From: Proceedings 10th World Congress of Cryosurgery
Cryosurgery of Advanced External Canc er.I- Cancers of the orbit, extremities, and pilonidal cancers

November 1998
J. C Almeida Goncalves
Department of Dermatology, District Hospital, Santarim, Portugal

Cryosurgery has enormous capabilities to treat bulky and advanced cancers but this has generally not been recognized. To be able to treat large tumours I devised simple, but very efficient, physical procedures to limit the target area to be frozen and to stop the running drops of liquid nitrogen spray over frozen surfaces onto the healthy skin.

The procedures are different and related with the location and stage of the malignancy. For tumours of the head and extremities, bandages are preferred because they are efficient and can be easily applied. The bandages are adapted to the shape of the tumour plus the safety margin and must be firmly placed with enough layers to efficiently stop the running drops of liquid nitrogen, leaving only the target exposed: the lesion plus its safety margin. Bandages are unsuitable for the trunk, due to the obvious impossibility of firm application. Here, paraffin gauze dressings folded 20 times, stitched around the target are indicated. With these principles, I developed several cryosurgical protocols to treat different types of advanced external cancers on various locations, with which I have cured a significant number of patients considered unsuitable for any conventional treatment, and have given palliative relief to many patients.

I treated 6 inoperable and radio-resistant, invading basal cell carcinomas of the orbit. Bandages were applied around the orbital region, thermocouples were introduced into the orbit, which was frozen twice, to -50 C with continuous spray. Two patients were cured; two had a long survival with good quality of life and two died shortly after the operation. Similarly, 27 squamous cell carcinomas of the extremities, in 20 patients, were treated. The tumours were adherent to the underlying planes and amputation had been proposed to all of them. Twenty-four cancers in 17 patients were cured, the amputation having been avoided. Only three tumours were not cured.

In three cases of advanced and inoperable squamous cell carcinoma developed on pilonidal sinus, the limitation of the targets to be frozen was done with surgical clothes firmly applied. All were cured.


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