Outcomes of Surgical Excision and Brachytherapy in Intractable Keloids

BACKGROUND Keloids as unusual scars are injury remnants characterized by bizarre cosmetics and painful itching. This study assessed outcomes of surgical excision and brachytherapy in intractable keloids.
METHODS Six patients with 10 keloid lesions were followed up. Surgical excision was done with 1-2 mm margin, and then radiotherapy was undertaken in 3 divided fractions on days 0, 1 and 2 after surgery. Scar improvement was evaluated by patients and observer with scar assessment scale (POSAS)
RESULTS Median age of patients was 38.3±6.4, while 40% were male and 60% were female. The mean primary size of the lesion before brachytherapy was 325.18±426.16 mm2 and the median size was 153.48 mm2. The mean primary size of the lesions with recurrence before brachytherapy was 150.50±124.78 mm2. The clinical improvement of the scars with POSAS scoring by the observer was 17.1±3.2 and by the patients was 20.8±11.5. In 5 patients who were evaluated, two keloid lesions showed recurrence (20%), and 8 lesions had no recurrence (80%). No patients reported side effects, but only one patient, a 43 years old woman with 5 keloid lesions, suffered wound infection and local dehiscence of the wound, followed by the second session of brachytherapy. The average time of relapse was 26.3±0.9 months.
CONCLUSION The use of surgical resection in combination with brachytherapy was demonstrated as a modality for treatment of refractory keloid scars that can be recommended to surgeons who deal with these patients.