Two of the most common procedures that are performed to remove skin cancers are curettage and electrodesiccation (C&E) and excision. These are explained in greater detail below.

Curettage and electrodesiccation (C&E)

C&E is a procedure that involves the use of a sharp round instrument to curette, or "scrape out" the lesion. This is followed by electrodesiccation, which uses electricity to treat the remainder of the lesion. No sutures are needed, and most of the time the entire procedure takes less than 15-20 minutes. Complete wound healing usually takes 2-3 weeks and requires daily wound care.

The long-term cosmetic results after C&E are typically very acceptable. The scar is usually round to oval, flat, and paler in color than untreated skin. Certain areas of the body, however, such as the upper trunk, shoulders, and hands may be more prone to developing a raised, or hypertrophic, scar. If this occurs, treatments are available to help flatten out the scar.

C&E is a very straightforward procedure that results in excellent cure rates. For primary basal cell carcinomas (BCC's), 5-year recurrence rates are around 7.7%* This means that 92.7% of patients undergoing C&E for BCC's do not have recurrences within 5 years.

Excision

Excision involves the use of a scalpel to cut out the skin cancer. The resulting wound is typically then closed with sutures. This a somewhat more involved procedure than curettage and electrodesiccation, but is often preferred for recurrent skin cancers, more aggressive skin cancers, or skin cancers on areas of the body where a round scar would not be cosmetically appealing. The sutures are typically removed anywhere from 1-2 weeks after the excision, but this will vary depending on different factors. Daily wound care is required while the sutures are present.

The typical scar after a skin cancer excision is a straight or curved line that can be slightly raised or depressed. Certain areas of the body tend to have better cosmetic results than others. The face and neck typically heal very well, whereas the trunk and shoulders can be left with more noticeable scars. The trunk is especially prone to scars "widening" over time.

Excision offers excellent cure rates similar to curettage and electrodesiccation. 5-year recurrence rates for primary BCC's treated by excision are around 10.1%*

Which procedure to choose?

In the end, both excision and electrodesiccation and curettage offer similar cure rates. The decision to undergo one vs the other (or other treatment options) should be made after discussion with your physician. Usually there will be one or more factors that will help guide the decision. These can include:

• The patient's age and medical condition
• Location of the skin cancer
• Type and severity of the skin cancer
• Activity level
• Long-term cosmetic results
• Primary vs recurrent skin cancer

*Cutaneous Medicine and Surgery, Arndt et al, W.B. Saunders, 1996; pg 1393.