What is electrodesiccation and curettage (ED&C)?
For particularly mild, well defined, and shallow skin cancers, Electrodesiccation and Curettage (“ED&C”), sometimes called “scrape and burn,” can be a good treatment option. ED&C’s are quick procedures often used to treat superficial or nodular basal cell carcinoma (BCC) and squamous cell carcinoma in situ (SCCIS) as well as some warts. Contact Dr. Brent Taylor at Premier Dermatology and Mohs Surgery of Atlanta to schedule a consultation and learn more about this procedure.
How is the electrodesiccation and curettage (ED&C) performed?
The area to be treated is sterilized then anesthetized, typically with lidocaine. A semi-sharp instrument called a curette is used to scrape the area until healthy skin is encountered. Because basal cell carcinomas are often softer than normal skin, they often scrape away easily. Squamous cell carcinoma in situ is often harder and rougher than normal skin, so a dermatologist can often tell when hard or rough skin is no longer present, leaving only healthy skin remaining. After scraping the area with the curette, an electrocautery device is used to apply small amounts of electricity to the treated surface. This can thermally injure (burn) any remaining cancerous cells and can sometimes loosen cancerous cells. The procedure is then typically repeated. This increases the cure rate by helping to eliminate any cancerous roots or cells. The wound is then dressed with ointment and a bandage and left to heal in over a couple weeks.
What are the benefits of ED&C?
Unlike other surgical skin cancer removal treatments like Mohs surgery, ED&C is fairly quick. The entire appointment usually takes less than an hour. Because ED&C is used for shallow tumors, stitches are not needed, and a follow up appointment for suture removal is not necessary.
What are the downsides of ED&C?
While ED&C is a quick and beneficial procedure in many regards, it does have some disadvantages and tradeoffs. The downsides fall under the categories of cure rate, scarring, and healing time.
In general, ED&C has a lower cure rate than Mohs surgery or standard excision. With Mohs surgery or excision, histologic margins are observed under a microscope, and a physician observes whether or not the margins are clear and free of tumor. With ED&C, tissue is not observed under a microscope, so neither the physician nor the patient knows whether the cancer is gone until months or years have passed – with time they know whether the cancer was successfully treated. For that reason, ED&C is typically only used for cancers that have very little chance of spreading to other parts of the body and which can be safely cut out later if they recur.
Depending on the body area, scarring with ED&C can be a downside. An ED&C leaves a cigarette or cigar-shaped circular scar that is typically hypopigmented (lighter in color) than surrounding skin. Sometimes the scar becomes thick and can be itchy or painful. In contrast, the scar after Mohs surgery or excision for such a cancer is typically a thin nearly inconspicuous linear scar. Note that undesirable scarring can occur after any procedure, but generally ED&C scars are more visible.
Healing time can be a downside of ED&C, with 2-3 weeks often required to heal if ED&C is performed on the chest or back and much longer healing time required on the lower extremities. By comparison, an surgical excision or Mohs surgery for such a lesion typically ends with suturing, and the suture is usually removed 1-3 weeks after placement, allowing for faster healing if there are no complications.
Again, the biggest drawback of ED&C is that, unlike with Mohs surgery or surgical excision, the histologic margin is not examined and a clear surgical margin is not confirmed via pathology. Because Mohs Surgery has a higher cure rate, is tissue-sparing, and is typically cosmetically superior, ED&C is most often considered for mild cancers on the upper arms, chest, abdomen or back.
If you’ve recently been diagnosed with either basal cell carcinoma or squamous cell carcinoma or you have a spot of concern and are exploring your treatment options, contact Premier Dermatology today to learn more about the ways that ED&C may be able to benefit you.