This works because abnormal tissue is often softer than the normal skin around it. A curette is a small ring or spoon with a sharpened edge. Drawn firmly across a seborrheic keratosis, a wart, a molluscum bump or a basal cell carcinoma, it catches and scrapes away the soft abnormal tissue and stops when it meets firm, normal dermis. The operator feels that change in texture, and that feel is what guides the depth.
The scraping leaves a raw, bleeding, saucer-shaped crater. A fine electric tip is then touched to the surface. It passes a high-frequency current into the tissue, which heats it, seals the small blood vessels and destroys a thin extra layer of cells. That extra layer is the point — it kills what the curette may have missed at the edges.
For a skin cancer, the whole cycle is usually repeated two or three times: scrape, burn, scrape again, burn again. Each round takes a little more.
The important limitation follows directly from the method. The tissue is destroyed and fragmented rather than removed intact, so a pathologist cannot check whether the edges were clear. There is no way to confirm that a tumour was completely treated. That is the single reason this technique is confined to small, thin, well-defined, low-risk tumours in places where a recurrence would be spotted early and dealt with easily — the trunk, arms and legs — and is not used on the face, ears, nose, lips or eyelids.
Because it heats tissue, it also carries the pigment risk that goes with heat: melanocytes can be destroyed in the treated area, and the healed scar often ends up lighter than the skin around it.
Very little.
Eat beforehand.
Do not stop a blood thinner unless you are specifically told to. Electrosurgery seals bleeding as it goes, so this is one of the easier procedures to do on an anticoagulant.
One genuine exception: tell your provider if you have a pacemaker or an implanted defibrillator. Electrosurgical current can interfere with these devices. It is usually still done, but with a different setting or a different technique, and they need to know in advance.
Mention a lidocaine allergy, diabetes, a history of keloids, or immune-suppressing medication.
Do not put creams or makeup on the area that morning.
Wear something that gives easy access to the site and that you would not mind marking.
If a child is having molluscum treated, ask about numbing cream — it needs 30 to 60 minutes on the skin under a dressing before the appointment, so it usually has to be applied at home.
No fasting, no driver, no time off.
This is a procedure with sounds and smells that nobody warns people about, and they are the part that unsettles people most.
You sit or lie down. The site is cleaned with cold antiseptic and often marked. A small sticky pad may be placed on your arm, thigh or back — that is the return electrode for the electrosurgical unit, and it does nothing except complete the circuit.
A fine needle goes in beside the lesion. Sharp prick, then a burning, stinging ache for five to fifteen seconds as the anaesthetic spreads. That burning is the lidocaine, which is acidic. Buffering or warming it noticeably reduces the sting, and it is fine to ask.
Your heart may flutter for a minute from the adrenaline in the anaesthetic — expected.
That injection is the whole of the discomfort. What comes next is pressure and noise.
Once numb, you are asked whether you can feel a pinch. Then the curette is drawn firmly across the growth. You feel strong scraping and pressure, a bit like something being scoured off the skin, and no pain. It takes a few seconds. There may be a scraping sound. The site bleeds — more than people expect for such a small procedure — and that is normal and short-lived.
The electric tip is brought to the base. You will hear a buzz, a crackle or a high-pitched whine, and often a small snapping sound. You will smell smoke that most people describe as burnt hair or burnt meat. Some clinics use a small suction device to clear it, and many do not.
That smell is your own tissue, it is completely normal, and it is the single detail people say afterwards that they wish someone had mentioned. It does not mean anything is going wrong, and it does not hurt, because the area is numb. You may feel warmth or a dull pressure, nothing more.
For a skin cancer the scrape-and-burn cycle is usually repeated two or three times. Each round is another 20 to 30 seconds.
The wound is left open, with an ointment and a dressing. No stitches. It looks like a small round crater or a burn, and that is what it is.
One lesion takes 5 to 10 minutes. A skin cancer with three cycles takes 10 to 20. The appointment including consent is 20 to 30 minutes.
Yes, immediately. No sedation, nothing that impairs you, no restrictions. Most people go back to work the same day.
This wound is left open on purpose and heals from the bottom up, which is slower and messier-looking than a stitched wound. That is normal and it is what people find hardest to believe.
Numbness wears off in one to three hours, and then it stings like a burn. Paracetamol is usually enough. Keep the dressing on for 24 hours.
Some oozing is normal. Firm pressure for 15 minutes stops any bleeding.
This is the part that needs doing properly. Wash the wound gently with soap and water once a day, pat dry, apply a generous layer of plain petroleum jelly, and cover it with a non-stick dressing. Every day, without letting it dry out.
Petroleum jelly, not antibiotic ointment — antibiotic ointments do not lower infection rates on a clean wound and cause an allergic contact rash in a notable number of people, which then gets mistaken for infection.
A moist wound heals faster and scars less than one that dries into a hard scab. The wound will look wet, yellow and unpleasant during this stage. Yellow slough is not pus and it is not infection — it is normal healing tissue.
Shower normally. No baths, pools, hot tubs or saunas until it has closed.
The crater fills in with new pink tissue and skins over from the edges. On the face this may be two weeks. On the trunk three to four. On the lower leg it commonly takes six weeks or more, because wounds below the knee heal slowly — this is worth knowing before agreeing to have a lesion on the shin treated this way.
A round, flat scar, usually noticeably paler than the surrounding skin and sometimes slightly depressed. It fades and softens over a year and then stops changing. It never disappears.
Sunscreen on the healing scar daily for the first year reduces how much it stands out.
If a skin cancer was treated, the site is checked at intervals. Because margins were not confirmed, follow-up is how recurrence gets caught, and it matters more here than after an excision.
The growth is gone the moment the procedure ends. What follows is healing, not waiting for a result.
Seborrheic keratoses and molluscum treated this way rarely return at the same site. New ones elsewhere are unaffected — nothing about this stops them appearing.
Warts do sometimes recur, because the virus persists in the surrounding skin. Curettage is usually a later choice for warts rather than a first one, precisely because it leaves a wound that takes weeks to heal and can scar. On the sole of the foot, that scar can stay tender for a long time, which is a genuine reason to think twice.
Basal cell carcinoma treated with curettage and electrodesiccation, when the tumour is small, thin, well-defined and on the trunk or limbs, has cure rates reported at roughly 90 to 95 percent — comparable to excision for that narrow group. Used outside that group, on the face or on thicker or recurrent tumours, cure rates fall substantially. That is the entire reason for the restrictions.
The unavoidable limitation is that nobody can tell you it was completely removed, because there were no margins to check. That is why follow-up appointments matter more after this than after an excision. A recurrence typically shows up within one to three years as a small pearly bump, a scab that will not settle, or a spot that bleeds at the edge of the scar. Recurrent tumours are treated with excision or Mohs, not with another round of scraping.
The scar is permanent. Round, flat, usually pale, close to final by a year.
There is no home version of this, and the equipment sold as one is a genuine problem.
Battery-powered "plasma pens," "mole removal pens" and skin-tag cauterisers are widely sold online. They burn skin. They are used without local anaesthetic, without any way to judge depth, without sterility, and without anyone diagnosing what is being burnt. Reported outcomes include full-thickness burns, permanent white or dark marks, and craters far worse than the growth. They are not the clinic device with the power turned down; they are an uncontrolled burn.
The more serious problem is the one you cannot see. A basal cell carcinoma can look like a shiny bump. An early melanoma can look like an ordinary mole. Burnt off at home, the tissue is destroyed, nobody examines it, the surface heals — and whatever is left keeps growing under the new scar, sometimes for years, until it is a much bigger problem. That risk applies equally to cutting a growth off, tying it off with thread, and caustic pastes such as black salve.
Said once, plainly: do not cut, burn or tie off a growth at home. If it is worth removing, it is worth knowing what it was.
What is worth doing at home is the aftercare, and it genuinely changes the outcome. Wash the wound daily, keep it covered with petroleum jelly and a non-stick dressing until it has closed, do not let it dry into a hard scab, and use sunscreen on the healed scar for the first year.