CRYOSURGICAL TREATMENT OF PROFESSIONAL CHRONIC RADIODERMATITIS

BACKGROUND. Chronic x-ray dermatitis in professionals is a frequent pr oblem for doctors in our country due to the fact that many of them wid ely used radiotherapy without any protection 15-20 years ago. Surgery has been the most accepted treatment, though it generally decreases ha nd function. OBJECTIVE. Up to now, cryosurgery was not usually conside red as a possible treatment if the lesions were located on fingers. In this study, the advantages of cryosurgery for the treatment of profes sional chronic radiodermatitis with incipient pretumoral lesions are e mphasized. METHODS. Cryosurgery was performed on six patients affected with chronic professional radiodermatitis that showed keratomas and u lcerations, using both spray (keratomas) and a probe 0.5 cm in diamete r (ulcerations, in situ squamous cell carcinoma). Nerve black anesthes ia with mepivacaine 1% was used in all cases. Before the treatment, al l suspected lesions were biopsied; if invasive squamous cell carcinoma was revealed in the dermatopathological study, the patient was reject ed. Variables such as blister and necrosis formation, pain, and achrom atic, sensibility, and mobility disorders were studied. The follow-up period was 2 years. RESULTS. Immediate postoperative results showed gr eat pain and. blistering in all cases. Residual achromias were observe d early postoperatively in all cases, but were repigmented 2 year afte r therapy in four cases (66%). Sensory alterations (hypo- and hyperthe sias) were found in four cases (66%) 1 month after treatment, although this complication was not observed 6 months after treatment. Finger m obility was perfect in all cases 2 months after treatment, and there w as no recurrence in any case after 2 years of follow-up. CONCLUSIONS. We believe cryosurgery must be considered as an excellent treatment fo r professional chronic radiodermatitis with keratomas, ulcerations, an d incipient squamous cell carcinomas. Its use may prevent further dram atic surgical treatment, like amputations, allowing the preservation o f finger function. (C) 1997 by the American Society for Dermatologic S urgery, Inc.