The Influence of Surgical Excision Margins on Keloid Prognosis

Abstract

Keloid disease is known to have variable clinical behavior in response to therapy and there is no clinicopathologic classification that predicts such varied behavior. The aim of this study was to study the effect of excision margins and other histopathologic characteristics on keloid prognosis.Seventy-five multiethnic patients presenting with keloid scars at a department of plastic and reconstructive surgery during an 11-year period were included in this study. Clinical data was collected and detailed histologic analyses using light microscopy were carried out on archived patient specimens.A detailed histopathologic examination of all tissue samples identified keloid border or margin characteristics which were classified into "circumscribed" (borders clearly-demarcated) and "infiltrative" (borders not clearly-demarcated and not easily-definable). The specific histologic findings were correlated with keloid recurrence which revealed that incomplete peripheral (P < 0.001) and deep excision margins (P < 0.001), as well as infiltrative borders (P < 0.05) were associated with higher 1-year reported recurrence rates.This study has given evidence that incomplete surgical excision are associated with higher recurrence and this may justify the practice of routine histopathologic reporting of keloid excision margins.

Fibroblasts from the growing margin of keloid scars produce higher levels of collagen I and III compared with intralesional and extralesional sites: clinical implications for lesional site-directed therapy

“…In our previous study, we reported that different lesional sites in keloid scars regulate gene expression differently, 41,42 and heterogeneity within the keloid lesion may exist in terms of gene expression 43,44 . This notion of site differences in disease progression has been strengthened by the observation that keloid recurrence as well as prognosis seems to be affected by total excision or retention of the growing margin (perilesion) of the keloid scar 45 . More importantly in relation to our work, different passage numbers of primary fibroblasts behave differently in their gene expression and growth kinetics of collagenase gene expression 46,47 .…”

A New Uniform Protocol of Combined Corticosteroid Injections and Ointment Application Reduces Recurrence Rates After Surgical Keloid/Hypertrophic Scar Excision

“…According to one study, postoperative steroid treatment of secondary keloids results in a higher recurrence than with treatment of primary keloids, but our study did not find any tendency for greater recurrence in secondary keloids than with primary keloids. Other studies have reported the recurrence rate of complete keloid excisions to be lower than that of incomplete keloid excisions . In our study, the peripheral and deep margins of the keloids were completely removed.…”

Are there any good treatments for keloid scarring after sternotomy?

“…Tan et al [3] undertook a retrospective study of 75 patients who underwent surgery and adjuvant therapy. The histopathology margins were studied.…”