What is the efficacy of excision for treatment of keloids and hypertrophic scars?

Updated: May 29, 2020
  • Author: Brian Berman, MD, PhD; Chief Editor: Dirk M Elston, MD  more...
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Decreased recurrence rates have been reported with excision in combination with other postoperative modalities, such as radiotherapy, injected IFN, or corticosteroid therapy. Excisional surgery alone has been shown to yield a 45-100% recurrence rate and should very rarely be used as a solitary modality, although excision in combination with adjunct measures can be curative. Most studies in which excisional surgery was combined with injected steroids reported a recurrence rate of less than 50%. Surgery followed by adjunctive radiotherapy has obtained recurrence rates of 0-8.6%. [86, 87, 88] A 2020 retrospective, chart review study describes 96 excised keloids receiving superficial radiation therapy (SRT) (61 patients) with more than 1 year of follow-up (or recurrence noted prior to 1 year) at four US sites. [89] Post keloidectomy, usually three 6-Gy fractions were given on postoperative days 1, 2, and 3 (biological effective dose of 30 SRT at 70 or 100 kV) to the suture closure line, with a 5-mm margin. Ten (10.4%) of 96 sites noted a keloid to recur within 12 months; 5 of 10 were clinically significant and 1 additional recurrence was noted by 18 months follow-up. The Kaplan-Meier Survival Probability Estimate cure rate was 85.6% from 24 months post-SRT treatment end onwards.

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