Cryosurgery has several unique advantages that make it ideally suitable as a surgical modality in primary care.

• High cure rate.
• Suitable for a wide range of indications in primary care.
• Short treatment times.
• Little or no scarring.
• Low set up and running costs.
• Techniques are relatively easy to learn.
• Low incidence of side effects.
• Low risk of cross infection.
• Immune stimulation (cryoimmunization).
• Equipment highly portable.
• Can be used with anticoagulants.

Success in cutaneous cryosurgery in dependant on four main factors.

• Cryogen
• Equipment
• Technique
• Patient selection.

Most group practices in Ireland now have liquid nitrogen filled, handheld cryoguns which is the most cost effective and versatile method of delivering cryosurgery. Not all patients and not all lesions are suitable for cryosurgery. Many lesions are better dealt with using different surgical techniques such as eliptical excision, cautery, curettage or radiosurgery. Cryosurgery is sometimes used in conjunction with some of these other surgical modalities to give higher success rates and better cosmetic results (e.g. surgical debulking prior to cryosurgery)

Cryosurgery is the surgical treatment of choice for all types of viral warts which are causing problems and fail to respond to topic treatments. Cryosurgery can also be useful for treating selected cases of non-melanoma skin cancers, but this should only be carried out the most experienced cryosurgeons and biopsies need to be taken to confirm the diagnosis histologically prior to or during a cryosurgery treatment.


Cryosurgery is also very useful for treating other commons skin complaints such as molloscum, actinic keratosis, seborrhoeic keratosis, home made tattoos, mucocoels, chondrodermatitis, spider naevi, keloids, hypertrophic scars, and xanthelasma.

The most important rule in cryosurgery in that one should never treat any lesion unless your can make a confident named clinical diagnosis on clinical grounds or by dermoscopy. If there are any doubts about the diagnosis a biopsy should be taken, or the patient should be referred to a colleague for a second opinion.

Children under 6 are not usually good candidates for cryosurgery. Children between the ages of 6 – 12 can sometimes tolerate the discomfort of cryosurgery particularly with the judicial use of topical, local or regional anaesthesia.

Serious side effects with cryosurgery are rare. However, swelling, serious or haemorrhaging blistering, hyper or hypopigmentation and pain can occur post prior surgery and patients should be warned about the possibilities of these side effects and how to manage them

Techniques in cutaneous cryosurgery are best learnt by seeing patients being treated by an experienced cryosurgeon. Training manuals, CD’s and online videos are also available: www.kerryskinclinic.ie/resources/videos-of-procedures

Choosing the appropriate patient, lesion, and treatment modality is essential for effectively addressing a significant medical concern. Cryosurgery is no exception to this principle. The purpose of this presentation is to offer insightful recommendations on patient selection and to delineate the various cryosurgical techniques, highlighting both well-established and less commonly utilized methods.

Rules for safer more effective cryosurgery
1. Never treat any lesion unless you can make a confident, clinical, named diagnoses on visual assessment or dermoscopy. If there is any doubt as to the diagnosis, take a biopsy or refer the patient on to a colleague for a second opinion.

2. Cryosurgery is unsuitable for most children under the age of six. Many children between the ages of 6 and 12 are unable to tolerate cryosurgery.

3. The treatment of choice for warts of verruca in children is either to do nothing or use topical treatments. Cryosurgery should be used only in children with very unsightly of painful warts or verrucae and only if they can tolerate local anaesthetic.

4. Always lie young patients down when performing cryosurgery, as fainting is not uncommon.

5. Always pare down horny or keratotic lesions before cryosurgery, as keratin is a very good thermal insulator and will prevent getting a sufficient depth of freeze.

6. Bulky tumours such as large warts and verruca should be debulked by paring, curetting or doing a deep shave biopsy under local anaesthetic before cryosurgery.

7. When treating lesions larger than 4mm such as warts and verruca or a cluster of warts close together, it is advisable to infiltrate with local anaesthetic using a 30g needle under the lesion before paring and freezing.

8. Always warn patients about post-operative swelling, pain and possible serous or haemorrhagic blistering. Instruct them to clean the area with an antiseptic, burst the blister with a sterile pin and squeeze out the fluid. Leave the roof of the blister on the skin as it acts as a biological dressing.

9. Oral analgesics such as paracetamol or ibuprofen may be required before or immediately after cryosurgery for larger lesions.

10. Treat just one hand per session when treating bilateral hand warts. If there are numerous hand warts, treat only half of one hand or less per session as postoperative pain and swelling can be troublesome.

11. When treating verruca treat one foot per session. In addition, treat only the fore foot or the hind foot (not both) per treatment session, as this will allow the patient to walk on either the heel or the toe post-operatively.

12. Any cryosurgery probes or tips that touch the patients’ skin should be sterilised between patients


13. Begginers should confine their treatments to warts and verruca for the first year until they get used to handling the equipment, the patient and the tissues. It is advisable to get training and supervision from an experienced cryosurgeon before treating patients alone in your surgery. To view videos of cryosurgery techniques, see: www.kerryskinclinic.ie/resources/videos-of-procedures. See more about cryosurgery in “Textbook of Primary Care Dermatology” by Dr David Buckley and Dr Paola Pasquali from www.springer.com
Special offer / Get 20% off the printed book or eBook! Enter the following coupon code at checkout on www.springer.com to apply discount. hFA84rLzMNKpGb / Valid Mar 27, 2025 – Apr 24, 2025

In the context of both surgical and non-surgical interventions, it is important to acknowledge the potential side effects and complications that may arise. This presentation aims to elucidate scenarios in which adverse events may occur, with the intention of minimizing the likelihood of errors.

During this session speakers will display and demonstrate some cryosurgery equipment and techniques using simulated tissues and videos.