Describe liquid nitrogen
Destructively cold, clear liquid
-346 F
How is liquid nitrogen maintained?
Vacuum sealed container
- Must have pressure relief valve
- Delivered to facility, placed in large storage container, then transferred to smaller containers for daily use, refilled daily
Liquid nitrogen MOA
- Destroys tissue
- Causes inflammatory response
Process of liquid nitrogen treatment
Freeze - destroy tissue - causes separation - blister - scab - resolution once scab heals (hopefully)
Indications for liquid nitrogen
Warts Skin tags Seb keratoses Lentiginies Actinic keratoses Early BCC/SCC *DO NOT FREEZE IF IT NEEDS A BIOPSY
Which conditions should NOT be frozen with liquid nitrogen?
Anything that needs a biopsy
Downsides of liquid nitrogen treatment
- Hypopigmentation
- Depressed scarring
- Nerve damage
- Incomplete lesion resolution
- Painful
Procedure of liquid nitrogen
- Each spot frozen for approx 10 secs
- Freeze 1-2 mm beyond lesion
- Trigger hold (continuous vs. pulsing)
If liquid nitrogen tx is near the eye, what should be done?
Cover eye with gauze
Post liquid nitrogen expectations
- Area will blister within 12 hrs
- Blister will dry and for a scab in a few days
- Scab will persist 1-2 weeks
Post liquid nitrogen care
None needed - ok to wet, no bandage, no abx ointment
Where may swelling occur after liquid nitrogen treatment?
Inferior to treatment site (gravity)
Follow up for liquid nitrogen therapy
Depends on what you are treating - ALWAYS see pt back if AK/BCC/SCC
What is saucerization?
Deeper shave biopsy
Define shave biopsy/removal
Superficial removal/biopsy of a lesion
Is shave biopsy/removal a clean or sterile procedure?
CLEAN - wear gloves, prep with alcohol and local anesthetic
What instruments are used in shave biopsy/removal?
15 blade on a scalpel handle OR small handheld blade (Dermablade)
Shave biopsy/removal should include how much skin?
Include epidermis and uppermost dermis (no deeper than 1 mm)
What can be used for hemostasis after shave biopsy/removal?
Aluminum chloride or electrocautery
What should be done after taking the shave biopsy/removal?
Apply vaseline or bacitracin and band-aid
After care of shave biopsy/removal
- Start 24 hrs after procedure
- Perform daily x 5 days
- Wash w/soap and water
- Apply Vaseline or bacitracin
- Apply band-aid
- Review s/s of infection w/pt
- Let pt know when to expect biopsy results
Complications of shave biopsy/removal
- Infection
- Scarring
- Bleeding
- Nerve damage
- Incomplete removal
Define punch biopsy/excision
Method of obtaining a specimen at full thickness (all layers) using a punch instrument
Indications for punch biopsy
Diagnose lesions, eruptions, hair evaluations
