Papers of The 2nd Japan Scar Workshop

11. Management and Outcome of Combination Therapy by Surgical Excision and Irradiation for Keloids

Yanagisawa Akira1, Hashikawa Kazunobu1, Kemmoku Kazutaka2, Terashi Hiroto1, Yoshida Kenji3, Tahara Shinya1

1:Department of Plastic Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
2:Department of Plastic Surgery, Sanda City Hospital, Hyogo, Japan
3:Department of Radiology, Kobe University Graduate School of Medicine, Hyogo, Japan

There is no consensus for the best way to treat refractory keloids because of the small number of studies on the subject. Combination therapy by surgical excision followed by irradiation is considered the most efficacious method for treating such keloids. Between 2001 and 2006, 31 keloids in 26 patients were selected and studied at Kobe University Hospital. The keloids were surgically removed. Some (15/31) were treated postoperatively with 20 Gy electron-beam irradiation, and all were followed up for more than 12 months. The therapeutic outcome was evaluated by classification into a recurrence group and a no-recurrence group. The recurrence rate in the external ear (including the auricle and the ear lobe) was 8.3% (1/12) after excision only and 16.7% (1/6) after excision followed by irradiation. The recurrence rate at other sites was 100% (4/4) after excision only and 66.7% (6/9) after excision followed by radiation therapy. Excision might be sufficient for the treatment of keloids in the external ear, at least primarily. On the other hand, excision followed by irradiation is required for the treatment of keloids at other sites, and more than 20 Gy irradiation might be desirable in some cases.
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