Keloid Excision and Adjuvant Treatments

Abstract

Background Keloid disease treatment continues to be unsatisfactory with high recurrence rates. We evaluated the literature regarding the effectiveness of keloid excision with various adjuvant treatments following surgery and assessed recurrence rates. Methods We systematically searched databases through November 2016. We performed pairwise meta-analyses and Bayesian network meta-analyses on the number of recurrences. Results Following screening, 14 studies including 996 patients with various types of keloids were eligible for inclusion. Patients were categorized based on the receipt of surgery and the type of adjuvant treatment employed afterward. Paired meta-analysis (6 meta-analyses) showed that “excision + 1 adjuvant drug” led to statistically significantly higher odds of recurrence compared to “excision + radiation” (odds ratio [OR], 3.22; 95% confidence interval [CI], 1.35–7.67). Based on the network meta-analyses, the ORs of keloid recurrence following various treatments compared to no excision were as follows: “excision + pressure, 0.18 (95% CI, 0.01–7.07); excision + 2 adjuvants drugs, 0.47 (95% CI, 0.02–12.82); excision + radiation, 0.39 (95% CI, 0.04–3.31); excision + skin grafting, 0.58 (95% CI, 0.00–76.10); excision + 1 adjuvant drug, 1.76 (95% CI, 0.17–21.35); and excision only, 2.17 (95% CI, 0.23–23.95). Conclusions According to our results, “excision + radiation” had significantly better outcomes than excision alone. “Excision + pressure” had better outcomes than excision + any other treatment modality, and excision + nonradiation adjuvant therapies were also better than “excision only,” although these findings did not reach statistical significance.

Surgical excision and postoperative radiotherapy for keloids

“…A much faster approach is to extirpate the keloid. Initially, however, surgical monotherapy was strongly avoided and used in only extreme cases due to the witheringly high rates of recurrence, 1 which were often much worse than the original lesion. This problem can be alleviated by the use of postoperative radiotherapy, which inhibits keloid recurrence by preventing new keloidogenic inflammation, possibly by inhibiting immune cell function and neovascularisation.…”

Keloid Formation after Circumcision: A Case Report and Current Literature Review

“…To date, various methods including intralesional therapies (corticosteroids, 5-fluorouracil, interferon, bleomycin injection, intralesional brachytherapy, intralesional botox), surgical excision, topical corticosteroid injection, radiation therapy (external beam radiotherapy; EBRT and brachytherapy), silicone gel therapies, compression therapy, and laser therapies have been trialled for the treatment of keloids. [5][6][7][8] Of these, intralesional corticosteroid injection, topical corticosteroid injection, surgical excision, and silicone gel therapies were reported to be successful for the treatment of penile keloids.…”

Extraskeletal Osteosarcoma After Postoperative Radiotherapy for a Keloid: a Case Report

“…Keloids are benign but can signi cantly affect patient quality of life. Since surgical resection alone associates with recurrence rates of up to 50-80% [1,2], resection followed by postoperative radiotherapy has become the standard treatment for these scars over the last few decades. This treatment paradigm is supported by the fact that the risk of carcinogenesis from keloid radiotherapy appears to be very low: our PubMed literature search showed that over the last 70 years, only six cases of putative keloid radiotherapy-induced carcinogenesis have been reported.…”

“…Although keloids are benign and not life-threatening, the associated pruritus and pain can be very bothersome for the patient. Surgical resection alone associates with extremely high recurrence rates [1,2]. Therefore, surgery followed by postoperative radiotherapy has become the standard treatment for keloids in recent years [1].…”