You Little Gem Clinic ◇ Benign Skin Lesion Removal
Cryotherapy
Procedure-specific consent addendum
1. Patient and lesion details
2. Planned treatment — practitioner
Liquid-nitrogen spray / device
Contact probe / applicator
Other agreed freezing technique
3. Relevant checks
Benign diagnosis / dermoscopy evidence verified
No open wound or active local infection
Circulation and sensation at the site assessed
Cold intolerance, Raynaud’s, cold urticaria or cryoglobulinaemia considered
Medication, allergy, diabetes, healing and scarring risks reviewed
4. Expected effects
Freezing commonly causes immediate stinging or burning, followed by redness, swelling and tenderness. A clear, blood-filled or dark blister and later crust or scab may develop. Healing time varies by site and treatment depth.
5. Cryotherapy-specific material risks
- Pain and blistering
- Prolonged or permanent pigment change
- Scarring or texture change
- Infection or delayed healing
- Temporary or rarely persistent nerve or sensation change
- Local hair loss
- Nearby tissue damage
- Incomplete response, recurrence or repeat treatment
- An unsatisfactory cosmetic outcome
6. Alternatives
Delay or decline treatment
Monitor the lesion and seek review if it changes
Alternative removal technique or referral
Seek another clinical opinion
7. Aftercare acknowledgement
Aftercare, normal healing and warning signs explained
Written / verbal aftercare provided
Follow-up and how to obtain advice explained
8. Consent and signatures
I have read and understood this addendum and the general consent form
The procedure, material risks, alternatives and aftercare have been discussed
I had the opportunity to ask questions and may withdraw consent before treatment
I voluntarily consent to the procedure recorded above