206: Cryosurgery

Question 1

What is the primary purpose of cryosurgery?

Answer 1

Cryosurgery is used to destroy cells of abnormal or diseased tissue using extreme cold.

Question 2

What are the effects of rapid freezing in cryosurgery?

Answer 2

Rapid freezing causes intracellular ice crystal formation, disrupting electrolytes and pH changes, leading to cell death more readily achieved.

Question 3

Which cryogen is considered the cryogen of choice in cryosurgery and why?

Answer 3

Liquid nitrogen is the cryogen of choice because it has the lowest temperature of all common cryogens and causes rapid freeze of treated tissue.

Question 4

What are the absolute contraindications for cryosurgery?

Answer 4

Absolute contraindications include lesions that require histopathology for diagnosis, recurrent nonmelanoma skin cancers, and tumors with indistinct borders or darkly pigmented features.

Question 5

What are some risks and complications associated with cryosurgery?

Answer 5

Risks and complications include pain, bleeding, pigmentation changes, nerve damage, scarring, alopecia, and insufflation of soft tissue.

Question 6

What is the open spray method in cryosurgery?

Answer 6

The open spray method involves using a handheld cryosurgical unit with a fingertip trigger to spray from a distance of 1-2 cm, suitable for superficial lesions with specific clinical freeze margins.

Question 7

What is the recommended treatment duration for seborrheic keratosis using cryosurgery?

Answer 7

The recommended treatment duration for seborrheic keratosis is 10-15 seconds with a 1-2 mm halo.

Question 8

What is the goal of treating actinic keratosis with cryosurgery?

Answer 8

The goal of treating actinic keratosis is to destroy the lesion in a single treatment using an open spray, single freeze-thaw cycle of 8-10 seconds with 1-2 mm margins.

Question 9

A patient presents with a small, well-circumscribed lesion in a confined location. Which cryosurgery technique would you use, and why?

Answer 9

The closed technique should be used because it involves pressing a copper cryoprobe against the lesion, making it ideal for small, well-circumscribed lesions in confined locations.

Question 10

You are treating a patient with actinic keratosis using cryosurgery. What is the recommended freeze-thaw cycle and margin?

Answer 10

For actinic keratosis, an open spray method with a single freeze-thaw cycle of 8-10 seconds and a 1-2 mm margin is recommended.

Question 11

A patient with cold urticaria needs cryosurgery. What should you consider before proceeding?

Answer 11

Cold urticaria is a relative contraindication for cryosurgery, so the procedure should be avoided or performed with extreme caution.

Question 12

What is the primary reason melanocytes are highly sensitive to cryosurgery?

Answer 12

Melanocytes are highly sensitive to cryosurgery because they are more prone to damage from freezing, which can lead to depigmentation.

Question 13

A patient undergoing cryosurgery experiences paresthesia. What is the likely cause?

Answer 13

Paresthesia is likely caused by nerve damage, which is a potential complication of cryosurgery.

Question 14

Why is liquid nitrogen the cryogen of choice in cryosurgery?

Answer 14

Liquid nitrogen is the cryogen of choice because it has the lowest temperature among common cryogens, allowing for rapid freezing of treated tissue.

Question 15

What is the effect of prolonged freezing (>30 seconds) during cryosurgery?

Answer 15

Prolonged freezing for more than 30 seconds can result in permanent pigment loss.

Question 16

A patient with a dermatofibroma is undergoing cryosurgery. What is the recommended freeze time?

Answer 16

The recommended freeze time for a dermatofibroma is 60 seconds.

Question 17

What is the primary difference between rapid and slow freezing in cryosurgery?

Answer 17

Rapid freezing causes intracellular ice crystal formation with disruption of electrolytes and pH changes, leading to more effective cell death, while slow freezing causes extracellular ice formation with less cell damage.

Question 18

What is the role of thawing in cryosurgery, and how does it affect cell damage?

Answer 18

Thawing leads to recrystallization, where ice crystals fuse to form larger crystals that disrupt cell membranes. Longer thawing times result in greater cell damage.

Question 19

A patient with Kaposi sarcoma is undergoing cryosurgery. What is the recommended treatment protocol?

Answer 19

For Kaposi sarcoma, two freeze-thaw cycles every 3 weeks are recommended, with an average of 3 treatments.

Question 20

What is the most frequent cryosurgery technique, and how is it performed?

Answer 20

The open spray method is the most frequent technique. It involves using a handheld cryosurgical unit with a fingertip trigger to spray from a distance of 1-2 cm.

Question 21

What are the absolute contraindications for cryosurgery?

Answer 21

Absolute contraindications include lesions that require histopathology for diagnosis and recurrent nonmelanoma skin cancers.

Question 22

A patient with seborrheic keratosis is undergoing cryosurgery. What is the recommended freeze time and halo size?

Answer 22

For seborrheic keratosis, a freeze time of 10-15 seconds with a 1-2 mm halo is recommended.

Question 23

What are the risks of using cryosurgery on lesions with indistinct borders?

Answer 23

Lesions with indistinct borders are a relative contraindication because it may be difficult to ensure complete treatment, increasing the risk of recurrence.

Question 24

What is the primary use of electrosurgery?

Answer 24

Electrosurgery uses the transmission of electricity to cut tissue, destroy tissue, and cauterize vessels.

Question 25

What are the main modalities of electrosurgery?

Answer 25

The main modalities include: - Electrofulguration: No contact with tissue; least damaging; superficial damage to epidermis. - Electrodessication: Direct contact with tissue; superficial damage. - Electrocoagulation: Direct contact with tissue; deeper damage; involves the patient in the circuit. - Electrosection: Bovie knife cuts and coagulates simultaneously. - Electrocautery: Causes protein denaturation; no current transfer to target tissue. - Electrolysis: Produces sodium hydroxide and hydrogen gas; used mainly for hair removal.

Question 26

What are the techniques used in electrosurgery?

Answer 26

The techniques include: 1. Monopolar: 1 tip 2. Bipolar: 2 tips 3. Monoterminal: Treatment electrode without an indifferent electrode 4. Biterminal: Use of both treatment and indifferent electrodes

Question 27

What are the common indications for electrosurgery?

Answer 27

Common indications include: - Hemostasis: Most common application; coagulation achieved through various modalities. - Benign tumors: Such as seborrheic keratoses, verrucae, and flat warts. - Malignant tumors: Curettage and electrodessication (C+D) for BCCs and SCCs.

Question 28

What is the primary use of electrolysis in electrosurgery?

Answer 28

The primary use of electrolysis is for hair removal, as it liquefies tissue by producing sodium hydroxide and hydrogen gas.

Question 29

How does electrocautery differ from other electrosurgery modalities?

Answer 29

Electrocautery causes protein denaturation and tissue coagulation without transferring electric current to the target tissue, making it suitable for nonconductive areas like cartilage, bone, and nails.

Question 30

What is the main advantage of using a Bovie knife in electrosection?

Answer 30

The Bovie knife can cut and coagulate tissue simultaneously, making it efficient for surgical procedures.

Question 31

A patient with seborrheic keratoses is undergoing electrosurgery. Which modality is most appropriate?

Answer 31

Electrodessication is most appropriate for seborrheic keratoses as it involves direct contact of a monoterminal electrode to the tissue for superficial damage.

Question 32

What is the primary application of electrosurgery for hemostasis?

Answer 32

Hemostasis is achieved by coagulation using electrofulguration, electrodessication, or electrocoagulation through direct application of the electrode to the bleeding vessel.

Question 33

What is the difference between monopolar and bipolar techniques in electrosurgery?

Answer 33

The monopolar technique uses one tip, while the bipolar technique uses two tips for more precise energy delivery.

Question 34

What is the least tissue-damaging modality in electrosurgery, and why?

Answer 34

Electrofulguration is the least tissue-damaging modality because there is no direct contact between the electrode and tissue, causing only superficial damage.

Question 35

What are the risks of using electrodessication on malignant tumors?

Answer 35

Electrodessication may not ensure complete removal of malignant tumors, increasing the risk of recurrence. It is often combined with curettage for better outcomes.

Question 36

What is the role of monoterminal electrodes in electrosurgery?

Answer 36

Monoterminal electrodes are used without an indifferent or dispersing electrode, making them suitable for superficial treatments.

Question 37

What is the primary difference between electrocoagulation and electrodessication?

Answer 37

Electrocoagulation involves deeper tissue damage and uses a biterminal electrode, while electrodessication causes superficial damage with a monoterminal electrode.

Question 38

A patient with molluscum is undergoing electrosurgery. Which modality is most appropriate?

Answer 38

Electrodessication is most appropriate for molluscum as it involves direct contact of a monoterminal electrode to the tissue for superficial damage.

Question 39

What is the primary mechanism of tissue destruction in electrosurgery?

Answer 39

Tissue destruction in electrosurgery occurs through the transmission of electricity, which cuts tissue, destroys tissue, or cauterizes vessels.

Question 40

What is the main risk of using electrocoagulation for hemostasis?

Answer 40

The main risk is deeper tissue damage, which may lead to unintended injury to surrounding structures.

Question 41

What is the primary indication for using electrocautery in nonconductive tissue areas?

Answer 41

Electrocautery is used in nonconductive tissue areas like cartilage, bone, and nails because it does not transfer electric current to the target tissue.

Question 42

What is the primary advantage of using bipolar techniques in electrosurgery?

Answer 42

Bipolar techniques provide more precise energy delivery, reducing the risk of damage to surrounding tissues.

Question 43

What is the primary use of curettage and electrodessication (C+D) in electrosurgery?

Answer 43

Curettage and electrodessication (C+D) is commonly used for treating basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs).

Question 44

What is the primary difference between electrofulguration and electrocoagulation?

Answer 44

Electrofulguration causes superficial damage without direct contact between the electrode and tissue, while electrocoagulation involves deeper tissue damage with direct contact of a biterminal electrode.

Question 45

What is the primary risk of using electrosurgery on darkly pigmented lesions?

Answer 45

Darkly pigmented lesions may obscure the borders, increasing the risk of incomplete treatment and recurrence.

Question 46

What is the primary mechanism of action in electrocautery?

Answer 46

Electrocautery works by causing protein denaturation and tissue coagulation without transferring electric current to the target tissue.

Question 47

What is the primary indication for using electrolysis in cosmetic procedures?

Answer 47

Electrolysis is primarily used for hair removal in cosmetic procedures.

Question 48

What is the primary advantage of using monoterminal electrodes in electrosurgery?

Answer 48

Monoterminal electrodes are simpler to use and are effective for superficial treatments without requiring a dispersing electrode.

Question 49

What is the primary risk of using electrosurgery on lesions with indistinct borders?

Answer 49

Lesions with indistinct borders may not be completely treated, increasing the risk of recurrence.

Question 50

What is the primary advantage of using electrofulguration for superficial lesions?

Answer 50

Electrofulguration is advantageous for superficial lesions because it causes minimal tissue damage and does not require direct contact with the tissue.