Curettage and cautery
C&C; curettage and electrodesiccation; ED&C; curettage and electrocautery
Curettage and cautery is a fast, low-cost, scar-tolerable destructive technique for low-risk skin lesions — particularly low-risk basal cell carcinoma on the trunk and proximal extremities, seborrhoeic keratoses requested for cosmesis, and selected actinic keratoses or warts. Carefully selected, BCC C&C has 5-year recurrence rates of 5–10%; poorly selected it can rise to 20% or more. Site, subtype and operator skill are the three determinants of outcome. C&C is not appropriate for any lesion in the H-zone of the face, for morphoeic / infiltrative BCC, recurrent lesions, immunosuppressed patients, or anywhere histology is mandatory.
Indications
- Low-risk BCC — nodular or superficial subtype, < 2 cm, on the trunk or proximal extremities, well-circumscribed, primary (not recurrent).
- Seborrhoeic keratoses for cosmesis after clinical confirmation.
- Solar lentigines (light pass).
- Selected hyperkeratotic actinic keratoses.
- Verruca vulgaris.
- Always confirm diagnosis clinically (or by prior biopsy) before destructive treatment — C&C destroys the specimen for histology.
Contraindications
- Any lesion where definitive histology is needed.
- BCC of the head / neck "H-zone" — central face, periorbital, periauricular, nasal, lip — site associated with elevated recurrence.
- Morphoeic, infiltrative, micronodular, basosquamous BCC subtypes.
- Recurrent or incompletely treated BCC.
- cSCC of any grade — risks under-treatment; use excision.
- Pigmented lesions where melanoma is possible.
- Immunosuppressed patients (transplant recipients) — recurrence and progression risk too high.
- BCC in the setting of Gorlin syndrome — RT exclusion zones, multiplicity make C&C unsuitable.
Technique
- Mark the lesion with a 2–3 mm cuff of surrounding clinically normal skin.
- Infiltrate with 1% lidocaine + adrenaline.
- Firm curettage with a sharp dermal curette (4, 5 or 7 mm) — tumour tissue feels softer ("gritty / butter") than surrounding dermis; this difference guides the depth.
- Electrodesiccation of the base and a 1–2 mm rim of surrounding normal skin.
- Repeat curette + cautery cycles (traditionally three) — the "C-E-C-E-C-E" sequence.
- Haemostasis; dressing.
- Heal by secondary intention over 2–4 weeks; cosmetic outcome on the trunk usually good; flat or slightly hypopigmented scar.
Outcomes and recurrence
- BCC 5-year recurrence rate:
- Low-risk site (trunk) — 5–10% with appropriate selection.
- High-risk site (head/neck H-zone) — 15–25% — do not use.
- Recurrent BCC — 40–50% — do not use.
- Cosmesis is acceptable on most non-facial sites; pigmented scars are common in Fitzpatrick IV–VI skin — counsel about post-inflammatory hyper/hypopigmentation.
- Histology not generated — incomplete excision cannot be detected; clinical surveillance is essential.
Aftercare and follow-up
- Daily soap-and-water cleansing; petroleum jelly to maintain moist healing; non-adherent dressing.
- Avoid sun exposure to the healing wound for 6 months to limit dyschromia.
- Skin examination at 6 months and annually for 2 years to monitor for recurrence.
- Counsel on photoprotection and self-examination.
References
- Rodriguez-Vigil T et al. Recurrence rates of primary BCC treated by C&C — systematic review. J Am Acad Dermatol; 2007.
- Nasr I, McGrath EJ, Harwood CA et al. British Association of Dermatologists guidelines for the management of adults with basal cell carcinoma 2021. Br J Dermatol. 2021;185(5):899-920.
Spot a correction?
If any clinical statement, citation or link on this page needs updating, please email admin@skinoncology.net with the page name, the proposed correction and the supporting source.