Abstract
Electrodesiccation and curettage (ED&C) is a widely used treatment for certain types of non-melanoma skin cancers, particularly basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). While this method is effective in removing superficial lesions, its use on the face presents unique challenges. This article reviews the clinical outcomes of ED&C on facial lesions, focusing on the cosmetic consequences and the heightened risk of cancer recurrence. Based on existing research, ED&C on facial skin is often associated with unsatisfactory cosmetic results and a higher recurrence rate, especially compared to other treatment modalities like Mohs micrographic surgery.
Introduction
Non-melanoma skin cancers (NMSCs), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are the most common types of skin cancer worldwide. Although these cancers are rarely life-threatening, their treatment, particularly on aesthetically sensitive areas such as the face, presents significant challenges. Electrodesiccation and curettage (ED&C) has been a standard treatment for superficial NMSC due to its simplicity, cost-effectiveness, and relatively short procedure time. However, when used on facial lesions, concerns arise regarding both the cosmetic outcomes and the risk of cancer recurrence.
This blog aims to explore the limitations of ED&C when used for treating facial NMSCs, focusing on cosmetic results and recurrence rates.
Electrodesiccation and Curettage: Procedure Overview
ED&C is a minor surgical procedure that involves two key steps: curettage, in which a curette is used to scrape away cancerous tissue, and electrodesiccation, in which an electric current is applied to destroy any remaining cancer cells and control bleeding. This process is typically repeated multiple times during the same session to ensure that as much cancerous tissue as possible is removed.
ED&C is particularly useful for treating low-risk, superficial skin cancers, such as:
– Small basal cell carcinomas (BCC)
– Superficial squamous cell carcinomas (SCC)
– Actinic keratosis (precancerous lesions)
While ED&C can effectively eliminate small, low-risk skin cancers, its application on the face is more complex due to the thinness of the skin, aesthetic concerns, and the risk of leaving residual cancerous tissue behind.
Cosmetic Outcomes of ED&C on the Face and Facial Hair
Scar Formation and Aesthetic Issues
One of the primary concerns with ED&C on the face is the cosmetic result post-procedure. Unlike other parts of the body where scarring may not be as noticeable, facial skin is thinner and more prone to visible scarring, discoloration, and textural changes after ED&C. The process of scraping and subsequent burning during electrodesiccation can result in uneven scarring, particularly on delicate areas such as the nose, eyelids, and lips.
Several studies have documented unsatisfactory cosmetic outcomes following ED&C on the face, with patients often reporting:
– Hypertrophic scars: Raised, thickened scars that can be difficult to conceal.
– Hypopigmentation: Loss of skin color in the treated area, leading to a noticeable contrast between the treated and untreated skin.
– Atrophic scarring: Depressed, sunken scars that can detract from the natural contours of the face.
– Textural irregularities: The destruction of normal skin architecture during electrodesiccation can result in uneven skin texture, with rough or pitted areas that may be difficult to treat post-procedure.
Patient Satisfaction
While ED&C is generally well-tolerated, the cosmetic outcomes on facial skin can lead to dissatisfaction among patients, particularly in those who undergo the procedure in highly visible areas. A study by Stasko et al. (2007) noted that patients who received ED&C on their faces often reported lower satisfaction with cosmetic outcomes compared to those who underwent alternative treatments, such as excisional surgery or Mohs micrographic surgery. Given the growing emphasis on both oncologic and aesthetic outcomes in skin cancer treatment, the unsatisfactory cosmetic results of ED&C present a major limitation.
Risk of Skin Cancer Recurrence
Recurrence Rates of Basal Cell Carcinoma and Squamous Cell Carcinoma after ED&C
One of the most significant concerns with ED&C, particularly when performed on the face, is the increased risk of recurrence. The recurrence rates of skin cancers treated with ED&C vary based on several factors, including tumor type, size, depth, and location. Studies have indicated that while ED&C may be effective for treating small, superficial tumors, its efficacy diminishes when treating larger or more invasive cancers, particularly on the face.
