Actinic Keratosis: Treatment—Cryotherapy

There are many treatment options available and one of the most frequently used is cryotherapy Liquid nitrogen is extremely cold, between -346.0 F to -320.44 F, and when used as a spray produces a rapid freeze of tissue.  This concentrates the thermal injury directly to the outer layer of cells, the abnormal proliferative cells that produce the actinic keratosis.  If used correctly, this does not produce a full thickness epidermal injury and does not result in scarring.  At times the area may lighten or darken related to post-inflammatory changes, but those features may be seen in any inflammatory event.  Don’t worry, it often is not permanent, and with time normal pigmentation returns.

The dermatologist freezes the area of concern until an even white frost appears, as shown above.  Depending on lesion thickness, I treat for 15-30 second thaw times.  It is an art and over freezing can result in blistering, ulceration and significant scarring.  Liquid nitrogen in the wrong hands can be very dangerous.  Do not try to use the over-the-counter sprays available to treat warts.  The rate of freezing with commercial products is slow in comparison and judging the thickness of a freeze comes with experience and examining the results.  I am frankly shocked that this product is available to treat warts because it can produce significant injury.

Most dermatologists do not treat more than 15 actinic keratosis per office visit and the reason for this is that insurance only pays for 15 (17004 code).  The 17004 code covers 15 or greater…thus there is no more reimbursement provided for any more than this to be treated.  I routinely treat hundreds of these actinic keratosis each visit because it works well.  I learned this in the military.  If I treated my patients aggressively treating 100-200 lesions each visit they improved immensely, and some cleared —they looked better, and I ended up doing less surgery cutting out skin cancers.  Many patients have severe sun damage resulting in many…many…actinic keratosis.  The patient above had an additional 30 lesions treated on his forehead alone.  To learn more about cryotherapy in dermatology click HERE.  To learn more about actinic keratosis click HERE.