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Currettage and Cautery (also known as Electrodessication and Curettage)

Currettage and Cautery is a very common procedure used in the treatment of basal cell carcinomas that are generally of small size and located in low recurrence areas of the body (neck, trunk, extremities). The area is first numbed with a local anaesthetic injection and then scraped from surrounding normal skin with a curette (a circular, sharp instrument). An electrosurgical needle is then used to desiccate (heat and dry up) the remaining cancerous tissue. This is repeated for a total of three or four times in succession in order to achieve maximal cure rates. This form of treatment is quick, efficient and cost effective. It is limited however, by leading to higher recurrence rates when treating large lesions and cancers of the mid face. Pain during treatment is minimal and post-operatively the area may feel comparable to a small burn.

The cosmetic result will appear as a lighter (hypopigmented) flat spot that is of similar size as the cancer was prior to treatment. The method requires no stitches, only one post operative visit (usually) and is healed with 10 - 21 days.

The chance of a cure in the lesion being treated with this procedure is 92 - 93% (this figure would be lower in high recurrence areas, and with treatment of larger and more aggressive tumours). There are no long term side effects, except for scarring as described above.

Ref: Telfer NR, Colver GB and Morton CA. Guidelines for the management of basal cell carcinoma. Br Journal of Dermatology 2008. 159: 35-48

 

Next Review January 2016

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Cryosurgery

Cryosurgery is a term given to a procedure that involves the application of a very cold substance in order to destroy tissue. To achieve tumour killing, a tissue temperature of -50C is required. In dermatology, the most frequently used cryosurgical substance is liquid nitrogen (-196C), which is applied using a pressurised canister. No anaesthesia is necessary for small tumours and the application of the freezing spray is felt as a burning sensation. With larger tumours, anaesthetics may be used, as may temperature measuring devices in order to monitor the extent of freezing within the cancer.

Cryosurgery, like Electrodessication and Curettage, is quick, efficient and cost effective. However, this method should be avoided when treating lesions in high recurrence areas.

The post-operative cosmetic result, follow up care, and healing time is very similar to Electrodessication and Curettage. One study has shown that surgical excision gives better cosmetic results than cryosurgery on BBCs on the head and neck. 

The overall chance of a cure with this procedure is 92 - 93% (as with Electrodessication and Curettage, this figure would be lower in high recurrence areas and with the treatment of larger and more aggressive tumours).

Cryosurgery, in a few cases, has lead to nerve damage and numbness, but in general has no side effects, except for scarring.

Ref: Telfer NR, Colver GB and Morton CA. Guidelines for the management of basal cell carcinoma. Br Journal of Dermatology 2008. 159: 35-48

Review date - January 2016

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Surgical Excision

Surgical excision is a technique that involves the use of a scalpel to excise (cut out) cancerous tissue. The area of the cancer is numbed using a local anaesthetic, and a small measurement of 2-4 mm of normal skin surrounding the lesion is made. The cancer plus surrounding normal skin is then removed by incision with the scalpel blade. Stitches are placed to bring the adjacent wound edges together. In some cases, extra skin may be mobilised or taken from a distant site (flap or graft), in order to cover the surgical defect (flap or graft). Pain during treatment is minimal and post-operatively may feel comparable to that of a bruise. Surgical excision may require 1-2 post operative visits (including suture removal), and heals more rapidly than Currettage and Cautery and cryosurgery.

The cosmetic result is superior to the previously mentioned techniques, but is dependent upon the size and location of the tumour.

The overall rate of cure in the lesion being treated is 94 - 98%. This statistic would be lower in high risk areas of the face, and on larger more aggressive tumours. 

The long term side effects are scarring, and rarely, nerve damage. An advantage of excision is that the margins of the excision specimen can be checked microscopically by a pathologist.

Ref: Telfer NR, Colver GB and Morton CA. Guidelines for the management of basal cell carcinoma. Br Journal of Dermatology 2008, 159: 35 - 48

 

Next Review January 2016

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Laser Vaporisation

Laser Vaporisation is a technique involving the use of the carbon dioxide laser to vaporise away abnormal tissue after the area has been anaesthetised. It may be combined with curettage and is particularly useful in cases of multiple/superficial tumours that are considered at low risk of occurrence.

Sometimes it can be useful in the treatment of patients with Gorlin Syndrome. It is not commonly used and there is relatively little evidence regarding its effectiveness.  Side effects of laser vaporisation includes scarring, bleeding and infection.

Ref: Telfer NR, Colver GB and Morton CA. Guidelines for the management of basal cell carcinoma. Br Journal of Dermatology 2008, 159: 35 -48

 

Next Review January 2016 

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 Originally produced by Professor P. A. Farndon, Clinical Geneticist, Jim Costello (deceased) and Margaret Costello.  We are reliant on a team of medical advisors for the clinical content of the website. We are grateful for their continuing support. 
Gorlin Syndrome Group is Registered Charity in the UK - No 1096361 
 
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