II. Indications

  1. Recalcitrant warts
  2. Basal Cell Carcinoma

III. Precautions

  1. Risk for painful scars (even by experienced Doctor)
  2. Lesions larger than 1 cm should be excised instead

IV. Precautions

  1. Wear a well-fitted mask (that filters HPV)
    1. Prevents verrucous laryngeal papillomas (rare)
      1. Can result in Squamous Cell Carcinoma
    2. Smoke evacuators also recommended
  2. Undertreat
    1. Avoids painful scarring

V. Technique

  1. Use Local Anesthesia
  2. Use mask and smoke evacuation as described above
  3. Insert electric needle into the wart
  4. Apply low-medium current for 5-10 seconds
    1. Until wart whitens and becomes boggy
  5. Follow current with Light curettage
  6. Coagulate bleeding with pressure and 88% TCA
  7. Residual wart tissue appears as blanched, punctate

VI. Follow-up

  1. Apply topical antibiotic ointment and dressing
  2. Postoperative pain is less than with Cryotherapy

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