**3.2 Curettage**

The curettage can be performed using a sharp ring curette or a scalpel blade. The purpose is to remove keratotic tissue by surface scraping the lesion. The scrape might be performed in a checkered pattern, performing parallel horizontal followed by perpendicular movements. Due to the possibility of subclinical lesion extensions, it is recommended that the curettage is performed using at least 5-mm margins surrounding the lesion to minimize the possibility of the recurrence. The curettage is also indicated to be applied before PDT [13, 15].

This technique is effective, quite inexpensive, and although it can offer light discomfort during the procedure, it is commonly acceptable both by health professionals and patients [19]. However, it is important to mention that there is a risk of bleeding, and when bleeding takes place, it may displace the cream and lead to a decreased PpIX formation, and thus lower treatment efficacy [20]. Despite this, studies reported that curettage associated with PDT increases the cure rate of treatment compared with no-curettage topical PDT. The combination may be repeated successfully for non-cure or recurrence cases without compromising the cosmetic effect or deteriorating skin structures. The treatment has shown a clearance rate of 91% for superficial BCC (131 lesions treated), 93% for thin nodular BCC (82 lesions), and 86% for thick nodular BCC (86 lesions) [21, 22].
