Battery-Powered Electrocautery and Curettage vs Electrodesiccation and Curettage for the Treatment of Nonmelanoma Skin Cancer

Electrodesiccation (a form of electrosurgery) with curettage (EDC) is commonly performed in rural populations to destroy nonmelanoma skin cancer (NMSC) at the time of biopsy, saving added trips for patients. It uses high-voltage, high-frequency current without a dispersive electrode (monopolar or monoterminal).¹ Electrosurgery poses small risk to patients with implantable electronic cardiac devices (IECDs), and IECD interference during electrosurgery is occasionally accompanied by inappropriate rhythm manipulation or defibrillation.^2-4 We routinely use battery-powered electrocautery and curettage (BEC) with a single-use battery-powered electrocautery device instead of hyfrecation in patients with IECDs. Battery electrocautery uses thermal energy to produce hemostasis and tissue destruction without delivering electrical current to the patient,¹ lowering risks of IECD interference.^1,5 The aim of this study was to assess whether cure rates of these 2 modalities are equivalent when destroying NMSC.

In this retrospective comparative effectiveness study, we reviewed medical records of patients with IECDs who had BEC of NMSC and follow-up surveillance evaluations at Marshfield Clinic Health System dermatology locations between January 1, 2000, and January 1, 2022. All surveillance examination documentation, including visits beyond 5 years, were reviewed. Use of BEC was confirmed by clinical documentation. Tumors were matched 1:2 between patients and controls, who received EDC, during the same period (Table 1). Data were analyzed December 1, 2020, to January 1, 2022. The study was approved by the Marshfield Clinic Research Institute institutional review board, and informed consent was waived because only deidentified data were used. This study followed the ISPOR reporting guideline.

Most BEC and EDC occurred at the time of initial biopsy with intention-to-treat suspected NMSC. The most frequent destruction technique used 3 cycles of curettage, ranging from 1 to 3 cycles. Timing and cycle number were not controlled for as independent variables. Tumors were tracked individually. Lesion location was recorded using published L, M, and H area designations (Table 2).⁶ Tumors were considered recurrent if documented to be clinically recurrent or by manual review of photographic documentation.

Five-year recurrence rates were reported with Clopper-Pearson 95% CIs. A 2-sample test of proportions with Yates continuity correction was used to compare differences in recurrence by procedure type. All comparisons were 2-tailed, with P < .05 considered significant.

A total of 167 tumors were treated with BEC from 86 unique patients, and 334 tumors were treated with EDC from 252 unique controls. Baseline demographic characteristics are presented in Table 1.

The 5-year recurrence rates of NMSC removed by BEC and EDC were 3.6% and 4.2%, respectively. There was no significant difference in the 5-year recurrence rates of either squamous cell carcinoma or basal cell carcinoma between groups. Recurrence rates of tumor subtypes and location are reported in Table 2.

A 2001 survey of 166 Mohs surgeons regarding experiences using electrosurgery in patients with IECDs found that complication rates were low (1.6 cases of interference per 100 surgeon-years and 0.8 adverse events per 100 years of surgical practice). However, 34% of respondents reported using only electrocautery devices, and 19% reported using bipolar forceps, which cause negligible IECD interference.²

Although it is infrequent, multiple studies report detection of electric current with potential to inappropriately trigger IECDs during electrosurgery.^3,4 Electrocautery carries the lowest risk of all electrosurgical techniques. We found that the 5-year cure rate of BEC was not significantly different than for EDC. Aside from minor differences in supply needs and tissue responses, procedural techniques and workflows of the 2 procedures are nearly identical.

Strengths of this study include a large, matched study population with 5-year dermatologic follow-up. Limitations include the retrospective single-center design. Because of regional demographic factors, all patients identified as White. We did not control for practitioner type or differences in destruction technique. Supply cost analysis was beyond the scope of the study.

The results of this study suggest that NMSCs treated with BEC have cure rates comparable to those of EDC.

Accepted for Publication: March 22, 2022.

Published Online: May 18, 2022. doi:10.1001/jamadermatol.2022.1450

Corresponding Author: Erik J. Stratman, MD, Department of Dermatology, Marshfield Clinic Health System, 1000 N Oak Ave, Marshfield Clinic, 3P2, Marshfield, WI 54449 (stratman.erik@marshfieldclinic.org).

Author Contributions: Dr Stratman had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Veverka.

Obtained funding: Veverka.

Administrative, technical, or material support: Veverka.

Supervision: Stratman.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was funded by the Division of Education at Marshfield Clinic Health System.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.