Assessing keloid recurrence following surgical excision and radiation

Abstract

Keloids are a fibroproliferative disorder that can result from a cutaneous injury to the reticular dermis. Recurrence rates as high as 100% have been reported following surgical excision alone. Consequently, a variety of post-surgical techniques have been employed to prevent keloid recurrence, including the use of radiation. Although numerous studies have shown post-excisional X-rays, electron beam, lasers and brachytherapy can reduce the rate of keloid recurrence, numerous inconsistencies, including a wide range of definitions for keloid recurrence, make it difficult to compare study outcomes. The review aims to examine the various means for defining keloid recurrence in clinical trials involving the use of radiation therapy. Searches of the Cochrane Library and PubMed were performed to identify the available information for post-surgical keloid recurrence following radiation therapy. Each identified study was reviewed for patient follow-up and criteria used to define keloid recurrence. The search results included clinical studies with external beam radiation, brachytherapy and superficial radiation therapy. Many studies did not include a definition of keloid recurrence, or defined recurrence only as the return of scar tissue. Other studies defined keloid recurrence based on patient self-assessment questionnaires, symptoms and scar elevation and changes in Kyoto Scar Scale, Japan Scar Workshop Scale and Vancouver Scar Scale scores. The results of this review indicate keloidectomy followed by radiation therapy provide satisfactory recurrence rates; however, clinical studies evaluating these treatments do not describe treatment outcomes or use different definitions of keloid recurrence. Consequently, recurrence rates vary widely, making comparisons across studies difficult. Keloid recurrence should be clearly defined using both objective and subjective measures.

Treatment of Keloids: A Meta-analysis of Intralesional Triamcinolone, Verapamil, and Their Combination

“…There are multiple delivery methods in use, including X-rays, electron beam, lasers, and brachytherapy. 5…”

Comprehensive Analysis of Circular RNA Expression in ceRNA Networks and Identification of the Effects of hsa_circ_0006867 in Keloid Dermal Fibroblasts

“…As benign skin fibroproliferative tumors, keloids are characterized by a typical fibrosis state and some cancer-like features (Gold et al, 2020). A previous study has reported that circRNAs participate in the progression of fibrosis in various organs, including the skin, heart, liver, lung, and kidney (Dong et al, 2021;Wan et al, 2021).…”

“…Keloids can invade surrounding healthy skin out of the original wound, usually causing pain, severe itch, malformation, and even dysfunction, seriously affecting the physical and mental health of patients (Bijlard et al, 2017). Therapeutic options for keloids are few and ineffective with common recurrence and deformities posttherapy (e.g., surgery, drug injection, and perioperative radiation therapy) (Qu et al, 2013;Gold et al, 2020;Lv et al, 2020). Therefore, there is an urgent need to explore and understand the aggressive progression of keloids to help identify novel effective treatment strategies and preventive methods.…”

Flourish of Proton and Carbon Ion Radiotherapy in China

“…Keloid is accompanied by chronic inflammation, which is prone to infection and ulceration. At present, the main treatment for keloids is surgical resection, but there is a high recurrence rate after surgical resection alone, so it is often necessary to combine other adjuvant treatments after surgical resection ( 131 ). Surgical resection combined with radiotherapy is a more conventional treatment for keloids.…”