On this page
Study tools
Write your answer
Saved on this device. No marking — you are the marker.
Stem
A 68-year-old man has a 9 mm pearly, rolled-border papule with surface telangiectasia on the upper back. Dermoscopy supports nodular basal cell carcinoma. He has a dual-chamber pacemaker for complete heart block. He asks whether the lesion can be “burned off” in clinic today.
Questions
a) Define electrosurgery and distinguish it from electrocautery. (2 marks)
b) Name the four classical electrosurgical modalities and state which are typically monoterminal. (2 marks)
c) Outline the step-by-step technique of curettage and electrodesiccation if this lesion is judged low-risk for C&E. (3 marks)
d) List key safety precautions relevant to his pacemaker and to fire risk. (3 marks)
Model answer
a) (2 marks) — Electrosurgery uses high-frequency alternating current delivered into tissue so resistive heating produces controlled desiccation, fulguration, coagulation, or cutting. Electrocautery heats a metal tip within the instrument; the hot tip is applied to tissue and no electrical circuit passes through the patient.[2]
b) (2 marks) — Electrodesiccation, electrofulguration, electrocoagulation, and electrosection. Desiccation and fulguration are classically monoterminal (high voltage, low amperage; hyfrecator-type). Coagulation and section are typically biterminal (active electrode plus dispersive pad).[2]
c) (3 marks) — Confirm low-risk features and counsel scar/recurrence. Local anaesthetic; alcohol prep fully dry. Curette soft tumour to a firm dermal base with a small peripheral rim. Electrodesiccate base and rim. Repeat curettage of residual soft/charred tissue and re-desiccate. Dress and arrange surveillance; curettings may confirm histology but do not prove clear margins.[2]
d) (3 marks) — Pacemaker: document device; prefer bipolar haemostasis if energy needed; short intermittent bursts; keep current path away from generator/leads; consider monitoring/cardiology advice; do not assume zero interference. Fire: ensure alcohol is completely dry before any spark; avoid free-flow oxygen enrichment across the field; use smoke evacuation/PPE for plume when available.[1][2]
References2ShowHide
- [1]Amin SD, Homan KB, Assar M, et al. Hyfrecation and Interference With Implantable Cardiac Devices Dermatol Surg, 2020.PMID 31652225
- [2]Taheri A, Mansoori P, Sandoval LF, et al. Electrosurgery: part II. Technology, applications, and safety of electrosurgical devices J Am Acad Dermatol, 2014.PMID 24629362