Lesions were treated by one of us (D.F.M.) using a CRY-AC container (Brymill Cryogenic Systems, Ellington, Connecticut) with an aperture C (0.022 inches) at a distance of 8 to 10 cm for a period of approximately 5 seconds for 2 cycles, obtaining a 2-mm margin around the lesion. One week following the spray with liquid nitrogen, patients were instructed to apply a thin coat of imiquimod for 5 consecutive nights, to take 2 days off, and repeat for a total of 6 weeks. Patients were seen halfway through this course and 2 weeks following the course. Records were reviewed from February 1, 2003, until June 1, 2011. If there was clinical suspicion of recurrence, a punch biopsy was performed.