Cryotherapy is often used in general practice, skin cancer medicine and dermatology to treat a number of common skin lesions. It is an established and inexpensive treatment and one of the most commonly used MBS items in general practice in Australia. A commonly used cryotherapy technique is timed spot freeze open spray (OS) which involves the use of a liquid nitrogen spray gun with a spray tip attachment.
Recently the Medical Council has received a number of serious complaints from patients related to pain and scarring associated with the use of OS cryotherapy by general practitioners.
The Council’s concerns include failure by practitioners to explain to patients the potential outcomes from the technique, alternative treatment options, and not applying safe and appropriate practice regarding the length and number of freeze-thaw cycles.
To avoid unexpected outcomes, distressed patients and potential complaints it is important when using cryotherapy to:
- Be confident in your diagnosis regarding the type of lesion because this is crucial in determining the dose and number of repeat treatments required.
- Clearly communicate with your patient to ensure you have their informed consent. In particular, it is important your patient is aware of:
- the pain associated with cryotherapy depending on the location of the lesion;
- the possible outcomes of cryotherapy such as ulceration and scarring; and
- alternative modes of treatment available for a patient’s lesion such as wart paints, field treatments or excision
- Use a well-accepted guide as to the length and number of freezes. A good reference is Optimising Cryosurgery Technique (2017) a peer-reviewed guide published by the Royal Australian College of General Practitioners.
- Australian College of Rural and Remote Medicine: a video by dermatologist Dr Lynda Spelman. Watch the video.