Apoptosis and leucocyte-endothelium interactions contribute to the delayed effects of cryotherapy on tumours in vivo.

In dermatology, cryotherapy is commonly used to treat benign and malignant skin lesions. However, studies investigating the time-course of the direct and delayed effects on the microvasculature and subsequent tissue destruction are lacking. Amelanotic melanomas (A-Mel-3) were implanted into the dorsal skinfold chamber of Syrian Golden hamsters (n=51). Tumour and normal tissue were frozen to -20 masculine C (cooling rate 150 masculine C/min). Intravital fluorescence microscopy was performed to assess microvascular changes and leucocyte-endothelium interactions up to 24 h. The relative degrees of necrosis and apoptosis and the accumulation of leucocytes were investigated by histology and immunohistochemistry. Apoptosis was quantified using the TUNEL assay in combination with computer-assisted image analysis. After cryotherapy, red blood cell velocity (RBCV) decreased in postcapillary venules and tumour vessels, whereas functional vessel density (FVD) was significantly reduced in tumour vessels as compared with postcapillary venules. Leucocyte-endothelium interaction increased first in normal and tumour tissue, and then after 24 h leucocytes accumulated in normal tissue close to the tumour margin. Necrosis was induced in the cryolesions directly after freezing and remained constant over the entire observation period. In contrast, apoptosis increased in the periphery of the tumour tissue up to 24 h following cryotherapy. In conclusion, tissue destruction by cryotherapy is not only induced by direct necrosis and microvascular stasis, but also by the inflammatory infiltrate and subsequent apoptosis. This could be an important finding regarding the generation of an immune response.