Regional Differences in Postexcision Outcomes of Keloids

BACKGROUND: The pathophysiology of keloid formation remains poorly understood, and treatment typically involves multimodal approaches. Previous studies suggest that keloids on the earlobes, head, and neck may be more responsive to radiation than those on other anatomic sites due to putative differences in skin tension and biomechanical properties. However, limited comparative data exist to substantiate these anatomic distinctions in clinical outcomes. AIM: To compare recurrence rates, treatment outcomes, and radiation-related side effects between auricular and nonauricular keloids following surgical excision with adjuvant radiation therapy or surgical excision alone. METHODS: This retrospective cohort study analysed 168 cases with keloids (60 auricular and 108 nonauricular) treated by a single surgeon between January 2020 and May 2024. Of these, 122 patients underwent surgical excision followed by adjuvant radiation therapy, while 46 patients received surgical excision only. Intralesional 5-Fluorouracil and Kenalog was injected across both groups during surgical excision. Demographic and clinical data, including age, sex, race, BMI, keloid site and size, and treatment modality, were collected. Patients were followed up post-treatment to assess recurrence, radiation-related side effects, and treatment response patterns. RESULTS: Auricular keloids were more common in younger patients and significantly smaller in size (median 12 vs. 19.5 mm for nonauricular, P<0.001). The majority of patients received 2100 cGy of radiation. Among those receiving surgery plus radiation, 17.07% of auricular and 16.22% of nonauricular keloids recurred (P=0.91). In the surgery-only group, recurrence was 47.37% and 44.12%, respectively (P=0.82). Notably, radiation-related side effects were significantly more frequent in nonauricular sites (37%) compared with auricular (20%) (P=0.022). Age, sex, race, BMI, and radiation dose did not independently predict recurrence in the final model. CONCLUSION: Anatomic site did not significantly influence keloid recurrence rates, challenging previous assumptions about site-specific treatment responses, while adjuvant radiotherapy significantly reduced recurrence irrespective of site. Radiation-related side effects were more common in nonauricular locations. Age, sex, race and BMI did not emerge as statistically significant demographic predictors of recurrence in this study. These findings support the routine inclusion of radiotherapy in keloid management and suggest that demographic and treatment factors may outweigh anatomic considerations in predicting outcomes.