Early Detection of Monopolar Radiofrequency Tip Rupture Using Polarized Dermoscopy: A Preventive Approach Against Treatment‐Related Burns

BACKGROUND: 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. AIMS: To evaluate whether using polarized dermoscopy and preventive measures can detect CM ruptures early and prevent burns in MRF treatments. METHODS: 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. RESULTS: 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). CONCLUSIONS: Polarized dermoscopy, combined with preventive steps, enabled early detection of CM tip ruptures and prevented MRF-induced burns.