Background

Curettage and electrodessication are medical procedures used in dermatology for the eradication of several benign and slightly malignant skin conditions. The dermatologists often employ them to remove off any tissues that occurs in the skin and are often regarded as untreated or unnecessary. A curette is a device that has medical applicability in minimally invasive surgeries, which falls in the curettage category of surgical techniques, a spoon-shaped tool employed in scraping out a cavity from a lesion in the skin. 

This method is usually used in combination with curettage to increase the efficiency of the process. Electrodessication then follows the scraping off the suspect tissue using the curette, where the dermatologist turns off any remaining or residual abnormality using an electrically charged needle or electrode. 

All these interventions are normally performed as outpatient procedures and are associated with decreased scarring compared with other more invasive surgical techniques. 

Indications

Benign Skin Lesions:  Hypopigmented or depigmented simple benign skin tumors including seborrheic keratosis. 

Superficial Basal Cell Carcinoma: Curettage is used in the management of the superficial basal cell carcinoma which is among the most frequent skin cancers.
Actinic Keratoses: It may be utilized in the treatment of precancerous changes in the epithelial tissue called actinic keratosis.
Warts and Other Viral Lesions: The electrodessication technique is used for the physical destruction of skin warts, molluscum contagiosum and other viral skin conditions. 

Sebaceous hyperplasia: Electrodessication is a frequent and benign treatment for sebaceous hyperplasia, an expansion of the sebaceous glands on the face. 

Contraindications

Allergies or Sensitivities: Any person prone to hypersensitivity reactions to local anesthetics or to any drug that may be administered during the time of the treatment session.

Infections: If the skin lesion or surrounding tissues demonstrate infection attributes, the procedure will begin when the infection is cleared.

Certain Skin Conditions: Patients who present any skin changes for instance dermatitis or psoriasis may need a review before carrying out curettage and electrodessication. 

Outcomes

Equipment

• Curette 
• Electrosurgical Unit 
• Electrodes 
• Local Anesthetic 
• Sterile Drapes and Towels 
• Skin Marking Pen 
• Dressing Materials

Patient preparation

Every surgery or invasive procedure requires some preoperative investigation procedures; It will  be done through the general clinical examination. 
 
Tell your surgeon about all the allergies, medications, or diseases you may be suffering from. 
 
Along with medication, some food products are important preoperative recommendations which the doctor can give to the patient. 
 
The patient should be encouraged to wear loose and comfortable dressings. 
 
Make sure that there is hygiene in the practice you perform when washing the treatment area with a mild soap and water prior to the procedure. 
 
The patient will have to sign a consent form before undergoing a procedure. 

Approach considerations

Be certain as to the nature of the lesion, i.e. benign tumour, basal cell cancer, etc.. 
Ensure that the lesion to be treated has well-defined margins and is within the curetted group. 
This could be due to the location of the lesions and other factors such as age etc. 
Curettage and electrodesiccation are not advised on micronodular, morphea form, infiltrative as well as nodular form subtypes of basal cell carcinoma. 

Technique considerations

Step 1: In cases where the wound is contaminated Betadine and Hibiclens or any other topical cleaner are employed to clean up the lesion.
Step 2: After the washing of the wound, the marking pen present in the mini surgical set is used to draw any line or shape the surgeon wants depending on the part of tissue to be removed.
Step 3: Giving anesthesia is generally done using a very fine needle mostly 25 or 30 which is used to drawn small amount of sample and the anesthetic solution has epinephrine added to with lidocaine 1% by helping in local hemostasis. 

Step 4: The Fox dermal curette which has the sizes 5mm,4mm and 3mm is most widely used metal curette. 

Fox dermal curette 

Step 5: Carefully scrape the lesion down to its base using the curette’s sharp edge in touch with the skin to produce a tactile feeling like that of the dermis.

Step 6: Forceful counterpressure is used to repeatedly scrape in numerous directions, following a checkerboard pattern, until all tissue is stiff and grit-filled in situations of probable squamous cell lesions or basal cell lesions. 

Step 7: It is common to identify the tumor tissue exhibits the texture that is seeming to be softer than that of the normal tissue. 

Step 8: This is done after gauze blotting to the dry base where electrodesiccation is done on the area. 

Step 9: Depending on the electrocautery unit type, which is either spark gap, hyfrecator or Bovie, the current setting is different for appropriate heat created coagulation of bleeding.

Step 10: Applying a mild electric current biphasic in action with a full star cautery tip using a back-and-forth stroke provides the visual spark and initial coagulation of a base of the lesion.
Stage 11: Apparently, patient should not experience any discomfort during the process, assuming that anesthesia and grounding have been adequately addressed. 

Laboratory tests
Biopsy before the Procedure:
Before the curettage and electrodessication treatment, the skin lesion may be biopsied to determine the type of skin lesion. This entails having a small portion of the tissue collected specifically for pathology examination. The biopsy results may be then useful to find out whether the lesion observed depends on whether it is cancerous or not.
Histopathological Examination:
In curettage or electrodessication, the tissue that is removed undergoes histopathological evaluation with the assistance of a laboratory.  

Microbial Culture (if infection is suspected): This procedure may be done if there is an infection indication or if the type of lesion that is to be removed is considered, a sample of the tissue may be taken to culture to identify the microbes present. 

Complications

Pain and Discomfort: Patients may feel pain or discomfort on the part of the body that is undergoing the treatment. Local anesthesia is more commonly administered to reduce such cases. 
Bleeding: Tenderness, redness, swelling and bruise like discoloration, are also other common occurring. Such cases of bleeding are mostly controlled by the surgeons to prevent during or after operation or any process that involves making an incision. 
Allergic Reaction: Some individuals are allergic to anesthetics or other medication that is administered at some time during the procedure. This is not very often, but one must be prepared for this situation. 
Lesion Recurrence: Even if all the treatments have been performed correctly at the beginning, the lesion can reemerge at some point. Make checkups by a healthcare professional to monitor the progression or signs of recurrence. 
Infection: An infection might develop called post-operative infection, more so if the surgeon’s failure to take proper care of the site of operation once the surgery is over.  

References

Curettage and electrocoagulation versus surgical excision in the treatment of low-risk basal cell carcinoma – Postoperative follow-up and satisfaction at three months: randomized clinical trial – PMC (nih.gov) 

References

Curettage and electrocoagulation versus surgical excision in the treatment of low-risk basal cell carcinoma – Postoperative follow-up and satisfaction at three months: randomized clinical trial – PMC (nih.gov)