Curettage and Electrodessication Technique

When evaluating lesions for treatment with curettage and electrodessication (C&D), the size of the lesion should be considered. In addition to avoiding lesions larger than 2 cm in diameter, pigmented lesions with irregular borders or rapidly changing appearance should be referred for full-thickness excisional biopsy.

The location of lesions should also be considered; lesions that involve the embryotic fusion lines such as the nasal labial folds or inner canthal regions or lesions in the postauricular folds (the so called "H" zone of the face) should be avoided. ^[6]

Subtypes of basal cell carcinoma that are not suitable for C&D include nodular, infiltrative, morpheaform, and micronodular types.

The lesion is prepared with alcohol or topical cleansing agents such as Hibiclens or Betadine.

Once dried, the area may be marked (according to surgeon preference) with a small surgical pen, outlining the tissue to be removed.

Anesthesia is typically performed by raising a wheal of anesthetic with a small No. 30- or 25-gauge needle with 1% lidocaine plus epinephrine to assist with hemostasis. ^[1]

A Fox dermal curette (size 3, 4, or 5 mm) is the most commonly used metal curette.

With the sharp side of the curette touching the skin, the lesion is scraped to its base, where a “gritty” feeling of the dermis is obtained.

In suspected basal cell or squamous cell lesions, this scraping is repeated in various directions in a checkerboard pattern with firm counterpressure and until all the tissue feels firm and gritty.

Most cancers have been described as having a softer feel than normal tissue.

Electrodesiccation is then applied to the area after it is blotted to a dry base with gauze.

Depending on the electrocautery unit (whether spark gap hyfrecator or Bovie), the current settings vary for achieving adequate heat-induced coagulation of bleeding.

Light application of the electrical current, creating a visible spark and instant coagulation of the lesion base, is accomplished with a smooth backward and forward motion with the cautery tip.

Patients should experience no discomfort during this procedure if adequate anesthesia and grounding has been secured.

A second approach recommended for any lesions suspected of malignant potential includes the initial procedure described above repeated 3 separate times. ^[7]