The results of surgical excision and adjuvant irradiation for therapy-resistant keloids: A prospective clinical outcome study

BACKGROUND: There is no consensus on the best way to treat keloids, because adequate studies on this subject are sparse. Surgical excision in combination with radiotherapy is considered the most efficacious treatment available in severe keloids following the International Clinical Recommendations on Scar Management. Unfortunately, the recommendations are mainly based on retrospective studies that do not define recurrence. METHODS: The authors evaluated the recurrence rate of therapy-resistant keloids treated with excision followed by radiotherapy (1200 Gy in three or four fractions). The minimum follow-up period was 12 months. The therapeutic outcome was judged as recurrence (elevation of the lesion not confined to the original wound area) or nonrecurrence. An evaluation of the outcome of the scars was obtained by using the Patient and Observer Scar Assessment Scale. RESULTS: Twenty-one patients with 32 keloids were evaluated. The recurrence rate was 71.9 percent after a mean follow-up period of 19 months. CONCLUSIONS: This high recurrence rate suggests that radiotherapy might be less efficacious than suggested by other studies. On the basis of the authors' results, surgical excision combined with radiotherapy should be reserved as a last resort in the treatment of therapy-resistant keloids.