what to expect during an ed & c
Electrodessication and curettage is a common treatment for certain types of skin cancer. It is routinely used to treat the two most common types of skin cancers called basal cell and squamous cell carcinoma. It is NOT a treatment for melanoma. After the lesion is anesthetized using a small caliber needle, a circular device (the appearance is similar to a spoon) called a curette is used to scrape away tumor cells. Then the area is cauterized/dessicated to stop any minimal pinpoint bleeding. The process is repeated up to 3 times and the cure rate approaches 90+% for certain tumor types and clinical scenarios. It is most commonly employed for tumors on the trunk and extremities that are relatively small in size. ED&C differs from excision of tumors (i.e. surgically cutting the skin cancer out) in that no tissue is sent for microscopic review. Thus, the physician cannot determine the adequacy of treatment and most follow the lesion over time to monitor for recurrence.
WILL IT HURT?
There is very little to no pain. Before any steps of the procedure are initiated, the lesion is anesthetized with 1% lidocaine (numbing medication). The vast majority of patients are amazed at the lack of discomfort. You may experience movement, tug, and pressure, as these sensations cannot be eliminated. However, we will not allow patients to feel any pain during the procedure.
WHAT SHOULD I TAKE FOR PAIN?
Most patients experience very little pain following the procedure. If any pain is encountered, it is usually relieved by over-the-counter medications and rarely persists beyond the day after the procedure. We encourage our patients to start with acetaminophen (Tylenol®). If the area is more extensive, a prescription strength medication may be given. If possible, avoid aspirin or other NSAIDs (non-steroidal anti-inflammatory) agents such as ibuprofen since they can thin the blood and increase the risk of post-operative bleeding. If you are currently taking aspirin or other blood thinners (i.e. Coumadin, Plavix) for heart issues, you should continue all medications unless instructed to stop by your primary care physician, cardiologist or Dr. Cowan.
DOES IT WORK?
Yes, a reported 94%+ cure rate for certain skin cancers. If excision is used for a benign growth such as a cyst, irritated mole or other lesion, Dr. Cowan will discuss the likelihood of cure before the procedure.
HOW DOES ED&C DIFFER FROM AN EXCISIONAL SURGERY?
ED&C involves scraping the surface of the skin to remove superficial skin cancers. If the tumor cells have invaded deeper into the skin, ED&C is ineffective. An excision involves removing a football shaped portion of skin called an elipse around the portion of the skin cancer easily visible to the naked eye. Unlike an ED&C, the incision is extended to the fat (recall the skin is like a sandwich and has layers; the top layer is very thin, almost microscopic and is called the epidermis; the second layer, the dermis, is what gives skin its structure and tumor cells can extend from the epidermis into this layer; the deepest layer is called the fat or subcutaneous tissue and tumor cells rarely extend to this depth). The tissue is removed and sent to a board-certified dermatopathologist to examine the edges (i.e. margins) to ensure all the tumor was removed.
WILL I HAVE A SCAR?
Yes, any procedure done to the skin involves the risk of a scar. No matter who does the surgery, scars are inevitable. However, there are ways to minimize the appearance of a scar and a dermatologic surgeon has the most experience and expertise in the treatment of skin cancer to achieve the best cosmetic result. Bowling Green Dermatology wants the site to look good and will do everything possible to minimize the scar. There are differences in the final appearance of a scar done by ED&C and that of an excision. Since ED&C involves scraping and cauterization but no sutures (i.e. stitches), the scar is oval or circular. It usually contracts over time and is approximately one-half the size of the original lesion treated. In contrast, excisions are usually closed side to side with stitches. Thus, the resultant scar is usually a thin line.
WHAT CAN I EXPECT AFTER THE TREATMENT?
The treatment site will progress through several predictable stages. Immediately following the procedure, there will be a dark black scab called an eschar (pronounced “ess-CAR”). Leave it in place and do not attempt to pick or rub it off. It is serving as a biologic dressing covering the healing tissue underneath. Over the next few days, the edges may turn red and the scab will start to get moist and loose. This assumes the patient is properly caring for the wound by cleaning the area and applying liberal amounts of the topical antibiotic mupirocin. Eventually, the scab will fall off and the underlying skin will be pink.
HOW WILL I KNOW IF THE SITE IS INFECTED?
Post-procedure wound infection is rare when the wound is taken care of properly. Signs of infection include enlarging painful redness and/or malodorous drainage. If you are concerned, please contact the office immediately.
- Hydrogen peroxide
- Cup (to mix half & half with warm water and hydrogen peroxide)
- Q-tips or gauze (wet them in the peroxide/water solution and gently clean the wound)
- Mupirocin 2% ointment (prescription topical antibiotic provided by Bowling Green Dermatology)