An 87-year-old female in whom B-cell CLL was diagnosed 4 years prior without any further special treatment was admitted to the authors' institution. The patient reported a rapidly progressive, painless skin lesion on the dorsum of the left foot that first appeared 1 month prior. Personal medical history also included hypertension, type 2 diabetes, dyslipidemia, and beta thalassemia minor. One year before the current admission, cutaneous KS localized on the patient's right foot was diagnosed and managed with local excision. The patient's medications at the time of admission were enalapril and atorvastatin.
On admission, the patient's weight was 58 kg and height was 1.65 m. Physical examination was unremarkable and the patient was afebrile. Blood pressure was 110/70 mm Hg, pulse rate was 80 beats per minute and regular, and respiratory rate was 17 breaths per minute. The skin lesion on the left foot was a dark brown, well-shaped nodule, 1.5 cm in diameter with a cicatricial nucleus and no accompanying edema (Figure 1). No other lesions were found. There was no lymphadenopathy.
Laboratory tests showed the following: erythrocytes 5.630/mm3, hemoglobin 11.2 g/dL, hematocrit 35.9%, leukocytes 21.340/mm3 (neutrophils 18.1%, lymphocytes 77.8%; monocytes 2.3%, eosinophils 0.9%; basophils 0.9%), platelets 197 000/mm3. Additional laboratory tests and a chest radiograph revealed no pathologic findings. Skin biopsy of the lesion was positive for KS. The lesion was negative for fungi and bacteria. Computed tomography of the chest, abdomen, and pelvis was performed, and neither tumor nor lymphadenopathy was revealed. Serologic tests for HHV-8 were not performed.
After the biopsy results were received, liquid nitrogen was sprayed on the tumor in a double freeze-thaw cycle once a week with freezing periods ranging from 10 to 30 seconds. After 4 weeks, most adhesions of the tumor had been lysed. The nodule had transformed into a red-brown fungiform tumor adherent to the dorsum of the foot (Figure 2), making it easily removable. The tumor was completely removed from the foot, and local pain was relieved by acetaminophen. The patient received daily standard wound care by a health care professional, and the wound was completely healed within 2 weeks. On reexamination 20 weeks later, the patient was asymptomatic; the lesion had no evidence of secondary infection, and the cosmetic result was considered acceptable (Figure 3). The patient experienced no complications or adverse events related to the cryotherapy treatment.
The patient's foot 4 weeks after the cryotherapy application from the (A) dorsal view and (B) profile view.
Wounds. 2022;34(1):E1-E6. © 2022 HMP Communications, LLC