Iatrogenic is a condition that is caused by a physician. In surgically removing a keloid, the surgeon's scalpel will first injure the skin and induce a wound that is often wider that the keloid itself. This wound will obviously trigger keloid formation, and will in great majority of patients results in formation if a much larger keloid. The unfortunate fact is that majority of keloid patients do not know this fact and undergo surgery.
Knowing that surgery alone will most often worsen the situation, surgeons who operate on keloids, often advise another treatment after surgery such as radiation therapy, to reduce the chance of recurrence of the keloid. Although this combination may work for some patients, the radiation element of this combination poses a real risk of causing cancer in future. For those of you who know and play chess, it is like making a wrong first move when playing with a strong opponent. In this case surgery, is like that wrong first move and Keloid Disorder is a very strong opponent. We can only beat this disorder, by making correct moves from the inset.
As depicted in the case below, removing a large keloid leaves a wound that the surgeon cannot easily close. In performing such procedures, in order to close the wound at the site of an excised keloid, some surgeons use another surgical procedure known as skin grafting. Skin grafting involves removing a piece of normal skin from another part of the body and transplanting it to the wound that cannot be otherwise closed.
Removing normal appearing skin for purpose of skin grafting in a keloid patient can result in formation of a new keloid at the site where the graft is taken from, one that is caused solely by that act of a surgeon. In medicine, this is called “iatro-genic”. Iatros in Greek language means “doctor”.
Below is case of a iatrogenic thigh keloid. This gentleman started with a small neck keloid. Unfortunately, he had several surgeries to remove his keloid, and each resulted in formation of a much larger keloid. At the end, a surgeon suggested to remove his neck keloid and perform a skin graft, as he could not close the wound in the neck area. Radiation therapy was also used after surgical removal of the neck keloid. Below are the results: