Intralesional cryosurgery enhances the involution of recalcitrant auricular keloids: a new clinical approach supported by experimental studies

Abstract

To explain the mechanism of action of a novel intralesional cryoprobe, thermal behavior measurements, and histological studies were performed in swine muscle specimens after intralesional cryosurgery ex vivo. Slow cooling (20 degrees C/min) and thawing (25 degrees C/min) rates, end temperature of -30 degrees C, produced 8 mm wide diffuse coagulative-type necrosis and a 3 mm-wide transition zone around the cryoprobe. In contrast, contact cryosurgery showed fast cooling and thawing rates (80 degrees C/min) and an end temperature of -100 degrees C. Efficacy and safety of the intralesional cryoprobe was further assessed in ten recalcitrant auricular keloids in nine Caucasian patients. There was a 67.4 +/- 23 percent reduction of scar volume at the end of the 18-month follow-up period after a single intralesional treatment (p < 0.005). Significant reduction of hardness, elevation, and redness as well as itching, pain, and tenderness was documented. The histomorphometric analysis, including spectral and fractal analysis, as well as assessment of the fast Fourier transform algorithm, showed parallel alignment and reorganization of the collagen fibers in the treated scar similar to that in the normal dermis. A long hold time in the deep scar core caused minimal damage to the superficial tissue, including melanocytes. There was no evidence of permanent hypopigmentation, active bleeding, infection, or recurrence. The major advantages of the intralesional cryoprobe, including the marked efficacy of a single treatment, may have a major importance in the clinical application of cryosurgery in the treatment of keloids and of other lesions localized deep in the skin.

Intralesional Cryosurgery to Treat Keloid Scars: Results from a Retrospective Study

“…Other studies have confirmed these good results, showing that intralesional cryosurgery reduced scar volume, hardness, colour and subjective symptoms of pain, tenderness, itching and discomfort [15,16]. Studies have also highlighted the fact that keloids on black skin exhibit less depigmentation following intralesional cryosurgery compared to the contact method [18].…”

“…This 14-gauge, stainless steel needle has a sharp-cutting, sealed, distal tip that enhances penetration into the hard, rubbery hypertrophic scar without the need for a stylet and causes less tissue trauma than might occur with an open cutting tip [6,7]. The inbuilt cryogen safety vent situated at the proximal end of the needle enables the creation of a uniform ice cylinder along the entire length of the needle and prevents direct spillage of liquid nitrogen onto the surrounding normal skin, which might occur with open-tip needles [15,16]. …”

Intralesional cryosurgery for the treatment of basal cell carcinoma in an elderly patient

“…1). This new and novel method has been extensively employed to treat hypertrophic scars and keloids (HSK) [10][11][12][13][14][15][16]. The cryoneedle which is inserted into the core of the scar is connected by an adaptor to a cryogun filled with liquid nitrogen, which is introduced into the cryoprobe thereby freezing the scar tissue.…”

“…The intralesional cryosurgery technology (CryoShape, Etgar Group Ltd., Kfar Saba) [10][11][12][13][14][15][16] is comprised of a 14-gauge, straight, double-lumen needle with a sharp-cutting sealed distal tip and a safety vent (Fig. 1).…”

Association of Surgery and Pulsed Dye Laser for the Treatment of an Ear Keloid: A Case Report

“…Due to the frequency of both ear piercing and otoplasty, the ear is probably the most frequent area [6] . These keloids are responsible for cosmetic disfigurement [7] . Numerous treatments have been utilized for keloids including surgical excision, intralesional corticosteroid injection, intralesional botulinum toxin A injection, radiotherapy, laser therapy, cryotherapy and classical and intralesional cryosurgery [8,9,10] .…”