<p>Keloid treatment: what about adjuvant radiotherapy?</p>

Abstract

Background: Keloids are debilitating fibrous skin proliferations with a high recurrence rate after surgical treatment. Postoperative radiotherapy (PORT) is a well-tolerated adjuvant treatment to reduce the risk of recurrence, but the optimal regimen for this combined treatment remains unknown. The aim of this study is to evaluate the efficacy of combining surgical excision and immediate PORT. Methods: We retrospectively reviewed the records of patients with keloid lesions treated with adjuvant PORT in the period 2005–2014 at Geneva University Hospitals. Main outcomes were the rates of complications and recurrence in patients with a minimal follow-up of 1 year, including the Patient and Observer Scar Assessment Scale satisfaction scores. Results: 10 patients with 16 keloids were eligible (mean follow-up, 37 months). Only one recurrence was reported (6%). In 12.5% of cases, mild erythema appeared in the early postoperative period. No major complications were observed. The overall patient and observer satisfaction rate was excellent. Conclusion: Surgical excision combined with immediate PORT is an effective and easy treatment with good esthetic results and an acceptable recurrence rate. It should be considered for patients with persistent keloid formation after failure of other treatments and those at high risk of relapse.

Efficacy of surgical excision and adjuvant high-dose rate brachytherapy in treatment of keloid: Our experience

“…[ 14 ] Studies show that there is an increased activity of fibroblasts to a milder stimulus leading to excess production of the collagen. [ 2 ] This increased activity leads to hypertrophic scar or the keloid. For the same reason, recurrence in these conditions is a common feature.…”

“…[ 23 ] Surgical excision is effective in removing the existing tumor. [ 2 ] However, many studies have shown that surgical excision alone cannot prevent recurrence, and recurrence rate was as high as >50% at 1-year follow-up. [ 24 25 ]…”

“…Ear piercing is one of the widespread practice in Indian community; the trauma caused by piercing leads to the ear keloids. Ear keloids formed 25% of patients in a study conducted by Petrou et al [ 2 ] In another study, ear keloids formed 100% of the cases. [ 27 ] The treatment, used in our study, the combination of surgical excision, and HDR brachytherapy had excellent results and we had only one recurrence at 12 months follow-up period.…”

“…As compared to hypertrophic scars, keloids tend to grow into the healthy surrounding skin. [ 2 ] Histopathology of keloids shows collagen bundles arranged in nodular/cluster fashion. This feature differentiates the keloid from hypertrophic or other scars.…”

“…[ 3 4 ] Although the histo-pathological examination is well defined, the pathophysiology of keloids is less known. [ 2 ] As the pathophysiology is less defined, the treatment of keloids is also challenging. The major concern for patients as well as treating doctor is the chance of recurrence.…”