Radiofrequency Cautery for Seborrheic Keratosis
Yes, radiofrequency (RF) cautery is a well-established and effective treatment option for seborrheic keratosis, commonly used alongside other destructive modalities like electrodesiccation and curettage.
Treatment Rationale
Seborrheic keratosis (SK) is a benign epidermal tumor that does not require removal for medical reasons unless histologic confirmation is needed or lesions become traumatized and symptomatic 1. However, these lesions frequently prompt cosmetic concerns and are commonly treated by dermatologists 1.
Standard Treatment Approaches
Primary Treatment Modalities
Cryosurgery remains the most commonly employed removal method for SK among dermatologists 1.
Electrodesiccation, curettage, and shave excision are other frequently used techniques, often in combination 1.
RF cautery (electrocautery) is explicitly recognized as a traditional and effective treatment option for SK, with comparable efficacy to cryosurgery 2, 3.
Dermatologists treat approximately 43% of SK patients presenting for evaluation, indicating selective treatment based on patient preference and lesion characteristics 1.
Treatment Selection Considerations
Careful patient selection is required to optimize cosmetic results, particularly in patients with skin of color, thick lesions, or numerous lesions 1.
All destructive methods (including RF cautery, cryosurgery, and electrodesiccation) can occasionally cause post-procedure depigmentation, scarring, and recurrence 3.
Treatment should be selected based on lesion location, thickness, number of lesions, patient skin type, and cosmetic expectations 1, 4.
Alternative and Emerging Options
Laser Therapy
Ablative CO2 and Er:YAG lasers achieve single-session clearance in up to 90% of lesions, with recurrence rates of 0-6% at 12-month follow-up 5.
Laser therapy is particularly advantageous when cosmesis is paramount, serving as a safe alternative to cryotherapy, curettage, and electrosurgery 5.
Patient satisfaction with laser treatment ranges from 64-95%, with generally mild and transient adverse events 5.
Topical Treatments
No effective topical therapeutic agent has been developed for SK, representing an area of unmet need despite significant interest from patients and providers 1.
One case report describes successful treatment with Siddha medicine (Pachaieruvai), but this lacks robust evidence and is not standard practice 2.
Common Pitfalls
Avoid using destructive techniques in patients with darker skin types without careful consideration, as post-inflammatory dyschromia is more likely 1, 5.
Do not assume all pigmented lesions are SK—if diagnostic uncertainty exists, biopsy should be performed before destructive treatment 1.
Multiple thick lesions may be better suited to laser therapy or shave excision rather than RF cautery to minimize scarring 1, 5.