Curettage and electrosurgery: fast removal of benign and selected lesions
A curette scrapes away tissue that is softer than the skin around it, and electrosurgery seals the base. Fast, cheap and effective for the right lesion.
Curettage uses a sharp ring shaped instrument to scrape away lesional tissue, exploiting the fact that many abnormal growths are less cohesive than normal dermis. Electrosurgery then coagulates the base for haemostasis and to destroy residual cells. The combination is quick, needs only local anaesthesia and avoids sutures [1].
Key points
- Excellent for skin tags, seborrhoeic keratoses, pyogenic granulomas and viral warts
- Used for selected low risk basal cell carcinomas on the trunk, not on the face
- The wound heals by secondary intention over two to four weeks
- A flat pale or slightly depressed scar is the usual outcome
- It gives fragmented tissue, so it is less ideal when precise margin assessment matters
What it suits
Benign raised lesions are ideal: seborrhoeic keratoses, skin tags, pyogenic granulomas, viral warts resistant to cryotherapy, and molluscum in cooperative patients. Removal is complete in one visit and the specimen can still be sent for histology if there is any doubt.
Curettage with electrodesiccation is also an accepted treatment for small, well defined, low risk basal cell carcinomas on the trunk and limbs, with good cure rates in appropriately selected lesions. It is not used on the face, in recurrent tumours or in aggressive histological subtypes, where excision or Mohs surgery is required [2].
- Seborrhoeic keratoses and skin tags: single visit removal
- Pyogenic granuloma: curettage with cautery of the base to prevent recurrence
- Resistant warts: curettage after softening, under local anaesthesia
- Low risk trunk basal cell carcinoma: three cycles of curettage and desiccation
The procedure
Local anaesthetic is injected, the lesion is scraped away with a curette until firm normal dermis is felt, and the base is treated with a hyfrecator or diathermy. In basal cell carcinoma three cycles of curettage and desiccation are standard.
A small round wound remains, dressed with an ointment and simple dressing. There are no sutures to remove.
Healing and scars
The wound heals from the edges inward over two to four weeks depending on size and site. Daily cleaning and a bland ointment under a non adherent dressing keep it moist, which speeds healing and improves the scar.
The typical scar is flat, round and slightly paler than surrounding skin. In darker skin the pale mark can be noticeable, and post inflammatory hyperpigmentation may appear first and fade over months. This is an important part of the consent conversation in Fitzpatrick types four to six.
Limitations
The tissue removed is fragmented, so a pathologist cannot assess margins reliably. When margin status matters, formal excision is the correct procedure.
Recurrence is possible if the lesion extends deeper than the curette reaches, which is why lesion selection is the main determinant of success.
Frequently asked questions
Is it painful?
The injection stings for a few seconds. The procedure itself is painless, and there is mild soreness for a day afterwards.
Why no stitches?
The wound is shallow and round, so it heals well on its own. Suturing a curetted base can trap tissue and does not improve the scar.
Can skin tags be removed at home?
No. Home removal with thread or over the counter kits risks infection, bleeding and scarring, and removes the chance to check anything unexpected.
References
- [1] Sheridan AT, Dawber RP. Curettage, electrosurgery and skin cancer. Australasian Journal of Dermatology. Source
- [2] Bichakjian CK, et al. Guidelines of care for the management of basal cell carcinoma. Journal of the American Academy of Dermatology. Source
This content is general medical education and does not replace a personal consultation. Any prescription must be coordinated with your local doctor.
Is this procedure right for you?
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