Curettage and Electrodessication

Curettage and electrodessication (C&D or ED&C) is a basic skin procedure in which the technique of curettage, using a sharp curette, is followed by electrodessication. The technique is often performed by dermatologists, family medicine physicians, and general surgeons in their offices on a regular basis.

For many indications, C&D has been replaced by curettage alone, as it yields similar cure rates and a better cosmetic outcome.

Curettage and electrodessication (C&D) may be used for small benign skin lesions and tumors, including warts, seborrheic keratosis, pyogenic granuloma, granulation tissue, and genital warts. ^[1] C&D may also be used to treat some skin cancers, including superficial basal or squamous cell carcinomas; however, primary excisional approaches are frequently required to achieve maximum cures and to obtain complete histopathologic diagnosis. ^{[2, 3]}

Cosmetic results may be better with other procedures such as shave removal or simple curettage. Seborrheic keratosis and genital warts may be treated with cryotherapy with superior cosmetic results. Lesions such as skin tags that have a narrow stalk may be better treated with snip excision to avoid channeling of the electric current into the underlying tissue.

C&D used to treat cancerous basal cell lesions less than 1 cm (< 0.4 in) in diameter yields an excellent cure rate, but similar results may be achieved with curettage alone. C&D should not be used for basal cell lesions larger than 2 cm, tumors with poor definitive edges, recurrent basal cells, or sclerosing basal cells. ^[1]

C&D is most effective on new skin cancers and is less successful for recurrent skin cancers when scar tissue has developed. ^[4]

Suspected malignant lesions larger than 2 cm and those in the "H" zone of the face are best removed using excisional technique or Mohs micrographic surgery (MMS).

The American Academy of Dermatology has established appropriate use criteria for MMS. These guidelines represent the most up-to-date evidence-based recommendations for the use of MMS. ^[5] MMS is a microscopically controlled method of cutaneous neoplasm removal with complete tumor eradication at the surgical borders in an area where retained carcinoma cells are often left using C&D alone.

Other contraindications to curettage and electrodessication (C&D) include obviously infected lesions, fibrotic lesions, and lesions believed to extend into the subcutaneous fat.

Curettage and electrodessication (C&D) requires minimal equipment and operator time for the physician.

In some cases, planning for C&D includes scheduling adequate surgical time in an appropriately sized room with the needed equipment and wound care materials. However, in many situations, small lesions can be treated during a regular office visit.

For appropriately chosen lesions, curettage and electrodessication (C&D) provides good results with few complications.

Possible complications of C&D include pain, hypertrophic scarring, hyperpigmentation, and wound infections. ^[1]

Superficial multifocal basal cell carcinoma involving the temple has a high rate of recurrence following C&D, so other modalities may be more appropriate in this setting. In addition, with large basal cell cancers, C&D can leave scars larger that the tumor being removed, ^[5] although the technique is often useful in patients at high risk for more invasive surgical procedures.

17110 Benign other than skin tags or cutaneous vascular lesions, 14 or fewer

17111 Benign other than skin tags or cutaneous vascular lesions, 15 or more

17000 Destruction, premalignant, 1st

17003 Destruction, premalignant, 2-14 (use only conjunction with 17000)

17004 Destruction, premalignant, 15 or more (do not use conjunction with 17000, 17003)

17260 Destruction, malignant; trunk, arm or leg, 5 mm or smaller

17261 Destruction, malignant; trunk, arm or leg, 6-10 mm

17262 Destruction, malignant; trunk, arm or leg, 11-20 mm

17270 Destruction, malignant; scalp, neck, hand, foot, or genitalia, 5 mm or smaller

17271 Destruction, malignant; scalp, neck, hand, foot, or genitalia, 6-10 mm

17272 Destruction, malignant; scalp, neck, hand, foot, or genitalia, 11-20 mm

17280 Destruction, malignant; face, 5 mm or smaller

17281 Destruction, malignant; face, 6-10 mm

17282 Destruction, malignant; face, 11-20 mm

Table. ICD-10CM (Open Table in a new window)