Rare penile keloid after circumcision: Case report and literature review

Abstract

Objective: To report a case of keloid formation after circumcision and review the literature for similar cases to formulate possible risk factors contributing to its development as well as its treatment options.Method: a literature review was done using Pub-Med and Google Scholar by searching the keyword "keloid", "penis" and "circumcision". Additional searches were done on references from related articles. The articles are then reviewed by the author, noting for possible predisposing factors to keloid formation, along with patient demographics and method of treatments. Findings were then tabulated and analyzed using Microsoft Excel (2018).Results: Thirteen case reports on penile keloid after circumcision with a total of 16 patients were found dating from 1993 to 2017. Circumcision in four cases (25%) were complicated with infection or dehiscence. The median age during circumcision is 9 years old. Two patients (12.5%) were reported with the tendency for keloid. The ethnicity of the patients is as follows; Turkish (7 cases, 43.7%), African descent (4 cases, 25%), Chinese (3 cases, 18.75%), Indian (1 case 6.25%) and Caucasian (1 case, 6.25%). Ten (62.5%) cases were treated with a combination of excision and immediate injection of triamcinolone acetate. Others were treated with either excision alone, steroid injection alone or excision with topical steroid. Maintenance treatment includes topical steroid, intralesional injection of steroid, and silicone gel. Recurrence occurred in one patient. Conclusion:The minuscule number of published reports of keloid formation after circumcision underscores the rarity of the complication. No specific risk factors can be attributed to stratify patients who may develop keloid after circumcision. Excision followed by triamcinolone acetate injection with maintenance therapy until scar maturity is the preferred choice of treatment for penile keloid.