CHALLENGING # CHEST WALL # KELOID

This is a 40 year old male with several chest wall keloids that started developing when he was in high school. He first presented to us in September 2012.

He had previously been treated with multiple rounds of steroid injections but the keloid was not responding to the injections. In Sept 2012, we started with application of cryotherapy to one of his keloids.

After this treatment, the patient did not return for follow up until November 2013. As seen in the image below, the keloid had progressed and enlarged. The two liner keloids had now merged into one large thick linear keloid.

At this point, we discussed the option of using intra-lesional chemotherapy, since his keloids had been growing actively. The keloids did initially respond to the first line chemotherapy, but subsequently relapsed.

Dr. Tirgan's Treatment approach to this keloid

We will post follow up on this case in September.

This has been a very challenging case. Patient is suffering from linear chest wall keloid. Main goal of treatment has always been to control the growth and induce a remission in these keloids. With failure of steroids and cryotherapy, we are now trying a second line chemotherapy drug, to which this patient has had partial response, as seen below. He was last treated with the second chemotherapy drug on July 15, 2014. Image below depicts the response to second line chemotherapy.

This case depicts the natural course of progression of chest wall keloid over time. First and second line chemotherapy drugs were to some extent painful for a few days, starting 24-48 hours after the injection and lasting 5-7 days. Patient is now tolerating the second line chemo well. We are encouraged with the partial results, and will see how far we can push back on this keloid. We are also using the scar formula cream on a regular basis.

Follow up

This keloid continues to respond to the second chemotherapy drug that is being injected at very minimal doses. Keloid remains free of pain and symptoms. The follow up image shows more improvement in overall appearance and thickness of this keloid. Achieving the results that we have achieved so far is simply not doable with any other treatment modality.

Chest Keloid

 
Keloid continues to respond to the second chemotherapy drug and remains free of pain and symptoms. The follow up image shows more improvement in overall appearance and thickness of this keloid. We treated this keloid again with chemotherapy.

Chest Keloid

Keloid continues to respond to the second chemotherapy drug and remains free of pain and symptoms. The follow up image shows continous improvement. One more treatment was applied. We will post photos as they become available.

Chest Keloid

Keloid continues to respond to the chemotherapy injections and remains free of pain and symptoms. The follow up image shows continues improvement. One more treatment was applied. We will post photos as they become available.

Chest Keloid