Optimizing curettage with a ‘backhand’

Editor Curettage is a simple and common dermatological surgical technique used to remove benign and malignant skin lesions.¹ In the United Kingdom disposable ring curettes are the most commonly used instruments to perform curettage compared with the traditional -metallic spoon-shaped instruments.²

When performing curettage the operator may apply the ‘fountain-pen technique’ or ‘potato peeler technique’.³ Typically a lesion is curetted by using the sharp edge of a ring curette by moving the hand in a downward and inward motion (towards the operator) (Fig. 1). This vector of movement, however, has a tendency to create a deep wound, especially in the atrophic, fragile skin of the elderly.

Figure 1.  The common ‘forehand’ method of curettage, with the down and inward movement of the curette blade.

A subtle variation (combined with a knowledge of racket sports!) in the above technique, however, can minimize the tendency to produce a deep wound. By simply initiating the curettage as a ‘backhand’ (i.e. moving up and away from the operator, Fig. 2) as opposed to the aforementioned ‘forehand’ technique, the risk of producing a deep wound is minimized and in our experience results in superior healing and ultimately a better cosmetic outcome.

Figure 2.  Proposed ‘backhand’ method of curettage in a direction away from the operator with the wrist ultimately moving in an upward direction.