Pre-Treatment Dermatological Assessment
The Importance of Pre-Treatment Dermatological Assessment
The pre-treatment dermatological assessment is the cornerstone of any safe and effective FreezPen cryotherapy treatment. At Réhabital clinic in Côte Saint-Luc, we consider this step not as a mere formality, but as an essential clinical process that determines patient safety, treatment suitability and optimal results. Every skin lesion presented for treatment undergoes rigorous examination by our certified aestheticians before any treatment is administered.
This methodical approach distinguishes our practice from clinics that offer cryotherapy treatments without thorough evaluation. The difference is fundamental: a lesion that appears benign on the surface may present atypical characteristics requiring more thorough medical evaluation. Our systematic dermatological assessment protocol ensures that only lesions confirmed as benign are treated with cryotherapy, protecting our patients from potential risks.
Components of the Dermatological Examination
Our pre-treatment dermatological assessment for FreezPen cryotherapy includes several complementary components. The first is the dermatological history — a detailed questionnaire about the patient's skin background, including the lesion history (date of appearance, evolution, associated symptoms), personal or family history of skin cancer, previous treatments and current medications.
The second component is the macroscopic visual examination. Our aestheticians examine each lesion with the naked eye under optimal clinical lighting, evaluating its color, shape, borders, texture and size. This initial observation identifies typical characteristics of benign lesions and spots any warning signs requiring further investigation.
The third component is the dermoscopic examination. Using a high-quality dermoscopic magnifier, our aestheticians examine the subcutaneous structures of each lesion at 10 to 20 times magnification. Dermoscopy reveals vascular patterns, pigmentary structures and architectural features invisible to the naked eye, providing crucial information about the lesion's nature.
Skin Lesion Evaluation Criteria
For each examined lesion, our aestheticians apply a standardized evaluation system based on international dermoscopy criteria. The ABCDE system (Asymmetry, Borders, Color, Diameter, Evolution) is used for pigmented lesions to exclude any suspicion of melanoma. For non-pigmented lesions, evaluation criteria include vascularization, surface texture, mobility and depth of the lesion.
Warts are identified by their distinctive dermoscopic characteristics: black dots (thrombosed vessels), papillomatous surface and interruption of dermatoglyphics (skin lines). Skin tags are confirmed by their pedunculated appearance, skin-colored tone and smooth surface. Seborrheic keratoses are recognized by their horny pseudo-cysts, fissures and characteristic "stuck-on" appearance.
Brown spots are evaluated to distinguish benign lentigos from lentigo maligna (melanoma in situ). Dermoscopy allows observation of the pigmentary network, presence of globules and regression areas that differentiate benign from malignant lesions with sensitivity exceeding 90%. Any doubt leads to a recommendation for specialized dermatological consultation before any treatment.
Réhabital's Safety Protocol
Our safety protocol includes multiple verification steps to guarantee patient protection. The first verification is confirmation of each lesion's benign nature. If the aesthetician identifies a lesion with atypical characteristics — marked asymmetry, irregular borders, inhomogeneous color, diameter exceeding 6 mm or rapid recent evolution — treatment is deferred and the patient is referred to a dermatologist for biopsy and histopathological analysis.
The second verification is the evaluation of general and local contraindications. General contraindications include pregnancy, breastfeeding, severe circulatory disorders, cryoglobulinemia and active autoimmune diseases. Local contraindications include active infection in the treatment area, insufficient blood supply and history of abnormal scarring (keloids) in the area.
The third verification is photographic documentation. Before each treatment, high-resolution photographs of each lesion are taken and archived in the patient's file. This documentation allows objective monitoring of post-treatment evolution and serves as a valuable reference for follow-up sessions.
Lesion Classification by Treatment Level
Following the dermatological assessment, each lesion is classified according to a level system that determines the optimal treatment protocol. Level 1 (Standard Treatment) includes superficial, well-defined lesions: small to medium skin tags, milia, flat warts and superficial brown spots. These lesions are treated with a single FreezPen freezing cycle of 3 to 10 seconds.
Level 2 (Moderate Treatment) includes medium-sized lesions with a deeper component: common warts of 3 to 5 mm, seborrheic keratoses of moderate thickness and medium-sized soft fibromas. These lesions require 2 freezing cycles with thawing intervals.
