion using a spray device or cotton-tipped applicator.
Key Considerations
- The freezing process usually lasts between 5-30 seconds, often repeated in cycles during the same visit.
- Patients may experience redness, swelling, blistering, and mild pain at the treatment site, which typically resolves within 1-2 weeks.
- The treated area will form a scab and eventually heal, leaving a flat, pale scar.
- Cryotherapy is most effective for low-risk BCCs and may not be suitable for larger, deeper, or recurrent tumors, or those in high-risk locations like the face.
- Follow-up visits are essential to monitor for recurrence, as reported in a study with a 5-year follow-up period 1.
Comparison with Other Treatments
- Cryosurgery has been compared with 5-amino-laevulinic acid (ALA)-PDT in the treatment of low-risk BCC, with statistically comparable histologically verified recurrence rates 1.
- A more recent guideline recommends considering cryosurgery, topical therapy, MAL- or ALA-PDT, and radiation therapy for low-risk BCCs when surgical therapy is not feasible or preferred 1.
- However, the 2018 guideline does not provide new evidence on the effectiveness of cryotherapy, and the 2008 study remains the most relevant and highest-quality evidence for this specific treatment modality 1.
From the Research
Effectiveness of Cryotherapy for Basal Cell Carcinoma
- Cryotherapy is a treatment option for basal cell carcinoma, with studies showing its effectiveness in treating superficial and nodular basal cell carcinoma 2, 3, 4, 5, 6.
- A prospective, randomised and controlled trial found that cryosurgery had a clinical clearance rate of 100% after 1 year, compared to 95.7% for curettage 2.
- A systematic review found that cryotherapy alone or with curettage had comparable efficacy to photodynamic therapy and surgery, but was inferior to radiation in terms of recurrence rate 3.
- A study found that a double freeze-thaw cycle with liquid nitrogen achieved a cure rate of 95.3% for facial basal cell carcinomas, while a single freeze-thaw cycle achieved a cure rate of 79.4% 4.
- A retrospective study found that cryosurgery had a cure rate of 95% after 5 years, with an excellent or good cosmetic outcome in 92% of cases 5.
- A systematic review and meta-analysis found that photodynamic therapy and cryotherapy had similar therapeutic effects, with no statistically significant difference in recurrence rate or complete response 6.
Comparison of Cryotherapy to Other Treatments
- Cryotherapy has been compared to other treatments, including photodynamic therapy, surgery, and radiation 3, 6.
- A study found that cryotherapy was inferior to radiation in terms of recurrence rate, but had comparable efficacy to photodynamic therapy and surgery 3.
- A meta-analysis found that photodynamic therapy and cryotherapy had similar therapeutic effects, with no statistically significant difference in recurrence rate or complete response 6.
Cosmetic Outcomes and Wound Healing Times
- A study found that wound healing times were shorter for curettage (4 weeks) compared to cryosurgery (5 weeks) 2.
- A retrospective study found that cryosurgery had an excellent or good cosmetic outcome in 92% of cases 5.
- A systematic review found that most patients had better cosmetic outcomes with photodynamic therapy and surgery compared to cryotherapy alone, and cryotherapy with curettage 3.