Management of pediatric penile keloid

Abstract

Keloids are abnormal scar tissue growths that extend beyond the original area of injury, occasionally occurring post-surgery. Risk factors for keloids include skin trauma, infection, prolonged wound healing and individuals of certain ethnicities. Keloid formation on the penis, however, is a rare occurrence even among circumcised males, and can produce both aesthetic and functional complications. We document the tenth patient in the literature, to our knowledge, to present with a keloid of the penis. IntroductionKeloids are abnormal scar tissue growths that extend beyond the original area of injury, occasionally occurring post-surgery. Risk factors for keloids include skin trauma, infection and prolonged wound healing. Keloid formation on the penis, however, is a rare occurrence even among circumcised males, and can produce both aesthetic and functional complications. We document the tenth patient in the literature, to our knowledge, to present with a keloid of the penis. Case reportA 19-month-old male of African descent was referred to us with a keloid of the shaft of the penis. The patient had undergone a circumcision in the neonatal period and had since developed a thickened tumour. The patient's mother describes wound separation post-circumcision, with several weeks before ultimate healing. The patient was asymptomatic from a urologic point of view, but the lesion was not aesthetically acceptable to the family. The patient, of African descent, had no previous or family history of keloid formation. Given the extreme size of the tumour (Fig. 1, Fig. 2) and to prevent future complications, we decided to excise the keloid and reconstruct this either with a skin graft or via advancement of the local tissues.An incision was established with a 1-mm margin around the tumour through skin to the level of the dartos fascia. The keloid, measuring 4.6 cm × 1.8 cm, was dissected off of the dartos fascia circumferentially, and then excised in its entirety and sent to pathology for further histopathological review (Fig. 3, Fig. 4). The dartos fascia was not breached nor was the urethra entered.For reconstruction, a small lip of normal tissue was left at the ventral base of the corona resembling a circumcisionstyle incision. Proximally, for about 2cm circumferentially, the level of dartos fascial layer was undermined for tensionfree advancement of the penile shaft skin. The proximal tissues were able to be advanced to the corona without any evidence of tension. As such, reconstruction and closure of the skin followed. Monocryl 5-0 interrupted and running intracuticular sutures were used to close the wound (Fig. 5). There were no intraoperative complications and dressings consisted of bacitracin ointment only. The patient was discharged on postoperative day 1. The patient was recurrence-free 3 years postoperatively (Fig. 6). The patient had no postoperative complications related to urologic function. The histopathology was suggestive of a keloid and no other abnormalities were found upon analysis. DiscussionKeloids are...

Location of Keloids and Its Treatment Modality May Influence the Keloid Recurrence in Children

“…Instead, only a few case reports describing pediatric keloids were rarely introduced. 2 The purpose of this study was to analyze pediatric keloids and to recommend our effective options to treat this complicated condition.…”

A rare presentation of penile keloids after traditional circumcision: Case report

“…Keloids can grow to large sizes and encroach on normal skin. They are commonly complicated by pruritus, tenderness, burning sensation, ulceration and secondary infection [8].…”

Literature review and case report of post-circumcision keloid management

“…It was excised twice and the surrounding skin exposed to radiotherapy to prevent recurrence. Since then there have only been 11 paediatric cases occurring after circumcision described in the literature and these have been treated with a mixture of excision, triamcinolone acetate and topical steroid application, as summarised in Table 1 [11][12][13][14][15][16][17][18][19][20].…”