Cryotherapy or liquid nitrogen is the most commonprocedure performed by skin cancer doctors. This time tested treatment can be used to treat a variety of skin cancers including solar keratosis or sunspots, superficial skin cancers such as basal cell carcinomas, and intra-epidermal SCCs. If performed correctly, the incidence of scarring is very low, whilst cure rates are high.
Important facts on cryotherapy or nitrogen for sunspots
The idea behind cryotherapy is to freeze abnormal cellsas well as a small amount of surrounding normal skin. When the frozen cells thaw out, thecells rupture and release their contents resulting in death of the cells.
Cryotherapy is a useful treatment for solar keratosis (sunspots), viral warts, small seborrhoeic keratosis and superficial basal cell carcinomas (BCC).
Read more about treating sunspots and solar keratosis
There are variations of this treatment. The commonest method uses liquid nitrogen. This drops the temperature of skin extremely quickly to a temperature below freezing point. The nitrogen is applied through a “gun” that sprays the liquid nitrogen onto the skin or alternatively, it is applied with a cotton bud or similar.
Day 1 following treatment:
The treated area will become red and swollen and a blister may develop. Blisters are best left alone, but can be burst with a sterile needle if they are uncomfortable.
Days 2 and 3 following treatment:
At this stage the skin becomes weepy. If the weeping is mild, leave it open to the air and you can safely wash the area with mild soap and water. If the weeping is excessive, cover the area with a dressing.
Days 3 to 4 following treatment:
At this stage a scab will form. The scab will remain in place for up to a week and then the area should heal without a mark. Do not pick at the scab as this can result in scarring. Occasionally following healing, the skin may be discoloured. More often than not this is temporary however it can be permanent.
Most treatment options have potential side effects and cryotherapy is no exception. The most common complication of cryotherapy is “hypopigmentation”. This refers to the skin that is treated ending upbeing pale when compared withsurrounding skin. Hypopigmentation occurs due to the destruction of the pigment producing cells (melanocytes) within the skin that are not regenerated. The effects of hypopigmentation are more evident in those with darker complexions.
Uncommon side effects can include infection, damage to tissues beneath the skin and blood blisters. Most of these will resolve in time.
Sunspots, also known as solar keratosis or actinic keratosis are commonly seen on exposed areas of the hands, face, chest, and in balding men the scalp. Due to the high UV exposure and index in Brisbane, sunspots are very common. Most Queenslanders will have at least one solar keratosis before the age of 50.
Sunspots should be treated due to the precancerous potential of these lesions. Liquid nitrogen is very effective for treatment of a few lesions or sunspots, however if damage is extensive, you may require other forms of treatment.
Your Skin Cancer Doctor will discuss treatment options for you and tailor a program for your lifestyle and extent of sundamage.
Some creams and lasers we use include the following:
Picato Cream: This cream is a Brisbane invention and is now used all over the World for the treatment of sunspots and solar keratosis. Unlike Efudix treatment, the downtime following Picato is only 4-7 days.
Read more about Picato treatment for sunspots
Efudix: This cream is also called 5 FU and has been used to treat sunspots for well over 2 decades. It is cheap, effective but associated with a downtime of 4 weeks plus.
The active ingredient of Efudix is 5-Fluorouracil which is a form of chemotherapy drug. Abnormal (pre-cancer or cancer) cells will selectively absorb Efudix allowing the drug to kill the abnormal cells. The treatment will produce a skin reaction that typically develops over the first week of treatment with redness and slight scaling. Over the second week the reaction intensifies with increasing redness and crusting with resolution of the reaction occurring several weeks following cessation of treatment. A stronger reaction will be observed in those who have a greater number of abnormal cells in the skin. It is important not to stop the treatment because of the reaction. Efudix is highly effective in treating AKs, particularly when large areas of skin are affected. Repeated treatments may be required and this is perfectly safe.
Read more about Efudix Treatment for sunspots
Aldara: This cream is called Imiquimod, and stimulates your immune system. It is very effective in clearing sunspots, but treatment times can be prolonged.
Aldara works by stimulating the immune system causing the release a number of chemicals called cytokines that are necessary tofight viruses and destroy cancer cells. Aldara treatment usually requires application of the cream 2 times a week for 6 weeks to a defined area of skin that should be no larger than 5cm x 5cm.
Common side effects of Aldara include:
Less Common effects:
Read more about Aldara for the treatment of sun spots
PDT: Is also known as photodynamic therapy. This treatment is covered under DVA for Specialist treatment of sunspots. PDT is a once off application with downtime of less than a week.
The advantage of PDT is its ability to treat large areas of skin at one time making it a suitable treatment for patients with large “fields” of affected skin. Usually only one treatment is required for AKs with costs ranging from $1500 – $2500 AUD depending on the area treated. Although generally well tolerated, common side effects may include slight burning or stinging during treatment and mild swelling and redness similar to sunburn afterward. Peeling and redness subside after about week. Overall PDT results are usually very good with excellent cosmetic outcomes.
Read more about PDT for sun-damage
Fraxel 1927 laser: This is treatment not only clears sunspots but rejuvenates the skin. One treatment can clear the majority of sun-damage; however patients with extensive sun damage and sun spots may require additional treatments. Costing is an issue with laser, each treatment cost $990, and is NOT COVERED BY MEDICARE. Treatments are supervised by specialist laser dermatologist.
Fraxel is a fractional laser treatment that works on both the epidermis (top surface of the skin) as well as the dermis (middle layer of the skin) to produce a reaction beneath the skin’s surface that eliminates old, damaged skin cells. Prior to treatment a topical anaesthetic cream is applied to prevent pain. Fraxel usually takes 20-40 minutes to perform depending on the area treated. Following treatment, mild swelling and a pinkish tone may be evident for about 3 days. Fraxel may be used on any area of the body with predictable results for all skin types and minimal disruption to a client’s daily routine.
Read more about Fraxel 1927 for sunspots