Level 3 (Intensive Treatment) includes deep, thick or resistant lesions: plantar warts, periungual warts, thick seborrheic keratoses and large fibromas. These lesions are treated with the multi-cycle freezing technique (3 to 4 cycles) with a 4-week follow-up protocol.
Treatment Protocol Personalization
The pre-treatment dermatological assessment goes beyond simple lesion identification — it allows complete personalization of the treatment protocol based on each patient's unique characteristics. Skin phototype (Fitzpatrick classification) directly influences the optimal freezing time and risk of post-treatment depigmentation. Patients with darker skin (phototypes IV to VI) require slightly reduced freezing times and more careful pigmentation monitoring.
The anatomical location of the lesion is another crucial factor. Lesions on the eyelids require ultra-delicate technique with the finest tip (1 mm) and very short freezing time. Lesions on fingers and toes require particular attention to underlying structures (tendons, nerves). Lesions on the trunk and limbs, where the skin is thicker, can tolerate longer freezing times.
The patient's general health is also taken into account. Diabetic, immunocompromised or anticoagulated patients require specific protocol adaptations. Diabetic patients, in particular, are assessed for peripheral circulation quality before any treatment on the feet.
Results Communication and Planning
At the end of the dermatological assessment, our aestheticians clearly communicate the results to the patient. Each lesion is explained: its probable type, treatment level, recommended protocol and expected results. Risks and potential side effects are discussed in detail to allow informed consent.
A written treatment plan is provided to the patient, including the number of lesions to be treated, the protocol for each lesion, the estimated cost and the follow-up schedule. For patients with many lesions, we can plan treatments in multiple sessions to maximize comfort and allow optimal healing between sessions.
Our rigorous approach to pre-treatment dermatological assessment is what distinguishes Réhabital as a trusted clinic for FreezPen cryotherapy in Montreal. By investing this time in evaluation before treatment, we guarantee our patients' safety and optimize results for every treated lesion. Contact us at (438) 842-3550 to schedule your dermatological assessment in Côte Saint-Luc.
When Assessment Leads to a Cryotherapy Refusal
Approximately 8 to 12% of patients who come to our clinic for FreezPen cryotherapy ultimately receive an unfavorable opinion for cryotherapy treatment after evaluation. This isn't a failure — it's precisely the reason pre-evaluation exists. The most frequent reasons include: a lesion showing atypical dermoscopic criteria (asymmetry, irregular pigment network, abnormal vascular structures) requiring a medical biopsy before any treatment, a high-risk location (eyelid, lip, periorbital area) where cryotherapy could damage sensitive structures, or a medical condition (cryoglobulinemia, cold urticaria, active autoimmune disease) contraindicating extreme cold.
In these cases, our aestheticians refer the patient to a Montreal dermatologist or family physician for further evaluation. We provide a detailed letter describing our dermoscopic observations, which significantly accelerates the patient's medical pathway. This cautious approach has allowed us to detect several precancerous lesions early in our patients from Côte Saint-Luc, Westmount and Hampstead, underscoring the genuine clinical value of systematic assessment.
Pre-evaluation is also an opportunity to educate the patient on prevention. At every consultation, we address photoprotection (daily SPF 50+), monthly self-examination using the ABCDE rule, and the recommended annual dermatological surveillance schedule for high-risk patients (fair skin, family history, intense sun exposure).
Related reading
Frequently Asked Questions — Pre-Treatment Dermatological Assessment
Other FreezPen Techniques
Pre-Treatment Dermatological Assessment at Cavendish Mall, Côte Saint-Luc
Our Réhabital clinic is ideally located at Cavendish Mall (D4-5800 Cavendish Blvd), in the heart of Côte Saint-Luc, on the Island of Montreal, about 15 minutes from downtown, with free parking and easy access by public transit. We welcome patients from Côte Saint-Luc, Hampstead, Westmount, NDG (Notre-Dame-de-Grâce), Snowdon, Mont-Royal, Côte-des-Neiges, Montreal West and the entire Montreal area.
As a multidisciplinary clinic, we offer the unique advantage of combining your pre-treatment dermatological assessment with other complementary treatments — all under one roof. Our professionals collaborate closely to provide you with an integrated, personalized care pathway.
Whether you're searching for a clinic in Côte Saint-Luc, Cote Saint-Luc, Cote St-Luc, CSL, or Cote SL — our clinic at Cavendish Mall is easily accessible from all surrounding neighborhoods.
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