Background Information:

What are the other Names for the Procedure?

• Curettage and Electrodessication
• C and C (Curettage and Cautery)

What is Curettage and Cautery surgical procedure?

• Curettage and Cautery (C and C) is a procedure used to remove benign and malignant growths from the surface of the skin
• A curette is the surgical instrument used to physically scrape and lift the abnormal growth of the skin
  • The functional portion of the curette is an open oval or circular surgical steel loop
  • One side of the loop is sharp, the other has some thickness to provide stability. It is attached to a straight simple handle
• The other instrument used is an electrocautery device
  • This device uses electronic components to create a low electrical current, at low enough strength to heat skin without penetrating deeply or giving a generalized shock
  • The current is altered by the surgeon to achieve the goal of stopping bleeding

What part of the Body does the Procedure involve?

The Curettage and Cautery procedure can be performed on most of the portions of the skin. It is difficult to use on areas with significant amounts of hair unless the hair is trimmed prior to the procedure.

• The procedure must be used cautiously around delicate tissues such as the eye
• It is ideal for use on the broad convex surfaces of the arms, legs, and trunk
• It is possible and common to perform Curettage and Cautery on the face, neck, and other areas

Why is the Curettage and Cautery surgical procedure Performed?

There are a variety of reasons for performing the Curettage and Cautery procedure. Among the criteria for a lesion and region being a good choice for this procedure would be when the target lesion is elevated above the surrounding skin surface, making the curette more effective. In addition, lesions that are well-defined physically and biologically are well-suited.

Some of these lesions include:

• Benign viral warts
• Molluscum contagiosum
• Benign seborrheic keratoses
• Basal cell carcinomas, particularly certain subtypes such as nodular and superficial BCCs
• Squamous cell carcinoma in situ

What are some Alternative Choices for the Procedure?

Some of the alternative choices for Curettage and Cautery include:

• Cryosurgery
• Excisional surgery
• Topical medications

What are the Recent Advances in the Procedure?

There are no significant improvements specific to the Curettage and Cautery procedure.

What is the Cost of performing the Curettage and Cautery surgical procedure?

The cost of the Curettage and Cautery procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding the Curettage and Cautery procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may seek a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

https://dermnetnz.org/topics/curettage-and-cautery/ (accessed on 05/16/2021)

https://www.cancercouncil.com.au/skin-cancer/treatment/curettage-and-cautery/ (accessed on 05/16/2021)

https://www.srft.nhs.uk/EasysiteWeb/getresource.axd?AssetID=76203&type=full&servicetype=Inline (accessed on 05/16/2021)

Prior to Curettage and Cautery surgical procedure:

How is the Curettage and Cautery surgical procedure Performed?

The Curettage and Cautery procedure is performed in the following manner:

• First, the area to be treated is cleaned and prepared. Curettage and Cautery procedure must be done with attention to good cleanliness standards to avoid contamination
• The area to be treated is anesthetized with local anesthesia by injection
• For those with lower pain tolerance or anxiety about needles, topical anesthetic creams may be applied first, or oral anxiolytics given by mouth
• The skin surrounding the lesion is stabilized by gently stretching the area by the surgeon and/or the assistant
• The sterile Curette of appropriate size and sharpness is chosen based on the size of the lesion and other factors
• The lower edge of the Curette is gently pressed down, the directed across the growth and finishing upward at the opposite side of the growth. This lifts the growth off the surrounding normal skin. This is repeated if necessary, to completely remove the lesion
• Once the lesion has been successfully taken off, the cautery device is used to stop any pinpoint bleeding. Because of the superficial growths usually targeted with this technique, bleeding is typically easily controlled. As little cautery is done as possible, to minimize local tissue injury and scarring
• For malignant lesions, such as squamous cell carcinoma in situ and basal cell carcinoma, the Curettage and Cautery procedure is performed three times at the session, to insure a higher cure rate. The light char of the surface is completely removed each of the two first passes, to assure there are no residual malignant cells
• The surgical site is then bandaged

Where is the Procedure Performed?

The Curettage and Cautery procedure is usually performed in a medical office, either in an appropriately designed exam room or surgical suite.

Who Performs the Procedure?

The Curettage and Cautery procedure is usually performed by a medical provider with appropriate training and experience. This can be a physician, physician assistant or advanced practice nurse.

How long will the Procedure take?

The Curettage and Cautery procedure usually takes about a total of 15-20 minutes.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the procedure and helps avoid complications.

• Provide medical history such as diabetes, hypertension, heart disease, etc. (if any)
• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are allergic to any topical antibiotics or other topical medications
• If you are taking blood thinners, such as aspirin, warfarin, clopidogrel, garlic pills, vitamin E, herbal supplements, or any other such medications
• Any medical or family history of bleeding disorders or blood clots
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• Any unusual effects of local anesthesia from prior surgery

What Preparations are needed, prior to the Procedure?

