Keloid treatment: what about adjuvant radiotherapy?

Ilias G Petrou,1 Kheeldass Jugun,2 Eva Meia Rüegg,1 Thomas Zilli,3 Ali Modarressi,1 Brigitte Pittet-Cuénod11Division of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva Faculty of Medicine, Geneva, Switzerland; 2Private Practice, Wellkin Hospital, Moka, Mauritius; 3Division of Radiation Oncology, Geneva University Hospitals, University of Geneva Faculty of Medicine, Geneva, SwitzerlandBackground: Keloids are debilitating fibrous skin proliferations with a high recurrence rate after surgical treatment. Postoperative radiotherapy (PORT) is a well-tolerated adjuvant treatment to reduce the risk of recurrence, but the optimal regimen for this combined treatment remains unknown. The aim of this study is to evaluate the efficacy of combining surgical excision and immediate PORT.Methods: We retrospectively reviewed the records of patients with keloid lesions treated with adjuvant PORT in the period 2005–2014 at Geneva University Hospitals. Main outcomes were the rates of complications and recurrence in patients with a minimal follow-up of 1 year, including the Patient and Observer Scar Assessment Scale satisfaction scores.Results: 10 patients with 16 keloids were eligible (mean follow-up, 37 months). Only one recurrence was reported (6%). In 12.5% of cases, mild erythema appeared in the early postoperative period. No major complications were observed. The overall patient and observer satisfaction rate was excellent.Conclusion: Surgical excision combined with immediate PORT is an effective and easy treatment with good esthetic results and an acceptable recurrence rate. It should be considered for patients with persistent keloid formation after failure of other treatments and those at high risk of relapse.Keywords: keloid, scars, radiotherapy, intralesional excision, scar correction, recurrenc