A study conducted by Silverman et al. (1991) reported that the recurrence rates for BCC treated with ED&C were approximately 3-7% for small, well-defined lesions located on non-facial areas. However, when the treatment was applied to facial lesions, the recurrence rate rose to approximately 10-15%, depending on the size and depth of the tumor.
For SCC, the recurrence risk is even more concerning. While SCC tends to be more aggressive than BCC, ED&C is often less effective in removing the entirety of the tumor due to its infiltrative nature. A retrospective study by Ceilley and Del Rosso (2006) found that SCCs treated with ED&C on the face had a recurrence rate of approximately 8-13%, compared to lower rates when treated with other methods such as excision or Mohs surgery.
Factors Contributing to Recurrence
Several factors contribute to the increased risk of recurrence when using ED&C on facial skin, including:
1. Inadequate Tumor Removal: Unlike Mohs surgery, which involves real-time microscopic examination of excised tissue, ED&C relies on the clinician’s visual and tactile assessment of the lesion. This can result in incomplete removal of the tumor, particularly for cancers with poorly defined borders or infiltrative growth patterns.
2. Location on the Face: Facial skin is anatomically complex, and certain areas, such as the nose, periorbital region, and ears, pose greater challenges for complete tumor removal. Tumors located in these areas may have deeper roots that are not fully addressed by curettage alone, increasing the risk of recurrence.
3. Tumor Size and Depth: Larger tumors, or those that extend deeper into the dermis, are more likely to recur following ED&C. The technique’s inability to precisely remove tissue at depth makes it less suitable for thicker or more invasive lesions.
Comparison with Other Treatment Modalities
Mohs Micrographic Surgery
Mohs micrographic surgery (MMS) is considered the gold standard for treating facial skin cancers due to its high cure rates and tissue-sparing technique. Mohs surgery involves the systematic removal of cancerous tissue layer by layer, with each layer examined microscopically until no cancerous cells remain. This technique has demonstrated much lower recurrence rates compared to ED&C, with cure rates of 99% for primary BCC and 97% for SCC.
Additionally, MMS offers superior cosmetic outcomes, as the precise removal of cancerous tissue spares as much healthy tissue as possible, minimizing scarring and textural irregularities. For patients concerned with both oncologic and aesthetic outcomes, Mohs surgery is generally preferred over ED&C for facial skin cancers.
Excisional Surgery
Excisional surgery, in which the entire tumor is removed along with a margin of healthy tissue, also provides lower recurrence rates than ED&C. While the procedure may result in a linear scar, it allows for more complete removal of the tumor, particularly for larger or deeper lesions. The scar resulting from excisional surgery can often be minimized with proper wound closure techniques, offering better cosmetic results than ED&C.
Conclusion
Electrodesiccation and curettage, while effective for certain non-melanoma skin cancers, poses significant limitations when used on facial skin. The procedure is associated with unsatisfactory cosmetic outcomes, including hypertrophic scarring, hypopigmentation, and textural irregularities, which are particularly concerning in aesthetically sensitive areas like the face. Furthermore, the risk of skin cancer recurrence is higher when using ED&C on facial lesions, especially for larger or more invasive tumors.
Given these concerns, alternative treatment modalities such as Mohs micrographic surgery and excisional surgery are often preferred for treating facial skin cancers. These techniques offer both superior cure rates and better cosmetic outcomes, making them the standard of care for most facial lesions. In conclusion, while ED&C remains a useful tool in dermatology, its role in the treatment of facial skin cancers should be carefully considered, with other options explored for optimal long-term results.
References
– Stasko, T., Brown, M., Carucci, J. et al. (2007). Aesthetic Outcomes in Dermatologic Surgery: A Retrospective Study. Journal of the American Academy of Dermatology, 56(2), 280-286.
– Silverman, M. K., Kopf, A. W., Grin, C. M., et al. (1991). Recurrence Rates of Treated Basal Cell Carcinomas: Part I: Overview. Journal of Dermatologic Surgery and Oncology, 17(9), 713-718.
– Ceilley, R. I., & Del Rosso, J. Q. (2006). Current Modalities and New Directions in the Treatment of Basal Cell Carcinoma. Journal of Clinical and Aesthetic Dermatology, 3(7), 6-10.