Does Keloid Histology Influence Recurrence?

Abstract

Keloids are fibroproliferative disorders characterized by high recurrence rates, with few factors known to influence the same. We conducted a study to determine whether keloid histology influences recurrence. This was a prospective longitudinal study to determine whether histopathological parameters of keloid influence recurrence. Patients with keloids managed by surgical excision were followed up at Kenyatta National Hospital between August 2018 and July 2020. The excised keloids were processed for histology using hematoxylin,/eosin, Masson, and trichrome stains. The slides were analyzed for inflammatory cells, fibroblasts, and capillary density using the hot spot technique and correlated to keloid recurrence. Postoperative follow-up was for a minimum of 1 year. A total of 90 patients with 104 keloids were recruited in the study. Overall keloid recurrence rate was 28.6%. There was a correlation between the absolute count of more than 50 per High power field of lymphocytes, fibroblasts, and macrophages with recurrence of the disease. The sensitivity and specificity for the above parameters were lymphocytes 48% and 81%, macrophages 57% and 83%, mast cells 32% and 33%, and fibroblasts 41% and 91%, respectively. There was no correlation between mast cells and vascularity status with recurrence. Routine histology should, therefore, be performed to determine these parameters. Close monitoring and second-line therapy should be considered for patients with elevated macrophages and/or lymphocytes so as to reduce the risk of recurrence.

Tissue RNA Sequencing Reveals Novel Biomarkers Associated with Postoperative Keloid Recurrence

“…We analyzed the patients' clinical features, including age, disease course, sex, site of onset, etiology, postoperative radiotherapy, pre-operative VSS, and DLQI scores. Recurrence was defined as keloids re-growing beyond the excision margins or patients demonstrating pruritus or pain more serious than those before the resection during the follow-up period [8].…”

“…Residual keloid tissues after surgical resection behave like invasive tumors, which may induce the postoperative recurrence of keloids [7]. Nangole et al revealed a positive correlation between keloid recurrence rate and the absolute counts of lymphocytes and macrophages [8]. Cytokines in Th2 cells, especially interleukin (IL)-4, are overexpressed in keloid tissues [9].…”

The Communication from Immune Cells to the Fibroblasts in Keloids: Implications for Immunotherapy

“…Immune cells release a variety of cytokines and growth factors that promote the deposition of ECM and the proliferation of fibroblasts, which further trigger the progression of keloids [10]. Moreover, a recent study has shown a positive correlation of immune cells with keloid recurrence [11]. This review summarizes the communication from immune cells to the fibroblasts and provides future directions for keloid immunotherapy research.…”

Mast Cells Are Activated in the Giant Earlobe Keloids: A Case Series

“…The most invasive treatment option is a combination of surgery and radiotherapy. However, keloids may recur even after excision of the lesion and post radiotherapy [ 1 ], and no definitive treatment plan has yet been developed.…”