In recent years electrosurgical excision techniques have been advocated for the evaluation and treatment of premalignant diseases of the vulva, vagina, and cervix. Technologic advances in electrosurgical generators and in fine wire loops have made these techniques feasible in the outpatient setting, and considerable experience has been accumulated in Europe and the United States. This article discusses the advantages and disadvantages of this "new" technology with emphasis on the available scientific literature. In summary, electrosurgical excision offers the benefit of providing tissue for complete histopathologic evaluation without compromising the established convenience, safety, and efficacy of ablative techniques.