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Cryotherapy/Cryosurgery in Small Animal Dermatology

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Cryotherapy/Cryosurgery in Small Animal Dermatology VOLUME 9 ISSUE 1 • 2020 WINTER EDITION CRYOTHERAPY/CRYOSURGERY IN SMALL ANIMAL DERMATOLOGY Katherine Backel, DVM, DACVD | Dr. Katherine Backel has joined Dr. Karen Farver on our Dermatology Team Although a relatively common tool in the intended lesion. Rapid cooling human dermatology, Cryotherapy, of cells causes intracellular water also known as Cryosurgery, is not to form ice crystals. Ice crystals frequently employed in veterinary then cause cell damage, resulting medicine. In humans, cryotherapy in rupture and death of target cells. has been used for over 150 years Sublethal damage to nearby cells with uses ranging from simple wart may result in subsequent apoptosis in removal, to use within a multimodal this region. Additional effects include approach to cutaneous leishmaniasis. vasoconstriction, and destruction (Zimmerman, 2012) (Asilian, 2004) of small blood vessels resulting in In small animal practice, its use ischemic necrosis to treated areas, has received only relatively recent which is the more effective strategy for attention, mainly for removal of inducing tissue destruction via rapid benign skin lesions and for various cooling followed by slow thawing. ophthalmologic diseases such as (Zimmerman, 2012) trichiasis and small eye lid masses. Dr. Katherine Backel (Zibura, 2019) However, due to A final tissue temperature of -60°C the minimally invasive nature and (-76°F) is required for cell destruction. speed of the procedure its potential Many different cryogens have been utility is great, and its use is growing employed to achieve this outcome. Depending on the tissue type and rapidly. (deSuza, 2016) (Richman, Liquid nitrogen (boiling point -195°C) goal, 1 – 4 free thaw cycles are 2017) (Shibata, 2002) At this time, and nitrous oxide (boiling point -85°C) utilized to achieve adequate tissue Metropolitan Veterinary Associates is are the most commonly employed for destruction. Liquid nitrogen spray offering cryotherapy as an excellent clinical use. For most dermatologic is applied to the entire lesion, as option for a number of dermatological uses, liquid nitrogen administered as well as a 1 – 2mm margin of normal issues. Our state of the art Cryoprobe a spray, provides the most efficient tissue. Freezing and thawing time allows for fast and accurate treatment method for targeting larger or irregular depends on the size and thickness without the need for sedation or cutaneous lesions. In contrast, nitrous of the lesion but is typically around anesthesia. oxide gas-cooled probes are utilized 10-30 seconds for freezing and 30- in ophthalmology practice to target 90 seconds for complete thawing. Cryotherapy works through controlled smaller, discrete areas along the Intermittent spraying allows for tissue destruction. Cryogens (agents delicate palpebral margins while deeper penetration, and formation of used to induce freezing of cells) are avoiding damage to surrounding an “ice-ball” up to a depth of 10mm. applied directly to or sprayed on normal structures. (Zimmerman, 2012) (Zimmerman, 2012, Angeli, 2019) REFERENCES 1. Angileri M., Furlanello T., De Lucia M. 6. Lucas R, Larsson CE. Evaluation of the SPECIALIZED Cryotherapy to treat benign skin tumours in practicality and efficacy of cryotherapy in conscious dogs. Vet Dermatol. 2019. (Early feline cutaneous squamous cell carcinoma. view) Vet Dermatol. 2004;15: 64-64 SERVICES 2. Asilian A, Sadeghinia A, Faghihi G, Momeni 7. Richman AW, Kirby AL, Rosenkrantz W, BEHAVIOR A. Comparative study of the efficacy of Muse R. Persistent papilloma treated with Jacqueline Wilhelmy, MS, VMD, combined cryotherapy and intralesional cryotherapy in three dogs. Vet dermatol. DACVB, CCBC-KA meglumine antimoniate (Glucantime) vs. 2017;28(6):625-e154 cryotherapy and intralesional meglumine CARDIOLOGY 8. Shibata K, Nagata M, Akakuma O, Nanko antimoniate (Glucantime) alone for the Marc Kraus, DVM, DACVIM (Cardiology) H. Canine epidermal nevus treatment with treatment of cutaneous leishmaniasis. Int J Michael Miller, MS, VMD, ABVP cryotherapy. Vet Dermatol. 2002;13(4):211- Dermatol. 2004;43(4):281–3. Megan Poad VMD, DACVIM (Cardiology) 229 Risa Roland, DVM, DACVIM (Cardiology) 3. Clarke RE. Cryosurgical treatment of feline 9. Zibura AE, Henriksen ML, Rendahl A, Lim cutaneous squamous cell carcinoma. Aust CC, Reilly C. Retrospective evaluation DENTISTRY Vet Pract. 1991. 21: 148-153. of canine palpebral masses treated with Corinne Durand, DVM 4. De Queiroz GF, Matera JM, Zaidan Dagli ML. debulking and cryotherapy: 46 cases. Vet DERMATOLOGY Clinical Study of Cryosurgery Efficacy in the Ophthalmol. 