Curettage and Cautery

What is curettage and cautery?

Curettage and cautery is a minor procedure carried out under local anaesthetic, in which a skin lesion is scraped away with a small, spoon-shaped instrument called a curette, and the base is then treated with heat (cautery) to stop bleeding and treat any remaining abnormal cells. The two steps are often repeated two or three times in the same session. No stitches are needed.

What is it used for?

Curettage and cautery is used for lesions that sit in the upper layers of the skin. These include seborrhoeic keratoses, thickened actinic keratoses, Bowen's disease, some low-risk basal cell carcinomas, particularly superficial and small nodular types on the body, pyogenic granulomas and some viral warts.

It is not suitable for lesions that may extend deeply, for high-risk skin cancers, or where it is important to check the edges of the removed tissue under the microscope. The scraped tissue is usually sent to the laboratory to confirm the diagnosis, but unlike an excision, the laboratory cannot confirm that the edges are clear.

Before your procedure

If you have private medical insurance, you will be given a procedure code. Please contact your insurer to obtain pre-authorisation, and check whether any excess applies, before booking. If you are self-funding, the clinic can give you the cost in advance.

Please tell us if you take any medicines that thin the blood, such as aspirin, clopidogrel, warfarin, apixaban or rivaroxaban, if you have a pacemaker or other implanted cardiac device, if you have ever reacted to a local anaesthetic, or if you are pregnant or breastfeeding. Do not stop any prescribed medicine unless you have been advised to.

You can eat and drink normally on the day. Try not to book the procedure in the two weeks before a holiday, an important event or a period of heavy physical activity, and avoid sun exposure, sea water and swimming while the wound heals.

If you need to cancel, please let the clinic know with as much notice as possible rather than on the day.

What happens on the day?

Dr Mounsey carries out the procedure himself. The area is cleaned and a local anaesthetic is injected, which stings briefly before the skin becomes numb. The lesion is scraped away with the curette, and the base is then sealed with a heated instrument or an electrical current. You may notice a slight burning smell, which is normal. A plaster is then applied. The procedure itself usually takes only a few minutes.

What to expect afterwards

The treated area looks like a shallow graze or burn, which forms a scab. It usually heals within a few weeks, though wounds on the lower legs can take considerably longer. It leaves a flat, round scar, usually a little larger than the original lesion, which can be pink at first and later paler or shinier than the surrounding skin.

Aftercare

Keep the plaster put on at the end of your procedure in place for the first 48 hours. After 48 hours, take it off, clean the wound with soap and water, then pat it dry. You can shower daily from this point. Each day, continue to clean the wound with soap and water, pat it dry, then apply a thin layer of Vaseline before putting on a fresh plaster. Continue this until the wound has healed.

Avoid picking any scab, and avoid swimming, baths, hot tubs and vigorous exercise for at least a week, or until the wound has healed. On the lower legs, keeping the legs raised when resting can help healing.

If the wound bleeds, press firmly on it with a clean, folded cloth or gauze for 10 to 15 minutes without lifting to check. If it is still bleeding after a second period of firm pressure, seek medical advice.

Paracetamol can be taken for discomfort once the local anaesthetic wears off. Avoid aspirin and anti-inflammatory painkillers such as ibuprofen for the first couple of days unless they have been prescribed for you, as they can increase bleeding. Avoiding alcohol for 48 hours and not smoking or vaping while the wound heals both help healing.

Contact the clinic if you notice signs of infection, such as increasing pain, redness, warmth or swelling around the wound, pus, or a fever, or if you have any other concerns.

Once the wound has fully healed, protect the scar from the sun with a broad-spectrum sunscreen of SPF 30 or above for at least six months, as sun exposure can darken or redden a new scar.

What are the risks?

Risks include discomfort, bleeding, infection, slow healing, particularly on the lower legs, and a scar that is paler, darker, indented or raised. Rarely, a keloid scar can form. There is a small chance that the lesion comes back, which is more likely with skin cancers, so the site should be watched and any regrowth checked.

Results and follow-up

Where tissue has been sent to the laboratory, results are usually available within around two weeks, and a follow-up appointment, which may be virtual, will be arranged to discuss them and check the wound. Please contact the clinic if you notice any lump, scaling or bleeding returning at the treated site.

More information

British Association of Dermatologists patient leaflet on basal cell carcinoma, which describes curettage and cautery as a treatment option: https://www.bad.org.uk/pils/basal-cell-carcinoma

This page gives general information only and is not a substitute for a consultation. Everyone's skin is different, and what is right for you will depend on your own circumstances. If you are worried about a skin problem, please book an appointment with Dr Mounsey or speak to your GP. If you have a mole or skin lesion that is changing, bleeding or growing quickly, please seek medical advice promptly.