OSCE — electrosurgery and curettage: modality choice, C&E technique, and device safety

Brief (to candidate)

You are in a dermatology minor-procedures clinic. A 70-year-old man has a 1 cm well-defined pearly papule on the upper back consistent with low-risk nodular BCC. He also has a skin tag on the neck he wants removed “with the burning machine.” He has an ICD. You have 8 minutes to explain modality choice, C&E technique, and safety.

Candidate instructions

1. Distinguish electrosurgery from electrocautery and name key modalities.
2. Decide whether C&E is appropriate for the back BCC and why.
3. Describe curettage endpoint and cycle concept.
4. Explain ICD precautions and alcohol fire risk.
5. State when you would refuse destructive treatment (e.g., pigmented uncertain lesion).

Mark scheme (examiner)

Simulated patient / resource facts

• ICD for secondary prevention; last check 6 months ago, functioning.
• No anticoagulation.
• Prefers single-visit treatment if safe.
• If asked: lesion has never been treated; biopsy not yet done — candidate should consider histologic confirmation pathway.

Examiner notes

Pass if candidate risk-stratifies, describes C&E sensibly, and prioritises CIED + fire safety. Fail if they offer hyfrecation for a changing pigmented lesion or claim curettings equal Mohs margins.^[2][7]