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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Answer

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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