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Techniques Mole Removal

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Aesthetics Journal

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CONTRAINDICATION

Using radio-wave surgery for mole removal

Patients with cardiac pacemakers are an absolute contraindication as radiowaves interfere

Dr JJ Masani explores the science and technique behind removing moles using radiosurgery WHAT IS RADIO-WAVE SURGERY? Radiosurgery (synonymous terms: radio-wave surgery, micro-wave surgery, high- frequency surgery, electro-surgery, Bovie’s Current) has a high frequency current of 2 to 4 MHz (million times/sec), and is cold to touch at the cutting electrode, thus produces less tissue damage.1 Domestic mains electric current of 50Hz (1 Hz = 1 wave form per second) creates copulation with high temperature, as well as tissue damage.1 The cutting electrode has less lateral heat than most lasers, creating excellent cutting ability, less tissue damage, less post-operative pain and above all, less scarring when removing moles. As there is no necrosis or carbonisation, the specimen can be sent for histopathology. There is also no pressure applied to skin, as with a scalpel. Radiowave surgery should not be confused with electric cautery, where the equipment uses heat (50 to 400 Hz) – the cutting electrode of radiosurgery is stone cold.1 Besides excision of moles, radio-wave surgery can be used (with no scarring to minimal scarring) in senile angiomas, xanthomas, keloids, rhinophymas, spider veins, epilation of hair and skin tightening). In my opinion we are, as aesthetic physicians, dermatologists and surgeons, underusing this innovative technology. There seems to be a lack of knowledge on radiosurgery as it is not yet taught in medical schools. Compared to scalpel technology, the equipment is expensive and the technique is quite different. HISTORY The application of heated stones to obtain haemostasis has been used since ancient times.2 Later, during the nineteenth century, surgeons used cautery and electricity within medicine. Although radiosurgery was introduced before the 1920s, credit is given to physicist William Bovie, who developed the first prototype of the modern radiosurgery generator for diathermy. This allowed Dr Harvey Cushing, a neurosurgeon, to successfully remove a vascular myeloma from the head of a 64-year-old patient on 1st October 1926 in Boston. Liebel-Flarsheim Co then purchased the patent for the Bovie Unit for $1, and proceeded to make millions.2

The first principle of all electromagnet wave form is that electrons move in an 2 See Figure 2 where the lead wire electromagnetic medium, always a circuit. Figure 1: Image demonstrates the completeing electromagnet circuit from the generator producing radiowaves (2 MHz to 4 MHz high frequency) passes to the active electrode with a loop, which is used in a feathering manner to cut the mole. The

SCIENCE BEHIND RADIOSURGERY 2 The first principle of all electromagnet wave form is that electrons move in an electromagnetic medium, always completeing a circuit.2 See Figure 1 where the lead wire from the generator producing radiowaves (2 MHz to 4 MHz high frequency) passes to the active electrode with a loop, which is used in a feathering manner to cut the mole. The loop is at room temperature. The radiowave then travels through the body on to the antenna (like the aerial of a radio loop is at room temperature. The radiowave then travels through the body on to the orantenna mobile back to thephone) generator. (likephone) the aerialand of a radio or mobile and backThe to thesecond generator.principle toThe understand is that there is a frequency and a wavelength to second principle to understand is that there is a frequency and a wavelength to consider in in anyany electromagnetic radiation, with domestic power having a longpower wavelength, consider electromagnetic radiation, with domestic low frequency and is hot to touch. Radio-frequency, on the other hand, is a shorter having a long wavelength, frequency is hot wavelength with high frequency andlow is cold to touch. Upand to visible lightto thetouch. infrared spectrum is non-ionising to our DNA, and beyond UV light it is ionising to our DNA and Radiofrequency, on the other hand, is a shorter wavelength with harmful.2 high frequency and is cold to touch. Up to visible light the infrared Figure 3: The electromagnetic radiation spectrum

COMPARISON OF LATERAL HEAT AND TISSUE DAMAGE BY ENERGY SOURCES2 1. Radio-Wave Surgery 2. CO2 Laser 3. Holmium Laser 4. ND:YAG

0.02 mm damage 0.5 mm damage 0.5 mm damage 2.3 mm damage

CONTRAINDICATION Patients with cardiac pacemakers are an absolute contraindication as radiowaves interfere with cardiac pacemakers – they too work on the principles of electromagnetic radiation.3 Some newer pacemakers are not altered by radiosurgery wave forms, and this should be checked with the cardiologist prior to treatment. 48

with cardiac pacemakers – theyjewellery too work on the of electromagnetic radiation.3 A patient must not wear orprinciples be in contact with metal Some newer pacemakers are not altered by radio surgery wave forms, and this should be the of cardiologist to treatment. duechecked to thewith risk burnsprior caused by an alternate current path or “capacitive coupling”. Radiowaves arewithnon-ionizing, thus cause A patient must not wear jewellery or be in contact metal due to the risk of burns caused by an alternate current path or "capacitive coupling". Radiowaves are non-ionizing, 4 no damage todamage animal DNADNA or orsurrounding tissue, like mobile thus cause no to animal surrounding tissue, just likejust mobile phones. However, 4 all general rules of safety with electro-magnetic equipment must be followed. phones. However, all general rules of safety with electro-magnetic This includes making sure no alcohol is used for cleaning and there is no presence of ignitable gases in the operating room. This includes making sure no alcohol equipment must be followed. SCIENCE BEHIND RADIOSURGERY is used for cleaning and there is no presence of ignitable gases in 2 the Figure operating room.

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Figure 2: The Electromagnetic Radiation Spectrum To understand the principle of an electric circuit, one could compare it with our WC where the cistern, which is full of water, has potential energy (voltage), and when we pull the flush, water runs down the pipe (current-measured in amperes) and the force with which it runs is classed January 2015as watts or power, or if timed in one second, a joule. Thus voltage X amperes = watts. Remembered by the pneumonic: VAW. Ohms is the resistance offered by what we clear in the WC, or in case of radiowave surgery, is our body offering the

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