Chemo Surgery or Chemical Cauterization of Skin Lesions

Chemosurgery means selective destruction of tissues using chemical agents. Chemsurgical procedures do not require any anaesthesia.it is also termed as chemical cauterization.

Such applications are usually needed

  • Chronic ulcers with unhealthy granulation
  • Flat warts
  • Resistant cases of chloasma
  • Papular lesions that do not respond to the conventional treatment.
  • Syringoma
  • Angiokeratoma

A lot of other lesions are also treated with this.

The cauterizing chemicals commonly used for chemo-surgery include

  • Carbolic acid (phenol)
  • Trichloroacetic acid
  • Strong acid
  • Strong alkali

Carbolic acid

It is s available as pinkish crystals which are highly hygroscopic and thus absorb atmospheric moisture to become liquefied. Othrewise, liquiefied phenol can be used as such. It is used in 50, 20 or 10 percent concentration after diluting with water.

Trichloroacetic acid

It is available as whitish crystals which can be dissolved in water to make similar concentrations as those of carbolic acid.

In  large and superficial cauterizations is required, a cotton swab tightly wound over a swab-stick should be dipped in the cauterizing solution, squeezed along the edge of the bottle and painted on the lesion.

Application
It is important to ensure that the cauterizing solution does not get applied on the adjoining normal skin of the patient, his clothes and also the fingers of the treating doctor.

Excess solution can then be mopped with a spirit-soaked swab to stop further action.

Some papular lesions need to be pricked with hypodermic needle to make the procedure effective.

Every time the hypodermic needle is subsequently pricked into the lesion the cauterizing solution flows out and permeates into the surrounding tissue and cauterizes it. Within 24 hours after cauterization, the tissue turns into a brownish black crust which falls off within week’s time after the underlying skin has healed.

It is important to inspect the skin at that time and repeat the cauterization if any part of the lesion has been left behind. In some cases, post-inflammatory hyperpigmentation may follow which however is not permanent.

Chemical cauterization is useful at places where other measures are not available and if used with care it can achieve excellent results.

The major drawback of chemical cauterization is that it is difficult to precisely control the amount of the chemical cauterant applied on the lesion. It can therefore be risky when treating lesions on sensitive areas of skin.

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