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You can see it in just about every dermatology office. Most patients know if by its high pitched “beep” and unfortunate smell that follows treatment. So it’s quite natural to wonder: What is that cautery machine and what does it do?
Cauterization involves the burning of part of the body in attempts to remove or destroy a benign or malignant growth, close off tissues, and/or reduce the chance of a complication, such as bleeding or infection. “This process actually dates back to ancient times when hot metal was used to ‘brand’ tissue in attempts to coagulate blood and stop bleeding,” says Dr. Adam Mamelak, board-certified dermatologist and skin surgeon in Austin, Texas. Early cauterization techniques however caused extensive tissue damage, often doing more harm that good. Thankfully, this procedure has evolved over the years.
“Well, we are no longer stoking a hot poker in the fire,” says Dr. Mamelak. Electricity, or electrosurgery, has made this technique far easier to deliver and to treat patients.
Heat cautery is still employed, typically by passing a direct current through a metal applicator. The applicator becomes super heated and can then be applied to tissue. “While the delivery might be a bit more elegant, the potential to damage tissues is still there,” explains Dr. Mamelak. Dr. Mamelak reserves this type of electosurgery for patients with pacemakers or implantable defibrillators, devices with the potential to be stimulated and offset by other types of electorsurgery.
Other types of electrosugery, including electrodessication and electrofulguration. These approaches utilize alternating electrical current, and have the ability to deliver heat more precisely, without causing as much collateral damage to tissue.
Electrodessication has many uses that include cauterization, as well as the removal of small bumps on the skin.
“Electrodessication can be extremely important in skin biopsies, allowing for hemostasis after a specimen is removed and causing an end to bleeding,” says Dr. Miriam Hanson, a board-certified Dermatologist at Sanova Dermatology. The machine, often called a Bovie, uses a precise electric current, applied to an area of the skin, to dehydrate cells and destroy lesions.
“Not only does this help to stop bleeding, it is also a very cosmetically effective way to seal the skin,” Dr. Hanson continues. This process is also useful for the removal of small bumps on the skin, like milia, skin tags, keratosis, and warts.
The same device can also be used to treat some superficial skin cancers, where it is often combined with curettage.
Patients are awake for most of the electrosurgery treatments performed in the dermatology office. The skin may or may not be numbed beforehand with topical or local anesthetic, and the procedure generally only takes a few seconds.