The high cure rates obtained with ED&C in published case series probably reflect a selection bias for smaller and less invasive lesions. Cosmetically, the scar from ED&C is usually a hypopigmented sclerotic circle, as compared with a thin line from excision. Although the circular scar often contracts, hypertrophic changes can also occur that may make it difficult to recognise recurrent SCC. For SCC lesions on the face, particularly adjacent to critical tissues, contraction of resultant scars may distort or destroy the normal or functional anatomy. In addition, a surgeon performing ED&C at sites adjacent to vital or anatomically complex structures (such as the nose or eye) might limit the margins of destruction or be less aggressive in order to preserve native tissue; this is likely to diminish the effectiveness of this technique. Whelan and Deckers39 found that the majority (65%) of lesions took 4 weeks to heal after ED&C, while in a separate study they found that the average time for healing was 5.1 weeks.40 Prolonged healing compared with surgical excision should be considered, particularly for lesions on the legs. Daily wound care is an essential part of ED&C, and diligence is required to prevent infection.
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