The cryocan filled with liquid nitrogen is used. The nozzle is kept on the top end of the punch. Note that when the punch is cut, the edge should be smooth and flat so that the nozzle sits perfectly on it. The liquid nitrogen is passed, and as the liquid nitrogen spray touches the lesion through the punch, the metal tip of the punch also gets cooled, which then slowly starts sinking into the lesion [Figure 2]. For the treatment of warts, freezing is continued till the bevelled edge of the punch enters the skin. When deeper cryotherapy is required, the punch is driven further inside the lesion. This helps in deeper delivery of the cryogen and increases efficacy, with least damage to the surrounding tissue. The punch need not be rotated to cut into the lesion; rather the effect of cooling itself makes the punch cold cut into the lesion [Video 1 online at www.jcasonline.com].