🔍 Search
ProceduralHaemostasisOPCS Y50

Electrosurgery (diathermy, hyfrecation)

Diathermy · hyfrecation · electrocautery · electrodessication · electrocoagulation · electrofulguration

Electrosurgery uses high-frequency electrical current to cut, coagulate or destroy tissue. Modalities include monopolar, bipolar, hyfrecation (electrodessication), electrocautery (heated wire, no current passing through patient) and electrofulguration. Skin-oncology applications span haemostasis, lesion ablation, Mohs adjunct and electrosurgery as standalone treatment of selected superficial BCC and benign lesions. UK BAD minor-skin-surgery and BSDS guidance underpin standards; pacemaker / ICD considerations are mandatory.

CurrentLast reviewed 16 May 2026

Modes

  • Electrocautery: heated wire / probe — no current passes through patient; safe in pacemaker / ICD.
  • Electrosurgery: current passes through patient.
    • Monopolar: current flows from active electrode through patient to dispersive return pad. Cut / coagulate / blend.
    • Bipolar: current flows between two tips of forceps; precise haemostasis around delicate structures (e.g. eyelid).
    • Hyfrecation (electrodessication): low-power high-voltage spark; superficial destruction; no return pad; commonly used in dermatology (Hyfrecator™).
    • Electrofulguration: spark gap; non-contact; superficial destruction.

Indications

  • Haemostasis during excision / Mohs / biopsy.
  • Curettage and cautery (C&C) for superficial BCC, Bowen disease, AK, sebK.
  • Treatment of benign lesions: skin tags, cherry angiomas, sebaceous hyperplasia, pyogenic granulomas, angiokeratomas, syringomas, milia, spider naevi, telangiectasia.
  • Genital warts (BASHH guideline).
  • Adjunct in Mohs for residual disease bed haemostasis.

Technique

  1. Pre-procedure: confirm pacemaker / ICD status; remove metal contact (jewellery); ground patient if monopolar.
  2. Sterile setup: clean field; suction smoke extraction.
  3. Local anaesthesia: typically with adrenaline for haemostatic synergy.
  4. Modality and power:
    • Hyfrecation 1-5 W for superficial destruction.
    • Cut 30-50 W for excision.
    • Coagulation 25-45 W for haemostasis.
  5. Activate sparingly; avoid prolonged contact (charring impairs healing).
  6. For superficial BCC C&C: curette → cauterise base; repeat 2-3 cycles.

Safety considerations

  • Cardiac devices (PPM / ICD):
    • Avoid monopolar electrosurgery near device; use bipolar or electrocautery preferentially.
    • If monopolar essential: short bursts <5 sec; place dispersive pad far from device current path.
    • Manufacturer / cardiac physiology liaison for high-risk procedures; magnet / re-programming may be needed.
  • Other implanted devices: cochlear, deep brain stimulator, intrathecal pump — manufacturer guidance.
  • Smoke evacuation: surgical smoke contains viable HPV and viral particles; smoke evacuator + N95 / surgical mask.
  • Combustion risk: alcohol-based skin preparation must be fully dry; ensure no oxygen pooling under drapes.
  • Burn risk: ensure dispersive pad fully adherent; avoid metal-to-metal contact between patient and bed / equipment.
  • Pregnant operator: surgical smoke extraction critical.
  • HPV infection control: especially when treating warts.

Practical points

  • Bipolar preferred near eyes (eyelid surgery), genitalia, fingertips, ears, nasal alar.
  • Hyfrecation ideal for small benign vascular / sebaceous / verrucous lesions.
  • Avoid in deep / poorly vascularised wounds — risk of charring and impaired healing.
  • Document settings, dispersive-pad position, smoke evacuation in operation note.
  • Counsel patients about pigment change (post-inflammatory hyperpigmentation more common in Fitzpatrick III-VI) and scar.
  • C&C for superficial BCC: 5-year cure ~92-95% on low-risk sites; lower on high-risk sites or aggressive subtypes.

References

  1. Sebben JE. Electrosurgery: high-frequency modalities. J Dermatol Surg Oncol. 1988;14:367-371.
  2. Vora HN et al. The use of electrosurgery in dermatology: a review. Indian J Dermatol. 2019;64:421-426.
  3. James ML et al. Management of cardiac implantable electronic devices around the time of dermatological procedures requiring electrosurgery: an important guidance update. Clin Exp Dermatol; 2024;49:403-405.
  4. Telfer NR et al. Guidelines for the management of basal cell carcinoma. Br J Dermatol. 2008;159:35-48.

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.