Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Pearls
89 (
4
); 634-635
doi:
10.25259/IJDVL_102_2022
pmid:
36332092

Needle-guided bipolar intralesional radiofrequency coagulation with scissor excision for bloodless resection of benign lesions

Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India

Corresponding author: Dr. Somesh Gupta, Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India. someshgupta@hotmail.com

Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Sharma A, Swarnkar B, Gupta S. Needle-guided bipolar intralesional radiofrequency coagulation with scissor excision for bloodless resection of benign lesions. Indian J Dermatol Venereol Leprol 2023;89:634–5.

Problem

Haemostasis is a prime concern during the excision of benign growths at highly vascular sites, such as the nose, lips and temple; which are also important cosmetically. Bipolar radiofrequency is used for coagulation of bleeders with minimal collateral damage as the flow of energy is restricted between its two poles situated 3–4 mm apart. This feature may be reutilised to compress and precisely ablate small sessile lesions sized up to 1 cm using a bipolar radiofrequency probe alone1; whereas monopolar tunnelling followed by bipolar coagulation may aid in the excision of larger lesions.2 However, extensive coagulation of the base of large lesions may result in scarring, which may be cosmetically disfiguring at sensitive sites. The tissue destruction in radiofrequency is directly proportional to the diameter of electrodes, therefore, the tips of the routinely used bipolar forceps may be unsuitable for areas needing precise ablation.

Solution

We propose the use of needle-assisted intralesional radiofrequency3 for coagulation (and subsequent haemostasis) of the base of benign skin lesions at vascular and cosmetically sensitive sites. Two 26G needles are inserted at the base in a converging fashion such that the distance between them is less than 5 mm within the lesion, but more than 5 mm at the point of entry [Figures 1 and 2]. Thus, when touched simultaneously by the two poles of bipolar forceps, the lesional base is coagulated without any epidermal damage, despite the needles being non-insulated. This process is repeated circumferentially around the lesion, which is then excised easily using ordinary scissors, leaving behind a healthy rim of tissue which may be sutured or left to heal by secondary intention [Video 1]. This method ensures a quick, bloodless resection with a favourable cosmetic outcome [Figures 3a and b]. Moreover, the tissue remains well-preserved for histopathology as the flow of energy is confined to the area between two terminals and thin-bore fine needles do not cause much tissue destruction.

Intralesional radiofrequency coagulation using two 26G needles inserted at the base of a benign skin tumour (solitary circumscribed neuroma) at the nasal vestibule, touched simultaneously by two poles of a bipolar forceps
Figure 1:
Intralesional radiofrequency coagulation using two 26G needles inserted at the base of a benign skin tumour (solitary circumscribed neuroma) at the nasal vestibule, touched simultaneously by two poles of a bipolar forceps
Method of needle-guided bipolar intralesional radiofrequency coagulation showing greater than 5 mm distance between the two terminals at the entry point, converging to less than 5 mm distance inside the lesion, thus sparing the epidermis while coagulating the base
Figure 2:
Method of needle-guided bipolar intralesional radiofrequency coagulation showing greater than 5 mm distance between the two terminals at the entry point, converging to less than 5 mm distance inside the lesion, thus sparing the epidermis while coagulating the base
Skin-coloured, conical, rubbery papulo-nodule of solitary circumscribed neuroma on the left side of nasal septum and columella
Figure 3a:
Skin-coloured, conical, rubbery papulo-nodule of solitary circumscribed neuroma on the left side of nasal septum and columella
Excellent cosmetic outcome 4 weeks after the procedure
Figure 3b:
Excellent cosmetic outcome 4 weeks after the procedure

Multimedia_1: video/mp4: Demonstration of the technique of needle-guided bipolar intralesional radiofrequency followed by scissors excision for bloodless removal of benign skin lesions at highly vascular and cosmetically sensitive sites.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflict of interest

There are no conflicts of interest.

References

  1. , , . Bipolar forceps of a high-power electrosurgical unit for precise removal of small benign skin lesions. J Am Acad Dermatol. 2020;82:e155-6.
    [CrossRef] [PubMed] [Google Scholar]
  2. , . Monopolar electrosurgical tunneling combined with bipolar coagulation for bloodless resection of sessile benign skin lesions. J Am Acad Dermatol. 2021;85:e5-6.
    [CrossRef] [PubMed] [Google Scholar]
  3. , , . Intralesional radiofrequency with a thin hypodermic needle in the management of papular acne scars. J Am Acad Dermatol. 2021;84:e259-60.
    [CrossRef] [PubMed] [Google Scholar]

Fulltext Views
3,114

PDF downloads
2,055
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections