Curettage is the surgical removal of growths or tissue from the wall of a body cavity or other surface, using a spoon-like instrument with a sharp edge called a curette. Electrosurgery is a procedure that cuts, destroys, or cauterizes tissue using a high-frequency electric current applied locally with a pencil-shaped metal instrument or needle. When the two procedures are combined, the surgery is referred to as curettage and electrosurgery.
The general purpose of curettage is to scrape an area free of undesirable tissue. The purposes of electrosurgery are to destroy benign and malignant lesions, control bleeding, and cut or excise tissue.
Specifically, a curettage and electrosurgery procedure is used to treat the following conditions:
Curettage—with or without electrosurgery—is the second most commonly used treatment in the United States. (Cryosurgery is the most commonly used treatment in the United States.)
Approximately 15% of actinic keratoses develop into squamous cell carcinoma. Based on current demographics in the United States, the incidence of actinic keratoses is expected to increase. Older individuals are more likely than younger ones to have actinic keratoses, because cumulative sun exposure increases with age. A survey of older Americans found keratoses in more than half of all men and more than a third of women between the ages of 65 and 74 who had a high degree of lifetime sun exposure. Some medical experts believe that the majority of people who live to the age of 80 have AKs.
Basal cell carcinoma is the most common form of skin cancer and the most common of all types of cancer. It affects about 800,000 individuals in the United States each year. BCC is primarily caused by chronic exposure to sunlight and until recently those most often affected were older, especially older men who worked outdoors. In the last several decades, the incidence of BCC among younger people has increased. So has the number of cases in women. However, many more men are still affected by BCC than women.
Squamous cell carcinoma is the second most common form of skin cancer, affecting more than 200,000 Americans each year. It too is most often caused by chronic exposure to sunlight.
Genital human papillomavirus infection is the most common sexually transmitted disease in the United States with about 55 million new cases reported each year. Genital warts are the most easily recognized sign of HPV infection, but many people with HPV infection never develop genital warts. Both drugs and surgery are used to treat genital warts, but the warts often come back after treatment because the treatment only removes the warts and does not cure the underlying infection.
In the case of AK, the procedure is carried out under local anesthesia to reduce discomfort during curettage. First, the surgeon uses a curette to scrape off the undesirable AK cells down to the level of uninvolved tissue. This is followed by electrosurgery to widen the area of AK cell destruction and removal, and to cauterize the wound to limit bleeding.
In the treatment of skin cancers, curettage is used to scrape away the tumor cells and then an extra margin of surrounding tissue is destroyed by electrosurgery. These steps may be repeated several times in the same treatment session. Curettage and electrosurgery are considered suitable for small primary lesions on sun-exposed skin. It is less effective in the case of recurrent lesions that have attendant scar tissue. Tumors that have spread into subcutaneous tissues or subcutaneous fat are less likely to be cured when treated with this procedure.
The major techniques that may be involved in the electrosurgery step include electrodesiccation (removal of water), fulguration (production of a spark to destroy tissue), electrocoagulation (forming blood clots to stop bleeding), and electrosection (cutting). Electrosurgery can be used to incise, to shave, and to remove lesions. The correct output power is determined by starting at low power and increasing the power level until the desired result is achieved (destruction, coagulation, or cutting).
Skin biopsies and histologic examination confirm diagnoses for AKs and skin cancers such as basal cell carcinoma. A recommendation for curettage and electrosurgery is made following patient evaluation.
Injectable lidocaine is administered before most curetttage and electrosurgical procedures. Lidocaine is often used together with epinephrine to further reduce blood loss. Anesthesia may not be necessary when small lesions are being treated. Another alternative is to use a mixture of local anesthetics, containing 2.5% lidocaine and 2.5% prilocaine, in a cream base. The cream is applied to the skin at least one hour before the procedure to achieve topical anesthesia.
After the procedure, the patient is advised to keep the wound clean and dry. The healing process takes at least several weeks or longer, depending on the size of the wound and other factors. Electrosurgery produces two types of skin wounds—partial- and full-thickness wounds. Partial-thickness wounds result from the electrodesiccation of skin lesions and the curettage and desiccation of basal cell carcinomas. These wounds may be cleansed daily and then covered with an antibiotic ointment that provides a moist environment for new tissue growth. The wound may then be covered with common adhesive bandages. Full-thickness wounds require closure with sutures.
As with every type of surgical procedure, there is a risk of infection. Antibiotics are not routinely given, but some physicians believe they may minimize the risk. Other potential risks include:
Curettage and electrosurgery results in the removal of the targeted skin lesion, AK, skin cancer, or genital wart and in the formation of a minor wound that heals rapidly after the procedure.
Alternative treatment for AKs include:
Alternative treatment for skin cancers include:
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American Academy of Dermatology Association. 1350 I Street NW, Suite 880, Washington, DC 20005. (202) 842-3555. http://www.aadassociation.org/ .
American College of Obstetricians and Gynecologists. 409 12th St., S.W., PO Box 96920 Washington, D.C. 20090-6920. (312) 786-1468. http://www.acog.com/ .
American Society for Dermatologic Surgery (ASDS). 5550 Meadowbrook Dr., Suite 120, Rolling Meadows, IL 60008. (847) 956-0900. http://www.asds-net.org .
National Association for Women's Health. 300 W. Adams Street, Suite 328, Chicago, IL 60606-5101. (312) 786-1468. http://www.nawh.org/ .
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Monique Laberge, Ph.D.
Curettage and electrosurgery is done in a hospital or clinic, although most physicians have small electrosurgical units in their offices to treat benign lesions. The procedure is usually performed by a dermatologist or dermatologic surgeon. The American Academy of Family Physicians and several private organizations offer basic training sessions in electrosurgery.