The physician performing the procedure will evaluate the patient prior to the procedure and discuss the details with risks for complications and obtain his/her permission (termed informed consent).

• Some medications increase a person’s chances of bleeding, but discontinuing these medications is not recommended for the Curettage and Cautery procedure 
• Individuals with diabetes and smokers have slower healing times and a higher risk of postoperative infections
• For individuals with diabetes, it is important that the blood sugar stays within the normal range, if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

Pregnant women are advised not to undertake this procedure.

What is the Consent Process before the Procedure?

The physician will obtain permission for the Curettage and Cautery procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is the approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

In case of minors and individuals unable to give informed consent, the parent or legal guardian or next of kin can sign the consent for the procedure.

What Tests are needed, before the procedure?

• In many cases, no tests are typically necessary prior to the Curettage and Cautery procedure
• However, if required, the healthcare provider may recommend blood tests, if there are reasons to worry about blood clotting, or other general significant health issues

What are some Questions for your Physician?

Some of the questions that you might ask your healthcare provider are as follows:

• What is a Curettage and Cautery procedure?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Curettage and Cautery surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Local anesthesia by injection is administered during the procedure.

How much Blood will you lose, during the Procedure?

There is not much blood loss during an uncomplicated Curettage and Cautery procedure.

What are the possible Risks and Complications during the Curettage and Cautery surgical procedure?

Excessive bleeding during the procedure, or difficulty stopping the bleeding can occur in patients with the following:

• A history of excessive bleeding 
• Patients on medications which impair clotting and coagulation
• Patients with blood disorders that lead to excessive bleeding
• Patients with end-stage liver disease that no longer enables one to make clotting factors

Some of the possible risks and complications that may arise during a Curettage and Cautery procedure include:

• Infection
• Bleeding
• Injury to the neighboring structures
• Pain and discomfort
• Anesthetic complications
• Need for further procedures
• Healing difficulty with resultant undesired cosmetic outcomes

What Post-Operative Care is needed at the Healthcare Facility after the Curettage and Cautery surgical procedure?

The patient is usually observed by a healthcare professional (a nurse) in the exam room or surgical room. Occasionally, patients may faint because of the pain and stress of having a surgical procedure. Usual treatment for fainting is provided until the patient is ready to ambulate and go home.

After the Curettage and Cautery surgical procedure:

What are the possible Risks and Complications after the Curettage and Cautery surgical procedure?

The risks and complications that may arise after Curettage and Cautery include:

• Excessive bleeding that may sometimes require an additional surgical procedure
• Low-grade fever

• Infection of the surgical wound

What is the Prognosis after the Surgery?

In most cases, the prognosis after a Curettage and Cautery procedure is excellent.

When do you need to call your Physician?

Do contact your physician or call 911 (or your local emergency number) based on the seriousness of any of the following symptoms:

• Fever and chills
• Severe pain
• Shortness of breath
• Bleeding or fluid discharge from the surgical wound
• Nausea and vomiting
• Signs of infection
• Severe fatigue
• Dizziness

What Post-Operative Care is needed at Home after the Curettage and Cautery surgical procedure?

At home, the following post-operative care is recommended after a Curettage and Cautery procedure:

• Keep the bandage dry and intact for the first 24 hours after the procedure
• Resume showering and keep the wound clean and dry. Gently wash the surgical wound with mild unscented soap
• Replace dressing after showering
• Take the prescribed medications following the procedure
• Avoid any strenuous activity for a period recommended by the physician
• Continue previously prescribed medications after checking with your healthcare provider

How long does it normally take to fully recover, from the Procedure?

The recovery time usually depends on the extensiveness of the surgery.

• Simple procedures have shorter healing period
• If the Curettage and Cautery resulted in a superficial defect, the healing time will be much shorter
• For a deep lesion to heal, it often takes about 4 weeks
• The healing time also is dependent upon the location

Facial lesions usually heal more rapidly. Defects on lower legs can take 6-8 weeks or longer to heal, depending on the health of the patient.

Additional Information:

What happens to tissue/samples (if any), taken during the Procedure?

The Curettage and Cautery procedure is not performed for diagnostic purposes. Only rarely, a curetted specimen would be sent to a pathologist for examination.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

In the rare circumstance of a specimen from Curettage and Cautery being submitted, the pathology report should be available in about a week, or whenever a routine report could be generated.

Who will you receive a Bill from, after the Curettage and Cautery surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The dermatologist
• The pathologist if a specimen is submitted

The patient is advised to inquire and confirm the type of billing before the Curettage and Cautery surgical procedure is performed.