2019;22(3):256-264. Katherine Backel, DVM DACVD and/or multifocal lesions is the most Treatment of Skin and Subcutaneous Tumors 10. Zimmerman E, Crawford P. Cutaneous Karen B. Farver, DVM, DACVD in Dogs and Cats. Vet Surg. 2008;37(5):438-43 common indication for use. Examples Cryosurgery. Am Fam Physician. 2012; FOR MOST DERMATOLOGIC include, but are not limited to, multiple BENEFITS OF 5. De Souza CP, Lucas R, Ramadinha RH, 86(12):1118-1124 EMERGENCY AND CRITICAL CARE USES, LIQUID NITROGEN sebaceous hyperplasia/adenoma, CRYOTHERAPY INCLUDE: Pires TB. Cryosurgery in association James Buckman, PhD, VMD ADMINISTERED AS A acrochordons, persistent papillomas with itraconazole for the treatment of Allison Buysse, VMD 1. Fast treatment times SPRAY, PROVIDES THE and epidermal nevi (Angileri, 2019) feline sporotrichosis. J Feline Med Surg. Jason Chamberlin, VMD (Richman, 2017) (Shibata, 2002) 2. Reduced hemorrhage 2016;18(2):137-43. Kathleen Crossman, DVM MOST EFFICIENT METHOD Additionally, a variety of malignant Cierra French, DVM 3. Improved comfort Robert Gaunt, VMD FOR TARGETING LARGER tumors have been targeted with 4. Well tolerated by most Jill Kalman, VMD OR IRREGULAR cryotherapy – however complete Jennifer McGough, VMD CUTANEOUS LESIONS. resolution relies on careful patient patients without sedation or Rachel Morgan, DVM selection. (Fernandes de Queiroz, general anesthesia (Practice limited to Emergency & Critical Care) Katie Slade, VMD 2008) Success has been reported 5. No need for suture removal ABOUT OUR DERMATOLOGY Marisa Suvannavejh, VMD While the procedure in adult humans for feline nasal planum and pinnal or specific post-procedure squamous cell carcinoma with low Katrina Tumielewicz, DVM is typically performed without local care SPECIALIST, KATHERINE BACKEL, (Practice limited to Emergency & Critical Care) anesthetic, mild to moderate pain is rates of recurrence. (Clark, 1991) 6. May be used on extremities DVM, DACVD INTERNAL MEDICINE associated with the procedure and (Lucas, 2004) Overall, reported and areas where incisions John V. DeBiasio, DVM, DACVIM lidocaine application is recommended success is somewhat variable for and primary skin closure is Dr. Katherine Backel, a Connecticut native, attended Cornell James F. Dougherty, MS, VMD in children. (Zimmerman, 2012) all tumor types ranging from 57- 98% remission rates. (Fernandes difficult University where she received her Bachelor of Science degree in Tabitha A. Hutton, DVM, MTR, DACVIM (SAIM) A recent canine study described Animal Science in 2010. She continued on at Cornell University Leslie A. Kuczynski, VMD, DACVIM behaviors interpreted as pain in de Queiroz, 2008), (Angileri, 2019) Because success is variable, for her doctorate of veterinary medicine, where she received NEUROLOGY 32% of dogs during the procedure. awards in dermatology, clinical pathology and immunology, (Angileri, 2019) Thus, local anesthetic especially with larger and malignant Lisa Lipitz, VMD, DACVIM (Neurology) tumors, it is important to discuss and ultimately graduating top in her class in 2015. After leaving the Daniella Vansteenkiste, BVetMed is used in most instances. upstate NY area, Dr. Backel completed her small animal rotating explore other treatment options prior DISADVANTAGES OF internship at Red Bank Veterinary Hospital in NJ in 2016. She ONCOLOGY to electing cryotherapy. Additionally, Lillie Davis, DVM, DACVIM (Oncology) Following treatment, erythema of the CRYOTHERAPY INCLUDE: was then accepted as a Dermatology resident at the University since cryotherapy damages tissue Suzanne Rau, DVM, DACVIM (Oncology) tissue occurs almost immediately. of Pennsylvania, Matthew J. Ryan Veterinary Hospital which she Within the first day, a blister may be needed for histopathology, it should 1. Prevents cytologic or completed in July of 2019 before joining MVA. She was awarded OPHTHALMOLOGY noted, but the treated area quickly not be used until a definitive diagnosis histopathologic interpretation board certification status as a diplomate of the American College Amanda Corr, VMD, DACVO crusts over to form an eschar. Over the is obtained via fine needle aspirate or once performed incisional biopsy. of Veterinary Dermatology in 2019. She has published original Chloe Spertus, DVM following 7-14 days, the eschar will fall 2. Treatment cause initial tissue research in the Veterinary Dermatology Journal and contributed RADIOLOGY off revealing treated underlying tissue. necrosis, which may be to the Journal of Feline Medicine and Surgery. If the lesion is fully resolved, no further Side effects of the procedure are Robert McLear, VMD, DACVR uncommon but may occasionally unsightly for owners Lisa Suslak, VMD, DACVR therapy may be needed. However, in Dr. Backel’s clinical interests include allergy, ischemic many instances (especially in lesions include sensitivity at the treated site, 3. Scarring, leukotrichia/ persistent alopecia, leukoderma, dermatopathy, auto-immune disease
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