There are many instances when electrosurgery (with or without curettage) can be used in lieu of excision. Electrosurgery can be performed more quickly than excision because there is little bleeding and suture closure is not carried out. Because the wound heals by secondary intention, however, healing time is long (2 to 3 weeks), and the resultant scar is larger and may be less cosmetically acceptable than it would be after excision. Moreover, since the tissue being treated is destroyed, there is no tissue specimen available for histologic examination. Of course, a biopsy can be carried out prior to electrosurgical destruction, but this still means there will be no way to microscopically check the margins of the lesion.

The device used for electrosurgery can be either a monopolar device such as the Hyfrecator, which requires no grounding plate, or a bipolar device such as the Bovie, which requires that the patient be grounded. In both instances, the destructive effect is obtained via a rapidly oscillating electrical field that disrupts cells both thermally and mechanically.

In carrying out monopolar electrosurgery, the clinician either may let a spark jump from the tip of the needle to the tissue to be destroyed (electrofulguration) or may touch the tip of the needle directly to the tissue (electrodesiccation) . The former results in a pattern of wide, flat destruction and is appropriate for superficial lesions, whereas the latter gives a more spherical pattern of destruction and is useful for deeper lesions.

When basal or squamous cell carcinomas are being treated, curettage to remove destroyed tissue is usually carried out . The use of a curet prior to electrosurgery gives a better sense of the type and margins of the pathologic process, whereas its use after electrosurgery results in fewer problems with hemostasis. The dermal curet, unlike an ear curet, has a cutting edge, but this edge is not nearly as sharp as that found on a scalpel blade. This semisharp edge allows for easy removal of soft cancerous tissue but will not easily cut through normal collagen. The experienced operator develops a feeling for the difference in substance between tumor and normal collagen. This allows the operator to determine tumor margins with a high degree of accuracy.

Curettage can also be carried out without accompanying electrosurgery. This process results in somewhat less scar formation, but since there is less destruction, the rate of recurrence is higher. For this reason, curettage without electrosurgery is usually reserved for benign lesions such as seborrheic keratoses and warts.

Considerable care should be exercised when electrosurgery is used on patients with pacemakers, as the electrical field that is created has the potential for disrupting pacemaker function. At the practical level this never occurs when short, intermittent bursts of electrical current are used.