Early Detection of Monopolar Radiofrequency Tip Rupture Using Polarized Dermoscopy: A Preventive Approach Against...

Monopolar radiofrequency (MRF) devices use a capacitive membrane (CM) tip to deliver uniform heat to tissue. A peri-procedural CM rupture, while rare, risks causing thermoelectric burns.

To evaluate whether using polarized dermoscopy and preventive measures can detect CM ruptures early and prevent burns in MRF treatments.

We retrospectively reviewed all patients who underwent monopolar radiofrequency (MRF) treatment at a single dermatologic clinic between 2012 and 2024 and experienced a peri-procedural capacitive membrane (CM) rupture event. Non-contact polarized-dermoscopy-aided CM rupture detection and relevant preventive measures (cryogen checking, shaving, and patient education) were introduced since 2017. Clinical photographs were assessed by two board-certified dermatologists to verify thermoelectric burns.

Among 13 cases of capacitive membrane (CM) rupture identified between 2012 and 2024, 8 ruptures were detected by naked-eye observation between 2012 and 2016, and all patients (8/8, 100%) developed thermoelectric burns. From 2017 onward, 5 ruptures were detected using non-contact polarized dermoscopy, and none of the associated patients (0/5, 0%) developed burns. This difference was statistically significant (p = 0.0008). In addition, the implementation of preventive measures-such as cryogen inspection and shaving protocols-was associated with a reduced number of CM rupture events (p = 0.0063).

Polarized dermoscopy, combined with preventive steps, enabled early detection of CM tip ruptures and prevented MRF-induced burns.