Curettage and cautery

Author: Dr Sonya Havill MBChB FRACP, Registrar, Department of Dermatology, Waikato Hospital, Hamilton, New Zealand, 2001.

Curettage and cautery (one type of electrosurgery) is a procedure in which your dermatologist scrapes off a skin lesion and applies heat to the skin surface.

What is involved in curettage and cautery of a skin lesion?

Your dermatologist will explain to you why your skin lesion needs treatment and the procedure involved. You may have to sign a consent form to indicate that you consent to the surgical procedure. Tell your dermatologist if you are taking any medication, you have any allergies or medical conditions.

The dermatologist will inject some local anaesthetic into the area surrounding the lesion to be treated. This will make the skin go numb so no pain should be felt during the procedure. You may feel a pushing sensation but this should not be painful. The skin lesion is scraped off with a curette, which is like a small spoon with very sharp edges.

The lesion should be sent to a pathology laboratory for analysis. The wound surface is then cauterised with a hot wire beaded tip or electrosurgical unit (diathermy). This stops bleeding and helps destroys any remaining skin tumour cells.

This procedure is usually repeated twice. A dressing may be applied and instructions should be given on how to care for your wound.

What types of skin lesions can be treated by curettage?

Curettage is suitable to treat lesions where the material being scraped off is softer than the surrounding skin or when there is a natural cleavage plain between the lesion and the surrounding normal tissue. The following can often be treated by curettage:

Basal cell carcinomas that are large, deep or recurrent are usually not suitable for curettage. Lesions where the edges are not easily defined are also generally unsuitable.

Will I have a scar?

You will always have some sort of scar. It is impossible to cut or curette the skin without scarring in some way. Your dermatologist will treat the lesion to keep scarring to a minimum.

The scars from curettage are usually flat and round. They are a similar size to that of the original skin lesion. Some people have an abnormal response to skin healing and these people may get larger scars than usual (keloids and hypertrophic scarring).

How do I look after the wound following skin curettage?

Your wound may be tender 1-2 hours after the curettage when the local anaesthetic wears off.

Keep the wound dry for 48 hours. You can then gently wash and dry the wound. If the wound becomes red or very painful, consult your doctor. There are no stitches to remove after curettage.

The wound from curettage will take approximately 2-3 weeks to heal over. The scar will initially be red and raised but usually reduces in colour and size over several months.

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