How Painful is Mole Removal by Electrocautery Without Any Anesthesia?

I'm considering having a mole removed near my eye using the electrocautery method. The doctor informed me that since the mole is close to my eye, he will not use an anesthetic. Can someone tell me how painful this is likely to be? Thanks.

Doctor Answers 7

Don't remove a mole with a cautery and no local

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First, this will hurt. Second, it is a bad idea to be cauterizing around the eye in an unanesthetized person - what if you jumped and the cautery hit your eye?? Third, cautery destroys the ability to check the pathology and be sure it isn't a skin cancer, Fourth, it may recur becasue of incomplete removal.

Cauterization without anesthetic

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I see red flags. If the lesion us near the eye, anesthesic agents should be used. I know of no plastic surgeon who charges for local anesthesia. I would not perform a procedure without appropriate anesthetics and you should inquire why your physician believes that it is appropriate to do so and, if you aren't satisfied with the response, seek another opinion. Electrocautery does not provide a specimen for pathological evaluation which is importan to rule out skin cancer. There should also be concern as to the secondary healing from cauterization and the scarring which can result.

Electrocautery, No Anesthesia? Why?

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Mole removal via electrocautery without anesthesia sounds like something used in a Medieval torture chamber, not a treatment done in a Surgeon's office. It is a bad idea from an oncologic standpoint as mentioned (margins cannot be determined) and a bad idea from an analgesia standpoint (Lidocaine works very well and is very inexpensive).

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 103 reviews

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Mole removal by electrocautery without anesthesia not a good idea

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Unless you are talking about using electrocautery for a small growth in an entity dubbed dermatosis papulosa nigra (think Bill Cosby), this is an ill advised idea.

Even if the tissue is sent to pathology for histologic examination, the electrocautery effect can make interpreting the tissue very difficult. This is a problem faced by pathologist when examining say a colonic polyp that has undergone cauterization in its removal. It is far more difficult when examining the remnants of a mole. An error in interpretation can have grave implications.

I am curious why you physician feels that this area cannot be anesthetized. This is really not a problem. The voltage of electrocautery needed to remove a nevus is quite high and would be fairly painful ( think the electric chair...well not really). Further, using that amount of electricity would lead to a white, not particularly attractive scar.

You would be much better off with a simple excision. Tissue would be preserved and you would have a better cosmetic outcome.

Arnold R. Oppenheim, MD
Virginia Beach Dermatologist

Burning a mole without anesthesia is not warranted

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I would suggest getting a second opinion. There is no place around the eye where a mole grows that I would not inject anesthesia. I would also agree that electrocautery would destroy the mole and preclude sending for a pathologic evaluation. In the end, I think a second opinion with a facial plastic surgeon, dermatologist, or plastic surgeon is in order.

D.J. Verret, MD
Dallas Facial Plastic Surgeon

Burning a mole and No anesthesia = Bad idea

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Several things in your question raise alarm bells.

1. Saving less than 1 dollar in local anesthesia cost. Being cut or burned hurts. Being cut or burned on the face hurts more. You should not have to endure and "bear" a painful procedure and I have a real problem with any physician who would put you through this.

2. I agree with Dr. Placik. As important as removing a mole is making sure that it was not cancerous OR if it is a cancer what kind it was, was all of it removed and how deep was it.

3. Lastly, burning (as you are about to have) or freezing a mole damages the wound edges and does NOT leave a nice scar. A MUCH nicer, less visible scar is obtained by cutting it out with a scalpel and properly closing the wound with stitches.

Dr. P. Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon

WE do do generally advise electrocautery for mole removal

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We generally do not advise mole removal by the electrocaustery method. One of the reasons for mole removal is to evaluate for the presence of disease (benign or malignant). Electrcautery destroys the lesion completely and does not provide for a specimen. Secondly, the mole typically extends to the dermis and electrocautery at the dermal level can produce scarring.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.