Surgery combined with postoperative radiotherapy gives excellent results in keloid disease

Objective: The optimal treatment of keloid scars remains unclear. Current protocols advise treatment with triamcinolone injection, when applicable, and surgery followed by adjuvant radiotherapy. However, the dosage and treatment modality of the radiotherapy vary among centres. This retrospective case series evaluated the long-term results of a single institution regarding keloid treatment using surgical excision, adjuvant external radiotherapy with site-dependent dosage, and wound site immobilisation with surgical tape and pressure treatment. Method: A review of the patient registry from Tampere University Hospital, Finland, between the years 2010 and 2018 was conducted. A total of 73 keloids on 58 patients were excised, followed by a site-dependent dose of external radiotherapy with electron beam therapy (EBT). The mean follow-up time was 19.6 months. Results: In total, 91.8% of the keloids were in remission at the end of follow-up, resulting in a 8.2% recurrence rate detected at 19.6 months on average. The highest recurrence rate—at 15%—was detected in the earlobe, which received the lowest level of irradiation according to the author's protocol. Conclusion: The results suggest that surgical excision with adjuvant EBT is highly efficient for keloid treatment in adult patients, and should be considered the first option in keloid treatment whenever excision is feasible. The recurrence rate of earlobe keloids with the current lower dose of EBT was higher than previously published and warrants further investigation.