- Electrodesiccation and curettage
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Electrodesiccation and curettage (EDC, ED & C, or ED+C) is a commonly performed procedure by dermatologists, surgeons and general practitioners for the treatment of basal cell cancers and squamous cell cancers of the skin.[1]
Contents
The procedure
A round dull instrument (curette) of varying sizes (1 mm to 6 mm) is used to scrape off the cancer down to the dermis[2][3][4]. A surgical margin of usually at least 5 mm is performed. The scraping is then paused while an electrosugical device like a hyfrecator is used next. Electrocoagulation (electrodesiccation) is then performed over the raw surgical ulcer to denature the protein of the dermis. The curette is used again over the surgical ulcer to remove the denatured dermis down to living tissue. The electrodesiccation is performed again, and the cycle is repeated until the surgeon is comfortable of the depth of the destruction and that adequate surgical margin has been obtained.[5]
Applications[6][7]
- Seborrheic keratosis
- Viral warts
- Bowens disease (in situ squamous cell carcinoma)
- Pyogenic granuloma
- Actinic keratoses
- Basal cell carcinoma
- Keratoacanthoma
- Skin tags
The cure rate
The cure rate is highly user dependent[8]. The more aggressive the surgeon is at performing EDC, the higher the cure rate. Like standard excision, the wider the surgical margin, the higher the cure rate. Cure rate for small cancer is higher than cure rate for larger cancers. Cure rate for nodular basal cell cancer is higher than for infiltrative basal cell cancer. Essentially, all the prognostic factors which applies to Mohs surgery and standard surgical excision will also apply to EDC.
Advantages
The method is quick and easy to perform under local anesthetic. Used correctly, it can allow for adequate to good cosmetic result on small tumor in certain area. No sutures are used, so a follow up visit might not be necessary. Minimal expense is required. If recurrence occur, rapid diagnosis is possible as the roots are exposed to the surface, and not buried by surgical closure methods (flaps, etc.)[9].
Disadvantages
As the surgical margin is not confirmed by pathology, the free surgical margin can not be confirmed by an objective pathology report. The recurrence rate for EDC is considered by many (NCCN) to be too high for use on many facial region, and on recurrent skin cancer[10][11]. As a surgical ulcer is created and is larger than the original tumor, healing time may be delayed and subsequent scarring obvious.
References
- ^ http://www.fpnotebook.com/DER/Procedure/ElctrdsctnAndCrtg.htm
- ^ http://www.healthpress.co.uk/acatalog/ffminsur.pdf
- ^ http://www.aocd.org/skin/dermatologic_diseases/dermatology_proced.html
- ^ http://dermnetnz.org/procedures/curettage.html
- ^ http://dermnetnz.org/procedures/curettage.html
- ^ http://dermnetnz.org/procedures/curettage.html
- ^ http://www.fpnotebook.com/DER/Procedure/ElctrdsctnAndCrtg.htm
- ^ Barlow, JO; Zalla, MJ; Kyle, A; Dicaudo, DJ; Lim, KK; Yiannias, JA (2006). "Treatment of basal cell carcinoma with curettage alone". Journal of the American Academy of Dermatology 54 (6): 1039–45. doi:10.1016/j.jaad.2006.01.041. PMID 16713459.
- ^ Barlow, JO; Zalla, MJ; Kyle, A; Dicaudo, DJ; Lim, KK; Yiannias, JA (2006). "Treatment of basal cell carcinoma with curettage alone". Journal of the American Academy of Dermatology 54 (6): 1039–45. doi:10.1016/j.jaad.2006.01.041. PMID 16713459.
- ^ http://www.skincancer.org/index2.php?option=com_content&do_pdf=1&id=82
- ^ http://wwwu.tsgh.ndmctsgh.edu.tw/commcpc/images/nccn/Non-Melanoma%20Skin%20Cancer-2007.pdf
External links
Operations/surgeries and other procedures of the skin and subcutaneous tissue (ICD-9-CM V3 86, ICD-10-PCS 0H) Skin Escharotomy · Suture · Skin grafting · Mohs surgery · Free flap · Rotation flap · TRAM flap · Electrodesiccation and curettage · Cryosurgery · Skin biopsy
Rhytidectomy · Liposuction · Z-plasty
medical imaging: Wood's lampHair Categories:- Dermatologic surgery
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