Curettage and electrodesiccation (C&D, or ED&C) is a basic skin procedure in which the technique of curettage using a sharp curette is followed by electrodesiccation. The technique is often performed by dermatologists, family physicians, and general surgeons in their offices on a daily basis.
C&D is a mainstay of treatment for basal cell and squamous cell cancers. For many indications, C&D has been replaced by curettage alone, as it yields similar cure rates and a better cosmetic outcome.
Technique:
- The lesion is prepared with alcohol or topical cleansing agents such as Hibiclens or Betadine.
- Once dried, the area may be marked (according to surgeon preference) with a small surgical pen, outlining the tissue to be removed.
- Anesthesia is typically performed by raising a wheal of anesthetic with a small needle with 1% lidocaine plus epinephrine to assist with hemostasis.
- A dermal curette (size 3, 4, or 5 mm) is the most commonly used. With the sharp side of the curette touching the skin, the lesion is scraped to its base, where a “gritty” feeling of the dermis is obtained.
- In suspected basal cell or squamous cell lesions, this scraping is repeated in various directions in a checkerboard pattern with firm counterpressure and until all the tissue feels firm and gritty. Most cancers have been described as having a softer feel than normal tissue.
- Electrodessication is then applied to the area after it is blotted to a dry base with gauze.
- Depending on the electrocautery unit (whether spark gap hyfrecator or Bovie), the current settings vary for achieving adequate heat-induced coagulation of bleeding.
- Light application of the electrical current, creating a visible spark and instant coagulation of the lesion base, is accomplished with a smooth backward and forward motion with the cautery tip.
Patients should experience no discomfort during this procedure.