What is Electrosurgery?

Electrosurgery (diathermocoagulation or electrocautery) is a widely used method in Invasive Dermatology. The same principles that apply to any electrosurgery procedure apply to electrosurgery for dermatology. The electrosurgical procedure involves using a special device. The device cuts, desiccates (dries the area), coagulates (forms blood clots) and fulgurates (destroys and removes) tissues.The term electrocautery is most often used in reference to a device in which a direct current is used to heat the cautery probe. As no current flows through the patient, this is not a true form of electrosurgery. It is therefore preferable to use the term thermocautery for these devices.

Electrosurgery includes:

  • Electrofulguration, results in sparks
  • Electrodesiccation, dehydration of superficial tissues
  • Electrocoagulation, causes clotting of the bleeding blood vessels
  • Electrosection, cutting through tissues using current
  • Electrolysis, using the heat of electrical current for hair removal or
  • removal of marks and stains
  • Thermocautery
  • Radiofrequency devices (very high frequency, for cutting [>1,500kHz])

How is electrosurgery performed?

Electrosurgery is performed with the use of a generator (also referred to as an electrosurgical unit, electrical current supply or waveform generator), and a handle with one or more electrodes. When the device is used to cut or coagulate in surgical procedures, it is called a “Bovie” after the man who invented it. In electrosurgical procedures, the tissue is heated by electrical current. Although electrical devices may be used for cautery of the tissue in certain applications, electrosurgery is usually used to refer to a completely different method form that of electrocautery. Electrocautery uses heat conduction from a probe that is heated by direct electric current. This may be accomplished by direct current from dry-cells in a penlight-type device. Electrosurgery, by contrast, uses alternating current to heat the tissue itself. This results in the destruction of small blood vessels and halting of bleeding, making in technically an electrocoagulation procedure.

Skin conditions in which electrosurgery is used

Electrosurgery is widely recognised for its value in treating skin conditions. It has replaced the lancet in many procedures, including the removal of benign and malignant cutaneous lesions. In the future it is believed that electrodes will completely replace the lancet, even for surgeries in deeper tissues. Electrosurgery is the recommended procedure for the removal of most types of skin lesions. Cutaneous conditions that are usually treated with electrosurgery are:

  • Non-cancerous moles (Electrosurgery is not used for excision of suspected or confirmed melanomas)
  • Common skin tags
  • Warts
  • Small basal cell carcinomas less than 5 mm in diameter
  • Squamous cell carcinoma (SCC) that is in situ
  • Angiomas and pyogenic granuloma
  • Seborrhoeic keratoses
  • Certain types of acne (comedonal acne)
  • Scarring

What are the possible complications of electrosurgery?

The procedure can be performed on an outpatient basis using local anaesthesia. Patients may feel a pushing sensation or pressure, but should not feel pain during the procedure. Given the fact that there are certain adverse effects in electrosurgery (e.g. burns, interaction with other electrical devices), the procedure should only be performed by a doctor, who is specially trained in this field, and who is familiar with the techniques used to avoid burns.