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Electrosurgery and hair removal
Electrosurgery and hair removal
There are two mechanisms by which hair removal can be achieved through electrosurgery: electrolysis and thermolysis. In electrolysis, a needle electrode is placed into the hair follicle and a direct electrical current (galvanic current) is then applied resulting in a chemical reaction that destroys the hair follicle. In thermolysis, alternating current is applied and the hair follicle is destroyed through thermal damage. Thermolysis is faster than electrolysis, though there is a greater risk of damage to the dermis and ensuing scar formation.36โ38 These are time consuming but are effective methods of hair removal for nonpigmented hairs or in patients with pigmented skin.
Electrosurgery for the treatment of malignant skin lesions
Electrodesiccation and curettage (ED&C) is a common and effective treatment for benign and superficially invasive neoplasms.39โ41 In the right setting, it is quick with less morbidity and cost than surgical excision. It involves two to three cycles of curettage followed by electrodesiccation. The ideal scenario for ED&C is a broad, superficial lesion in an area with thick underlying dermis, that is, the trunk or extremities. ED&C is not an ideal treatment modality for lesions that have the potential for follicular extension, as they are at higher risk for recurrence.1,42โ47
Basal cell carcinoma is perhaps the most common neoplasm treated by ED&C. Recurrent or micronodular/morpheaform basal cell carcinomas should be treated surgically through excision rather than ED&C because they are at increased risk for having deep dermal infiltration. The cure rates with ED&C are highly operator dependent, with cure rates ranging from 88% to 99%. The studies that report the highest cure rates also utilize the largest reported safety margins, ranging from 2 to 8 mm.47 A meta-analysis of basal cell carcinomas treated by ED&C reported a weighted average 5-year recurrence rate of 8%.48
One study examined the determinants of 5-year recurrence rates of 2314 primary basal cell carcinomas treated by ED&C between 1955 and 1982. The only variables that impacted occurrence rate were lesion size and location. Patient age, sex, or duration of the lesion had no impact. Researchers divided the body into three categories: high-, middle-, or low-risk anatomic sites. The high-risk sites included the nose, paranasal, nasolabial fold, ear, chin, mandibular, perioral, and periocular areas. Middle-risk sites were the scalp, forehead, pre- and postauricular, and malar areas. Low-risk sites were the neck, trunk, and extremities. Lesions that were ED&Cโd in lowrisk areas had a 3% recurrence rate within 5 years regardless of the lesionโs diameter. Middle-risk sites had a 5-year recurrence of 5% for lesions <10 mm in diameter and a 23% risk for recurrence with lesions >10 mm. High-risk sites had a 5-year recurrence
rate of 5% for lesions <5 mm and 18% for lesions >6 mm.49