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Prospects for cryosurgery
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Prospects for Cryosurgery
Eckhard W. Breitbart, MD, and Elzbi&a Dach&v-Siwi&,
From the Department of Lkrmato10~, University of Hamburg, Hamburg, Feokrai Republic of Germany, and Warsaw Academy of Medicine, Warsaw, Poland
MD
The dermatologist may choose from five different methods for the treatment of premalignant and malignant lesions: (I) surgery (2) electrosurgery (3) laser therapy (4) dermabrasion (5) cryosurgery The various alternatives allow for the development of individual, patient-oriented therapy concepts. Thereby, the respective advantages and disadvantages of the individual methods must be weighed with respect to the nature and localization of the lesion and the patient’s condition. The advantages of cryosurgery lie in the uncomplicated performance, low costs, ambulatory treatment, minor pain intensity, and good scar formation. The principle disadvantages are associated with the very long healing time-dependent on the depth of necrosisand the possible consequences of an open wound. Considering the many advantages of cryosurgery, as well as the minimization of the disadvantages accorded by appropriate patient counseling, it is incomprehensible that cryosurgery is not employed worldwide in every dermatology practice. In order to increase the distribution of this simple, but sophisticated method, in the future it is necessary to: (1) develop new, easy-to-handle equipment (2) extend the availability of liquid nitrogen (3) carry out intensive instruction at congresses and technical seminars The theme most crucial to the further development of cryosurgery is the investigation of cryoimmunology. The fascinating clinical observation that following the freezing of cutaneous metastases from malignant melanoma, additional metastases, which are located far from the vicinity of the freezing, may vanish. This points to an activation of the immune system. Furthermore, striking differences in the T-cell populations were noted during the course of a randomized, controlled clinical study “Surgery versus cryosurgery of cutaneous melanoma.” For example, significant increases were observed in total T (p < 0.001) T-helper (p < O.OOl),T-suppressor b < O.OOl),and HLA-DR positive (p < 0.001) cells following cryosurgery, in contrast to a decrease in these parameters following conventional surgery. These data underline the necessity of future immunologic investigation of this highly interesting phenomenon. 115
116
E. W. Breitbart, and E. Dachbw-Siwi&
Clinics in Dermatology
Address for correspondence: Eckhard W. Breitbart, MD, Department of Dermatology, Universitaets-Hautklinik und -Poliklinik, Martinistrasse 52, D-2000, Hamburg 20, Federal Republic of Germany.
Prospects for Cryosurgery
Eckhard W. Breitbart, MD, and Elzbi&a Dach&v-Siwi&,
From the Department of Lkrmato10~, University of Hamburg, Hamburg, Feokrai Republic of Germany, and Warsaw Academy of Medicine, Warsaw, Poland
MD
The dermatologist may choose from five different methods for the treatment of premalignant and malignant lesions: (I) surgery (2) electrosurgery (3) laser therapy (4) dermabrasion (5) cryosurgery The various alternatives allow for the development of individual, patient-oriented therapy concepts. Thereby, the respective advantages and disadvantages of the individual methods must be weighed with respect to the nature and localization of the lesion and the patient’s condition. The advantages of cryosurgery lie in the uncomplicated performance, low costs, ambulatory treatment, minor pain intensity, and good scar formation. The principle disadvantages are associated with the very long healing time-dependent on the depth of necrosisand the possible consequences of an open wound. Considering the many advantages of cryosurgery, as well as the minimization of the disadvantages accorded by appropriate patient counseling, it is incomprehensible that cryosurgery is not employed worldwide in every dermatology practice. In order to increase the distribution of this simple, but sophisticated method, in the future it is necessary to: (1) develop new, easy-to-handle equipment (2) extend the availability of liquid nitrogen (3) carry out intensive instruction at congresses and technical seminars The theme most crucial to the further development of cryosurgery is the investigation of cryoimmunology. The fascinating clinical observation that following the freezing of cutaneous metastases from malignant melanoma, additional metastases, which are located far from the vicinity of the freezing, may vanish. This points to an activation of the immune system. Furthermore, striking differences in the T-cell populations were noted during the course of a randomized, controlled clinical study “Surgery versus cryosurgery of cutaneous melanoma.” For example, significant increases were observed in total T (p < 0.001) T-helper (p < O.OOl),T-suppressor b < O.OOl),and HLA-DR positive (p < 0.001) cells following cryosurgery, in contrast to a decrease in these parameters following conventional surgery. These data underline the necessity of future immunologic investigation of this highly interesting phenomenon. 115
116
E. W. Breitbart, and E. Dachbw-Siwi&
Clinics in Dermatology
Address for correspondence: Eckhard W. Breitbart, MD, Department of Dermatology, Universitaets-Hautklinik und -Poliklinik, Martinistrasse 52, D-2000, Hamburg 20, Federal Republic of Germany.