The purposes of electrosurgery are to destroy benign and malignant lesions, control bleeding, and cut or excise tissue. The major modalities in electrosurgery are electrodesiccation, fulguration, electrocoagulation, and electrosection. Electrosurgery can be used for incisional techniques that produce full-thickness excision of nevi, for shave techniques that produce partial-thickness removal of superficial lesions, and for removing vascular lesions such as hemangiomas or pyogenic granulomas. The correct output power can be determined by starting low and increasing the power until the desired outcome is attained (destruction, coagulation, or cutting). Smaller cherry angiomas can be electrocoagulated lightly. Larger cherry angiomas may be easier to treat by shaving them first, then electrocoagulating or desiccating the base. The elevated portion of pyogenic granulomas can be shaved off with a scalpel or a loop electrode using a cutting/coagulation current. The base of the lesion is curetted to remove the remaining tissue and then electrodesiccated. Complications such as burns, shocks, and transmission of infection can be prevented by careful use of the electrosurgical equipment.
Electrosurgery is used to destroy benign and malignant lesions, to control bleeding, and to cut or excise tissue.1–3 Electrosurgery is simple to perform and is useful for treating a variety of skin lesions, especially small superficial lesions (skin tags and small angiomas). The major modalities in electrosurgery are electrodesiccation, fulguration, electrocoagulation, and electrosection.
Modern, high-frequency electrosurgical devices transfer electrical energy to human tissue via a treatment electrode that remains cool. Most electrosurgical units work at frequencies just below the AM radio frequency band. The electrical resistance of human tissue helps convert this electrical energy into molecular energy, which causes denaturation of intracellular and extracellular proteins, resulting in coagulation or desiccation effects. Raising intracellular water above the boiling point causes cell membrane rupture to produce a cutting effect.
Electrosurgery has many applications in cutaneous surgery: incisional techniques that produce full-thickness excision of nevi; shave techniques that produce partial-thickness removal of superficial lesions, such as warts, without the need for suturing; and removal of vascular lesions such as hemangiomas or pyogenic granulomas with little or no blood loss. Electrosurgery has become familiar to family physicians who treat cervical dysplasia using the technique of loop excision of the transformation zone of the cervix. This technique is performed using the same electrosurgical equipment and procedures as in skin surgery.
Electrosurgery is often incorrectly referred to as electrocautery. In electrocautery, the electrode tip, rather than human tissue, serves as the source of electrical resistance. In electrocautery, the electrode tip becomes hot and can cause a burn in tissue. While electrocautery is a form of electrosurgery, it is inaccurate to refer to electrosurgical techniques that use a cool electrode tip as electrocautery.