Electrosurgery


Minimally invasive surgery in an outpatient setting

You have been diagnosed with skin cancer or you have skin lesions that you think are benign and you would like a treatment that could be carried out in an outpatient setting without going to the operating room.

Cryosurgery may be a valid option, but do you know if it is the right option to solve your problem?

Verónica Ruiz dermatóloga en Barcelona

I am dr.
Verónica Ruiz

Throughout my 15-year professional career as a dermatologist, I have successfully treated numerous superficial skin lesions using cryosurgery with good cosmetic results.

In my opinion, it is a decisive, simple technique that offers good cosmetic results, being able to treat especially superficial benign skin lesions.

Electrosurgery as a minimally invasive surgery option in the dermatology clinic

Electrosurgery is a minor dermatological surgery technique that we often use in our practice to provide cutting or destruction of superficial skin tissue using an electrosurgical device.

With electrosurgery we can solve a large number of superficial skin lesions, especially benign skin lesions, quickly, easily and with very few complications.

No specific preparation is needed on the part of the patient and it is performed on an outpatient basis

Electrosurgery or electrocautery?

We have to differentiate electrosurgery from electrocautery, as they are often concepts that are misused interchangeably.

While electrosurgery applies electrical current to the patient, electrocautery uses thermal energy without passing electrical current to the patient.  In the latter, the electrode heats up due to the resistance produced by the passage of electrical current, heat that is applied directly by contact to the tissue.  Electrocautery systems are available in a small version (like a pen) with a disposable battery.

What is a
electric scalpel?

The electric scalpel or electric scalpel is an electrical device that generates controlled alternating current that applied to a tissue point through an electrode is capable of destroying soft tissue by applying an electric current of certain characteristics through a terminal.  In turn, it can be biterminal (2 electrodes) or monoterminal (1 single electrode). 

In our dermatology practice we use the monoterminal mode due to its adequate performance for a minor surgery.

What type of skin lesions can be treated with electric scalpel?

1

Benign lesions

filiform warts (or skin tags) seborrheic keratosis, flat warts, angiomas, or rub points, spider veins,(telangiectasias),

2

Malignant lesions

actinic keratosis, superficial carcinomas.

In my experience, I usually reserve the electrosurgical unit for use in the office and personally I do not use it as a cutting and / or coagulation technique when removing skin lesions in the operating room, instead of using the cold scalpel and absorbable suture for proper cutting and hemostasis.

The scabs produced in the tissue secondary to the use of the electric scalpel can make the histological interpretation difficult in Mohs surgery.

Frequently asked
questions

Generally, a wound is left open (not sutured) and covered with a sterile dressing; sometimes this dressing has to be somewhat thick and compressive to prevent possible bleeding. 

The patient is recommended to remove the sterile dressing the day after the procedure and perform  normal hygiene on the treated area, applying daily some topical antiseptic (for example iodine or alcohol) to disinfect and help dry the wound and scab formation.

The scab will take 2-3 weeks to fall, leaving a more vulnerable area of skin, so it is very important to apply sun protection during the days and months after the technique is performed to avoid the development of little cosmetic spots (hyperpigmentation).

The main complications to consider when treating a patient with an electrical scalpel are the possibility of delayed bleeding and scarring with hypo or hyperpigmentation (whitish or dark scars).  

To avoid late bleeding (which does not occur immediately but minutes after the technique is performed), a small compression bandage can be placed on the treated area for several hours or a 1 day after the procedure.  To minimize the risk of hyperpigmentation, it is recommended that the patient uses high sun protection during the months after the technique is performed.

Yes.In patients with pacemakers, implantable defibrillators, cochlear implants and neurostimulators, the use electrocautery is recommended since with it there is no current that flows through the patient to compromise the device`s function.

There is NO contraindication to using the electrosurgical unit in the presence of metal dentures, osteoarticular metal prostheses (nails, screws, plates) and the IUD