FAQs
We present a number of frequently asked questions. If there are any specific queries you have, or if you'd like to see additional questions answered on this page, please contact us.
CryoSuccess FAQs
What is Nitrous Oxide?
Otherwise known as laughing gas, nitrous oxide is an oxide of nitrogen. It is commonly used in surgery and dentistry for its aesthetic effects. It is also used for Cryosurgery as an alternative to liquid nitrogen.
How does the Cryosuccess work?
The Cryosuccess dispenses nitrous oxide at a temperature of -89°C directly on to the skin (the tip must be in contact with the skin). This freezes the tissue around the capillary and causes erythema. The patient may feel a slight burning effect during treatment, with the possibility of a nettle rash type reaction and/or blister after treatments. After 2 or 3 days a necrosis scab will appear which will detach after 10 14 days.
What is the Cryosuccess suitable to treating?
The Cryosuccess will treat all types of skin conditions including warts, plantar warts, acne, age marks, certain skin tumours and some carcinomas.
What are the possible side effects?
Immediate effects
Some pain and stinging may be experienced during the treatment and can continue for some hours after the treatment. Redness and sometimes swelling and blistering can occur at the treatment site. This may happen immediately or a day or two later. If blisters occur these can be blood filled.
Long-term effects
Lightening or darkening can occur at the treatment site, especially in darker skin types. This may be permanent. Permanent scarring at the treatment area is rare but possible.
What are the advantages of the Cryosuccess over liquid nitrogen spray cannisters?
The Cryosuccess is easy and comfortable to hold compared to the bulkiness of liquid nitrogen canisters, therefore allowing a more precise application. Treatments are easy and almost painless. The Cryosuccess offers complete control of the gas, whereas liquid nitrogen has a characteristic to evaporate, requiring daily refills. Storage and delivery costs of liquid nitrogen are expensive.
How many procedures will the cartridge perform?
There are approximately 300 seconds of gas in the 23.5g cartridge. Treatment time depends on the type and size of the lesion. Maximum treatment time 20 seconds (Plantar Warts).
Should the cartridge be removed from the device between procedures?
There is no reason to remove the cartridge until it is empty. Removing the cartridge between procedures will cause some loss of gas, due to weakening of the valve.
What is the rate of evaporation from the cartridge?
There is little evaporation from the cartridge once connected. Even after the first treatment evaporation is approximately 1% each year.
Are there any storage precautions with nitrous oxide cartridges?
The nitrous oxide cartridges should be stored away from heat & direct sunlight. Storage temperature min -10°C and max +45°C .
Should the tip be in contact with the skin during procedures?
The tip must always be in contact with the skin. Pressure need not be applied. It is at the point of contact, where the gas rapidly expands, that the temperature is -89°C.
Should the tips be sterilised after use?
Please refer to your clinics sterilisation procedure. If necessary the tips can be steam sterilised at 134°C. The cartridges and body of the unit must never be steam sterilised.
How long is the warranty for the Cryosuccess?
The Cryosuccess is guaranteed for 12 months from purchase date. Only nitrous oxide cartridges designed for use with the Cryosuccess should be used. The device must not be dropped or modified in any way. Only use as per the instructions provided with the device and do not use your Cryosuccess if it becomes damaged in any way.
Dermoscopy FAQs
What is the difference between epiluminescence microscopy, dermatoscopy and dermoscopy?
There is no difference at all, just different names for the same technique. In 2001 at the 1st World Congress of Dermoscopy the various terms were discussed and it was decided that in order to unify the terminology particularly with respect to research the term Dermoscopy should be used.
Why should a dermatologist start doing dermoscopy?
Dermoscopy is a fusion of the two major principles that facilitate good skin examination, namely magnification and illumination. By using dermoscopy dermatologists will be forced to examine individual lesions more closely. Their diagnostic accuracy for diagnosing not only pigmented skin lesions and melanoma, but also a whole variety of dermatoses, including infections and inflammatory conditions will increase, with time and training.
As with all aspects of medicine, diagnostic accuracy increases with experience, takes time and perseverence. We suggest that doctors beginning with dermoscopy should initially rely on as usual their clinical judgement and should start to use dermoscopy for unequivocal lesions only. In this way their familiarity with dermoscopic features will gradually increase. Attending a course or meeting in dermoscopy will increase your confidence in dermoscopy and will increase your diagnostic accuracy particularly for pigmented skin lesions in general and early invasive melanoma, including melanoma in-situ. By looking at other dermatoses with dermoscopy repeatable features can be seen that are otherwise invisible with the naked eye, e.g. the scabies mite will no longer be able to hide!
