Curettage & Cautery

Curettage and cautery is an effective treatment option for select superficial skin cancers and pre-cancerous lesions. This technique combines mechanical scraping of abnormal tissue using a curette with electrocautery to destroy residual tumour cells at the wound base. When applied to appropriately selected low-risk malignancies, it offers high cure rates with a straightforward procedural approach.

Cancer and Pre-Cancer Indications

In dermato-oncology, curettage and cautery is used primarily for the treatment of superficial basal cell carcinoma (BCC), Bowen disease (squamous cell carcinoma in situ), and actinic keratoses. The technique is best suited for small, well-defined, superficial tumours located on the trunk and extremities, where the risk of deep invasion or aggressive behaviour is low.

Patient and Tumour Selection

Careful patient and tumour selection is critical to achieving optimal oncological outcomes with curettage and cautery. The technique is appropriate for low-risk, primary (not recurrent) superficial skin cancers with well-defined clinical borders. It is not recommended for tumours located on the head and neck (particularly the nose, ears, and periorbital area), tumours with aggressive histological subtypes, recurrent cancers, deeply invasive lesions, or tumours with poorly defined margins.

The Procedure in Cancer Treatment

After local anaesthesia is administered, a curette is used to scrape away the cancerous tissue. The softer consistency of tumour tissue compared to the surrounding normal dermis allows the curette to selectively remove the abnormal cells. Electrocautery is then applied to the wound bed to destroy any residual cancer cells and achieve haemostasis.

For malignant lesions, the curettage-cautery cycle is typically repeated three times to maximize the likelihood of complete tumour removal. This multiple-cycle approach reduces the probability of residual cancer cells remaining at the treatment site.

Limitations and When Excision Is Preferred

A key limitation of curettage and cautery in oncological practice is the absence of a tissue specimen for histopathological margin assessment. Unlike formal surgical excision, the technique does not allow pathological confirmation that all tumour has been removed. For this reason, excision is preferred when margin assessment is important, when the tumour has aggressive features, when the cancer is recurrent, or when the lesion is located in a high-risk or cosmetically sensitive area.

Cure Rates and Recurrence Monitoring

When used for appropriately selected superficial BCC, curettage and cautery achieves cure rates of approximately 90 to 95 percent. For Bowen disease and actinic keratoses, similarly high clearance rates are reported. However, recurrence rates are higher than those achieved with formal excision, particularly for tumours on the head and neck or those with ill-defined borders.

Regular follow-up is essential after treatment to monitor for local recurrence. Any recurrence is typically managed with formal excision to ensure complete removal with histological confirmation of clear margins.

At the Centre for Medical and Surgical Dermatology, Dr. Maksym Breslavets carefully evaluates each skin cancer to determine whether curettage and cautery is the most appropriate treatment approach, ensuring optimal oncological outcomes for every patient.