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Notes on the application of cryosurgery


Iinform our readers that we are preparing a series of presentations related to interventions of cryosurgery on the face, neck and tongue of patients with cutaneous melanoma.
These interventions, carried out during these years, Dr. Marco Scala and his collaborators showed the effects and effectiveness of cryosurgery.
We note that the surprising results related to the low temperatures that are not yet known biologically. That is, the reasons are the biochemical consequences of the effect of the interventions are under study.
Members of our team are becoming involved in such research that will be described in detail below.

We continue the intervention (Fig. 1) the description of which was published in January 2006 [1]

We mention in the clinical case of a person woman of 101 years. Patient with advanced malignant melanoma of the skin of the face. This example is reported in order to assess the feasibility and tolerability of the technique used, as well as the biological implications that the cryosurgical treatment obtained in this specific tumor.

The assessment of surgical risk should take into account different aspects such as: the stage of the disease, side effects related to previous or concurrent treatment, the physical condition of the patient, the presence of co-morbidity factors (cardiovascular, respiratory, metabolic, urologic , cognitive, and incontinence). The type of operation as well as the experience of the surgeon.
[2]Negli ultimi anni, la chirurgia è diventata meno aggressiva e invasiva, con una grande enfasi sul fatto di poter minimizzare il numero di trattamenti, soprattutto nei pazienti anziani, in cui lo scopo della chirurgia è principalmente quello di migliorare la qualità della vita piuttosto che prolungare la sopravvivenza.
Cryosurgery is consequently used for the treatment of many benign and premalignant lesions of the head and neck, especially of the oral cavity, as well as in selected patients with advanced diseases, thanks to the easy access to many cancers of the oral cavity that particular types of probes allow to run smoothly.
It allows the possibility of using local or regional anesthesia procedures, the treatment of patients at high surgical risk, with deficiency of coagulation and / or with large lesions with better functional results and rehabilitation. In this case it has a relatively painless postoperative course, and finally, the direct visual control of the area of crionecrosi that gives right to repeat the cycles of freezing on residual disease. [3]
Recently cryosurgery has been proposed for the treatment of melanoma of the head and neck, mainly for melanomas in mucosal sites anatomically as critical for high-risk patients with diseases not resettable. [4] [5]
Cryotherapy has also been applied for the treatment of lentigo maligna which was well tolerated in two patients. [6] [7]
The treatment was carried out by means of serial criochirurgiche applications that have been achieved in three months (fig.2, 3,4). The mass of the lesion has been treated with a liquid nitrogen cryoprobe while residual disease with cryoprobe to nitrous oxide, through the technique of insertion.
It 'clearly visible the physical and psychological state of the patient after surgery.

REFERENCES
[1] Scala M., Gippone M., Queirolo P., et al. Cryosurgery for advanced malignant melanoma of the facial skin. A case of report. In Vivo 2006; 20: 153 – 156.
[2] Lise M: Surgical decisions in elderly cancer patients. Tumori 2002; 88 (S): S51-52.
[3] Scala M, Margarino G, Mereu P, Gipponi M: Cryosurgery in oral disease. In "Basics of Cryosurgery. Korpan NN (Ed); Sprinter-Verlag, Vien, 2001: 285-8.
[4] Scala M, Gipponi M, Comandini D, Franzone P, Fabiani P, Del Bello A: Cryosurgery alone or in combination with radiotherapy and hyperthermia in the treatment of head and neck mucosal and cutaneous melanoma. J Exp Clin Cancer Res 1994; 13: 243-6.
[5] Tanaka S: Cryosurgery for malignant melanoma. In "Basics of Cryosurgery. Korpan NN (Ed); Sprinter-Verlag, Vien, 2001: 289-93.
[6] Collins P, Rogers S, Goggin M, Manning W: Cryotherapy for lentigo maligna. Clin Exp Dermatol 1991; 16: 433-5.
[7] McKenna DB, Cooper EJ, Kavanagh GM, Davie RM, McLaren KM, Tidman MJ: Amelanotic malignant melanoma following cryosurgery for atypical lentigo maligna. Clin Exp Dermatol 2000; 25: 600-4.

Un grazie particolare al chirurgo Davide  Marenco
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