Curettage and Electrosurgery Health Article

Definition

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.

Purpose

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:

• benign skin lesions, such as angiomas, nevis, and warts
• actinic keratoses (AKs), which are premalignant skin lesions
• skin cancers, chiefly basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC)
• genital warts that result from human papillomavirus (HPV) infection

Demographics

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.

Description

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).