What are the recommended margins for Elliptical Excision (ED&C) for Basal Cell Carcinoma (BCC)?

Recommended Margins for Electrodesiccation and Curettage (ED&C) for BCC

ED&C does not involve surgical margins in the traditional sense—it is a destructive technique that relies on the curette to distinguish tumor from normal dermis through tactile feedback, not measured excision margins. 1

Understanding ED&C Technique

ED&C is fundamentally different from surgical excision and does not use predetermined clinical margins:

• The procedure involves alternating cycles of curettage (scraping tumor tissue) and electrodesiccation (tissue destruction), typically performed up to 3 cycles per session. 1

• The endpoint is determined by the operator's ability to feel firm, normal dermis versus soft tumor tissue with the curette—not by measuring margins around the visible lesion. 1

• No histologic margin assessment is possible with ED&C, making it unsuitable for tumors requiring margin verification. 1

Appropriate Patient Selection for ED&C

ED&C should only be considered for properly selected low-risk tumors in non-terminal hair-bearing locations. 1

Acceptable indications:

• Low-risk primary BCC (well-defined, <2 cm, non-aggressive histology) 1
• Trunk and extremity locations preferred 1
• Superficial lesions only 1

Critical contraindications:

• Terminal hair-bearing areas (scalp, beard, pubic, axillary regions) are absolutely contraindicated due to risk of follicular tumor extension that the curette cannot detect. 1
• If subcutaneous fat is reached during curettage, the procedure should be abandoned and surgical excision performed instead—the curette cannot distinguish tumor from soft adipose tissue. 1
• High-risk tumors, aggressive histologic subtypes, or poorly defined borders require surgical excision or Mohs surgery, not ED&C. 1

Reported Outcomes

• Five-year cure rates for appropriately selected cases range from 91-97%, but some studies report recurrence rates of 19-27% when used for high-risk locations or aggressive subtypes. 1
• Results are highly operator-dependent and optimal outcomes require experienced practitioners. 1

Critical Caveat

If ED&C is performed based solely on clinical appearance and subsequent pathology reveals high-risk features (aggressive histology, deep invasion, perineural invasion), additional definitive therapy is mandatory. 1

Comparison to Surgical Excision

For context, when surgical excision is chosen instead:

• Low-risk primary BCC requires 4-mm clinical margins for >95% complete removal. 1
• High-risk BCC requires Mohs micrographic surgery or wider margins with complete margin assessment. 1