Do we still need histopathology when performing dermoscopy?
Dermoscopy is a non-invasive clinical method that is currently used to supplement the traditional clinical diagnosis, not replace it. With dermoscopy, morphological features that cannot be detected by the naked eye alone become visible. Therefore, dermoscopy opens up a new dimension of clinical morphology that can be regarded as the missing link between clinical morphology and histopathology. Nevertheless, when a pigmented skin tumour is excised, conventional histopathological examination is still recommended.
What are the limits of dermoscopy?
Dermoscopy allows visualization of the horizontal plane of a given skin lesion only to the level of the papillary dermis. Pathologic structures situated in the reticular dermis cannot be visualized at all (like with the naked eye). Heavily pigmented skin lesions are sometimes very difficult to diagnose, and hypopigmented or amelanotic melanoma represents a particular diagnostic challenge. Very thick tumours may lack a number of dermoscopic features and thus clinical experience and clinical diagnosis remains very important in these lesions. If diagnostic doubt remains with dermoscopy then the lesion should be biopsied. Dermoscopy is not 100%, so do not expect it to be!
What type of dermatoscope is better?
Oil immersion dermatoscopes have a longer history of use in dermatology, however the inconvenience of applying an oil or interface fluid (alcohol gel or ultrasound gel) makes these instruments time consuming when multiple lesions are being examined, and also raises the question of cross contamination as they involve contact with the patient. They have a bright image and usually a heavy handle.
Cross-polarised light dermatoscopes are becoming very popular with dermoscopy enthusiasts as they are now of a suitable quality that the device brightness is comparable with the oil immersion instruments. They are more expensive, however they are more versatile, smaller and lighter, and multiple lesions can be examined quickly without the need for interface fluid application. Newer devices have an extendable faceplate for use with interface fluid if needed, for instance looking at hyperkeratotic lesions.
Ultimately the choice of dermatoscope will reside with the doctor and include factors such as personal preference, and likely population of patients to be examined. Note, some dermoscopic structures are seen differently with the two types of devices, and it may take some time to get your eye in with the new device. Both instruments are battery operated therefore do not forget to keep them fully charged!
What type of immersion oil is best used for the oil immersion dermatoscopes?
Alcohol gel is preferred, as it should be easy to hand in the examination room and will reduce the theoretical risk of cross contamination. Around the eyes and nails ultrasound gel is beneficial as it will not irritate the eye and does not run off the nail (Note, do not forget to clean the instrument with alcohol gel if ultrasound gel was used).
For the instruments with cross-polarised lenses there is no need for immersion oil; however care should still be taken to keep the instrument clean and to avoid cross contamination between patients.
What magnification is the best used for dermoscopy?
A 10-fold magnification is standard and works well for diagnosing pigmented skin lesions. With digital cameras the magnification can be enhanced digitally which may help when visualising blood vessels in tumours.
What camera should I buy to take dermoscopic images?
Both types of hand held dermatoscopes can usually be connected to digital cameras, either directly, via a screw thread, or via an adapter ring. Cameras and dermatoscopes vary and may not be compatible, therefore please contact the manufacturer of the device for specific recommendations. The cross- polarised devices may need to be placed in contact with skin to avoid camera shake, the newer devices have an extendable faceplate for this purpose. Again consider the risk of cross contamination.
Will computer mole mapping substitute diagnosis by an experienced dermatologist?
Research into this field is increasing. At present the computer machines have limitations including:
Low image resolution compared with hand held devices.
High cost and very bulky compared with hand held devices.
Software limitations (good with very clear melanomas, not so good with thin / early / small melanomas or hypopigmented melanomas.
Difficulty with hyperpigmented benign skin tumours.
Difficulty with visualising blood vessels in tumours as contact is required in the majority of devices.
A higher magnification (digitally x20 x50) is often promoted as an advantage, however due to the initial lower image resolution there is no advantage over a hand held x 10 image that is digitally magnified.
Can only comment on lesions preselected for examination.
However they also have some advantages including:
Facilitating easier follow up of patients.
Numerous naevi can be catalogued easily.
Follow up images are standardised for magnification and brightness, and therefore easily compared with earlier images taken with the same device.
Therefore we would not recommend their use for diagnostic purposes alone; however they are very useful in the follow up of patients.
In summary they will not replace dermatologists but will be an increasing part of dermatology practice particularly in the follow up of patients with multiple naevi.
Miltex FAQs
How do i sterilize Miltex instruments
Apply 134 C for 3 minutes in an autoclave for instruments.
Miltex sterilization guide for aluminum hand is 132 C for 4 minutes.
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