Curettage and cautery

Principle

Curettage and cautery - scraping a lesion away with a curette followed by electrocautery/diathermy to achieve haemostasis and destroy residual tissue at the base - a common office technique for certain benign and low-risk lesions
Widely used for lesions with a soft consistency that curettes away readily from firmer surrounding normal skin, distinguishing benign/superficial lesions (which curette easily) from more invasive processes (which do not)
The technique exploits the differing tissue consistency between many benign/superficial lesions and normal dermis - a lesion that curettes away cleanly, leaving a well-defined base, supports a benign/superficial process, while a lesion with poorly-defined margins or resistance to curettage should raise suspicion of a more invasive process requiring formal excision instead

Appropriate for seborrhoeic keratoses, some viral warts, pyogenic granuloma, and some superficial basal cell carcinomas in appropriate low-risk settings
The curetted tissue can be sent for histology (unlike cryotherapy), providing some diagnostic information, though less complete than an excisional specimen with defined margins

Leaves a wound that heals by secondary intention over 1-3 weeks depending on size/depth; scarring is generally minimal for superficial lesions but can be more noticeable for deeper/larger lesions
Not appropriate where a firm, poorly-demarcated, or deeply invasive lesion is suspected - these should proceed to formal excisional biopsy instead for both diagnostic and margin-control purposes

Seborrhoeic keratosis, pyogenic granuloma, viral warts, superficial basal cell carcinoma (selected cases)

The tactile feedback during curettage (a lesion "shelling out" cleanly vs resisting removal) is itself a useful, if imprecise, diagnostic clue - a lesion that does not curette away easily should prompt reconsideration of the technique and diagnosis rather than persisting with more aggressive curettage

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