Lesion Site Is the Key Prognostic Factor for Keloid Patients Receiving Surgery With Adjuvant Radiotherapy

Chen, Fanglin; Kuo, Yur-Ren; Huang, Chih-Jen; Tang, Jen‐Yang; Chiang, Chen-Han

doi:10.1097/sap.0000000000003315

Cited by 3 publications

(5 citation statements)

References 25 publications

(69 reference statements)

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“…The keloid located on chest had the highest recurrence rate, while keloid located on ear had lowest recurrence rate. Similar results were also reported by other study [ 22 ]. The prescription BED was similar to other studies, and also achieved a satisfactory effect.…”

Section: Discussionsupporting

confidence: 93%

Treatment outcomes of surgery followed by short-course every other day radiotherapy in keloid

Zhou,

Li,

Yin

et al. 2024

Radiat Oncol

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Background Postoperative radiotherapy can significantly reduce keloid recurrence. However, consensus on the optimal radiotherapy dose and treatment schedule remains elusive. This study aims to evaluate the effectiveness of surgery followed by a short-course of radiotherapy administered every other day for keloid treatment. Materials/Methods We conducted a retrospective analysis of 498 patients with keloids treated at our institution between January 2010 and December 2017. All patients underwent electron beam irradiation at a dose of 16 Gy, delivered in four fractions every other day, starting within 24 h post-surgery. The primary endpoint of the study was the local control rate. Results A total of 130 (26.5%) keloids recurred after a median follow-up of 68.1months (42.6-129.9 months). The local control rates at 1 year, 3 years and 5 years for all patients were 89.5%, 82.5% and 81%, respectively. The highest recurrence rate was observed in keloids located in the chest region (50.8%), followed by the suprapubic (47.8%), head and neck (38.8%), limbs (33.3%) and ear (14%). Both multivariate and univariate analyses identified the presence of pain and or pruritus as an independently prognostic factor for keloid recurrence (p<0.0001). The local control rates at 1-year, 3-years and 5-years for patients with or without symptom of pain or pruritus were 45% vs. 98.8%, 12.5% vs. 95.9%, and 8.8% vs. 95%, respectively (HR:37.829, 95%CI: 24.385–58.686, p<0.001). In the ear keloid subgroup, the 1-year, 3-year and 5-year local control rates for patients with pruritus were significantly lower than those without pain or pruritus (60.0% vs. 97.9%, 26.7% vs. 94.7%, 26.7% vs. 94.3%, HR:30.209, 95% CI:14.793–61.69, p<0.001). The same results were found in other location(p<0.001). During treatment and follow-up, two patients experienced infections, and one patient developed a cutaneous fibroblastoma. Conclusion This study suggests that a combination of surgery followed by short-course, every-other-day radiotherapy can yield satisfactory local control rates for keloids. Pain and or pruritus symptom was an independently prognostic factors for recurrence of keloid. To further validate these results, a prospective randomized controlled trial is recommended.

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Section: Discussionsupporting

confidence: 93%

Treatment outcomes of surgery followed by short-course every other day radiotherapy in keloid

Zhou,

Li,

Yin

et al. 2024

Radiat Oncol

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“…13 This induces the augmentation of inflammatory cells and growth factors such as macrophages, mast cells, neutrophils, lymphocytes, and vascular endothelial growth factor (VEGF), inducing cell proliferation, angiogenesis, and collagen synthesis. 16 In this study, moderate and severe inflammatory infiltrates were observed more at the edge of the lesion (chest, shoulders, and ears) than in the center of the lesion, which is in accordance with the Jiao et al study reporting moderate perivascular chronic inflammatory infiltrates in all keloids. 21 Another study described increased inflammation at the edge of the lesion, which then gradually declined, toward the center of the lesion.…”

Section: Discussionsupporting

confidence: 92%

“…17 The predilection site of keloid is a hightension area, such as the chest, back, and shoulders. 16 We also found that keloids were predominantly observed on the chest. This finding is in accordance with the Huang et al study in 2020, in which keloids were dominantly seen on the chest, the high-tension area.…”

Section: Discussionmentioning

confidence: 52%

“…5 The high tension-induced mechanical stimulus triggers increased production of extracellular matrix, vascularization, and macrophage activity. 16 Histopathologically, keloids are marked by thickened epidermis in the form of rete ridges or tongue-like or flattened area, while in the dermal layer there is an increase in perivascular inflammatory cell infiltrates, along with enhanced vascularization. 18 Samaka et al study described that in the dermal layer there are more inflammatory infiltrates at the edge of the keloid lesion than in the center one.…”

Section: Discussionmentioning

confidence: 99%

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The Association of Keloid Site with its Histopathological Features: an Analytical Observational Study

Wibisono Nugraha,

Muhammad Eko Irawanto,

Moerbono Mochtar

et al. 2024

BIKK

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Background: Keloid is a growth of fibrous tissue in the wound tissue of susceptible individuals. This tissue extends beyond the boundaries of the previous wound. The site of keloids commonly appears on a high-tension area, such as the chest, shoulders, and neck. Histopathologically keloids show thickened the epidermis and the vascularization and infiltration of inflammatory cells in the dermis. Purpose: This study aims to determine the relationship between the site of keloids and the histopathological appearance of keloids. Methods: An analytical observational study was conducted on keloid patients visiting the Dermatovenereology outpatient clinic of Dr.Moewardi Hospital. The sample collection used consecutive sampling techniques Result: The majority of keloid patients are >30 years old (46.4%). Most patients with keloids were female (53.6%). Keloids were mostly found on the chest (25.0%). Tounge-like appearance of the epidermis at the edges of the lesions was mostly on the shoulders and chest (33.3% each, p=0.048); flattened appearance was found on the middle epidermis of the lesions, which were mostly on the ears, shoulders, and upper extremities (22.7% each, p=0.011). Increased vascularity was found in the dermis at the edges of the lesions, especially in the ear and chest areas (31.3% each, p=0.046). Moderate-severe inflammatory infiltrates in the dermis at the edges of the lesions were commonly found on the chest (p=0.04). Conclusion: There is a significant relationship between the site of the lesion and the histopathological appearance of the keloid in epidermal as well as dermal layers.

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“…If divided into two groups of locations containing cartilage and not containing cartilage, the rates are 58.07% and 41.93%, respectively. This rates are also quite variable in the studies of other authors in the world: Tae Hwan Park studied 842 keloids with 77.08% cartilage-free keloids, Bernardo Hochman also recorded the same results with Park with 82% of keloids at the cartilage-free position; in the study in Thailand with 43 auricular keloids, the position containing cartilage also accounted for 67.4% (11). Because the formation of keloids is affected by various factors, there seems to be no rule as to which location the keloid is more dominant.…”

Section: Locationmentioning

confidence: 88%

Clinical Characteristics of Auricular Keloids Treated Surgically at 108 Military Central Hospital

Le,

2024

VMJ

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Purpose: to describe the clinical characteristics of surgically treated auricular keloids. Subjects and methods: Cross-sectional descriptive study on 45 patients with auricular keloid surgery at 108 Military Central Hospital during the period from June 2020 to June 2023. Study subjects had their past medical history taken, clinical examination, and lesion size measured to record research indicators. Results: The study subjects had an average age of 20.7 ± 4.4 years old, all patients were female, accounting for 100%. The main cause of keloids is ear piercing, accounting for 97.7%. Surgical auricular keloids have an average size of 4 ± 3.5 cm2, the main location of keloids is in the helix accounting 44.1% and the earlobe accounting for 41.93%, the number of keloids is from 1 to 5. Conclusion: auricular keloids are mainly found in teenagers with an average age of 20.7 years old, 100% are female patients, 97.7% are caused by piercing. The location of keloids treated by surgery is in the earlobe and helix areas account for 44.1% and 41.93%, respectively; On average, there are 1.76 keloids/person, the average auricular keloid size is 4.07±3.58 cm, mainly in groups 3 and 4 according to Michael Tirgan's classification (1).

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Lesion Site Is the Key Prognostic Factor for Keloid Patients Receiving Surgery With Adjuvant Radiotherapy

Cited by 3 publications

References 25 publications

Treatment outcomes of surgery followed by short-course every other day radiotherapy in keloid

Treatment outcomes of surgery followed by short-course every other day radiotherapy in keloid

The Association of Keloid Site with its Histopathological Features: an Analytical Observational Study

Clinical Characteristics of Auricular Keloids Treated Surgically at 108 Military Central Hospital

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