By Ellie Baker; Susan Goldstine
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Additional resources for Cutaneous Cryosurgery, Fourth Edition
25). For cryosurgery of the skin, a 1-mm tip is useful for fine work, including small warts or skin tags. A 3- to 4-mm rounded or beveled tip is useful for larger warts, seborrheic keratoses, and other medium-sized lesions. There are larger disk-shaped tips that are used in cryosurgery for the treatment of cervical dysplasia. Occasionally these can be useful in cryosurgery of large skin lesions, but it should be noted that distinct circular areas of hypopigmentation will result from the use of these large round disks.
The control of the application of cryogen with these devices is not as tight as the adherent probes. Treatment of multiple lesions is not quite as fast with this equipment as with liquid nitrogen spray. It is similar in speed to the compressed nitrous oxide-adherent probes. These units reach −72 to −90°C, but tissue temperatures are not as low so they should not be used for cryosurgery of cancers. The size and shape of the treatment area are constrained by the size and shape of the restricting cones (when the liquid evaporation method is used).
Of course, if the spray paint technique is continued for at least 30 seconds a deeper freeze may be obtained (this technique is used for superficial BCCs over 2 cm in diameter). 5 cm in diameter. Beyond this size, tissue temperatures at the periphery only reach −15°C and may be insufficient to achieve the desired destructive effect. This may leave an outside ring of untreated disease and risk the recurrence of malignant lesions. 5 cm in diameter, the area may be treated with overlapping circles of spot freezes.