Cryopeeling (extensive cryosurgery) for treatment of actinic keratoses: An update and comparison

BACKGROUND. The treatment of actinic keratoses is the most common procedure in dermatology and liquid nitrogen freezing is the most used method of destruction. Yet it is criticized for its limitations of treating only small areas and its tendency to leave hypopigmented skin. 5-fluorouracil (5-FU) treatment is also widely utilized. It has the advantage of treating large areas, but the disadvantages of length of treatment, morbidity, and only partial effectiveness in removing deep or hyperkeratotic actinic keratoses. OBJECTIVE. Long-term follow-up results are reported on the use of extensive cryosurgery to treat areas of widespread solar damage. The literature is reviewed comparing the advantages and disadvantages versus 5-FU treatment. METHODS. Three hundred and seventy-three patients were initially treated for extensive actinic keratoses in a private dermatology office in an retirement community in Florida. Individual lesions were counted under good lighting conditions with the aid of a 2.5x stereoscopic lens. The treated areas were predominately on the face and scalp areas, although some arms and hands were treated. A total of 34,604 were initially treated by spraying each individual keratosis with liquid nitrogen as well as the entire surrounding skin area. RESULTS. The data show that cryopeeling was approximately twice as effective as 5-FU when measured at 1-3 years postoperatively. In addition, the ease of application, its availability, the low cost of materials, its versatility in treating all forms of actinic keratoses, the reduced healing times, and its predictably good cosmetic results make this procedure a logical choice for treating widespread actinic keratoses. The number of squamous cell carcinoma recorded over the entire 6.5-year study was 33 with no metastases, much lower than predicted for patients with actinic keratoses left untreated. CONCLUSION. Extensive cryosurgery (cryopeeling) is a highly effective method for removing actinic keratoses and preventing recurrences. The subsequent incidence of squamous cell carcinoma is also greatly reduced.