Keloid Staging System

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STAGING OF KELOID DISORDER:…

Staging System

In his most recent publication, “Neck Keloids: evaluation of risk factors and recommendation for keloid staging system” Dr. Tirgan has designed a staging system that allows for proper categorization and grouping of keloid patients into various stages.  It is common sense that a patient with only one small keloid lesion will have a different outcome than one who has numerous large keloid lesions.

Staging systems have been used in management of cancer patients.  It is common sense that a patient with very small, stage one breast cancer will have a different outcome from patients with metastatic, stage four breast cancer.  Dr. Tirgan, in devising his #Keloid Staging System has followed the same methodology that is utilized in staging cancers.  TNM cancer staging system has been used for several decades and allows proper stage grouping of cancer patients. A great majority of caner treatments, clinical trials, and standard treatments are guided by the TNM staging of the cancer at any given time. Conduct and interpretation of the result of oncology clinical trials are virtually dependent on this staging system.

Without such a staging system for Keloid Disorder, the interpretation of all published keloid study results is very difficult. For example, when a study looks at the rate of recurrence of ear keloids after surgery, common sense tells us that patients who only have one keloid on one ear, will have a different rate of recurrence from those who have numerous keloids on their skin. Also, those who have had prior surgical removal of their keloids will have a much higher rate of recurrence than those patients who have never had surgery before.

To assess each keloid patient properly, to better understand the natural history of this disorder, and to be able to compare future keloid study results among various patients groups, we clearly need a staging system that can allow us to describe the severity keloid disorder based on the size, location and/or extent of the keloidal lesions; as well as history of surgery or radiation therapy, and perhaps other factors that are currently unknown to us. It is quite conceivable that proper management of keloid patients could be guided by such a staging system. Dr. Tirgan’s staging system for keloid disorder is a method that can stratify for such preexisting inherent risks of recurrence, such as response to prior treatments, positive family history, age, gender, race, and so forth.

A well-designed clinical staging system will need to be validated by review of retrospective studies as well as planned prospective clinical trials. Dr. Tirgan is leading the efforts to refine this staging system.

 

CLINICAL STAGING AND CLASSIFICATION OF KELOID LESIONS:

Stage 0: Genetically predisposed. At least one parent has had keloids. Index person has no clinical evidence or history of keloid or any hypertrophic scars.

Stage I: Presence of only one keloidal lesion.

Stage 1A: Presence of only one keloidal lesion that measures no greater than 2 centimeters in any dimension.

Stage 1B: Presence of only one keloidal lesion that measures 2.1 – 10 centimeters in any dimension.

Stage 1C: Presence of only one keloidal lesion that measures greater than 10 centimeters in any dimension.

Stage II: Presence of multiple keloidal lesion. The sum of the largest diameter of the keloids is up to 30 centimeters.

Stage II A: Keloids measure ≤ 2 centimeters in largest diameter; the sum of the largest diameter of all keloids measures 10 centimeters or less.

Stage II B: Keloids measure ≤ 10 centimeters in largest diameter, at least one keloid measures 2.1 – 10 centimeters in its largest diameter; the sum of the largest diameter of all keloids measures 10.1 – 20 centimeters.

Stage II C: At least one keloid measures 10 centimeters in largest diameter; the sum of the largest diameter of all keloids measures up to 30 centimeters.

Stage III: Presence of multiple keloidal lesions; the sum of the largest diameter of the keloids measures 30.1 – 50 centimeters.

Stage III A: Keloids measure ≤ 2 centimeters in largest diameter; the sum of the largest diameter of all keloids measure 30.1 – 40 centimeters.

Stage III B: Keloids measure ≤ 10 centimeters in largest diameter; at least one keloid measures 2.1 – 10 centimeters in its largest diameter; the sum of the largest diameter of all keloids measures 30.1 – 40 centimeters.

Stage III C: At least one keloid measures 10 centimeters in largest diameter; the sum of the largest diameter of all keloids measures 30.1 – 50 centimeters.

Stage IV: Presence of multiple keloidal lesions; the sum of the largest diameter of the keloids is greater than 50 centimeters.

Stage IV A: Keloids measure ≤ 2 centimeters in largest diameter; the sum of the largest diameter of all keloids measures greater than 50 centimeters.

Stage IV B: Keloids measure ≤ 10 centimeters in largest diameter; at least one keloid measures 2.1 – 10 centimeters in its largest diameter. The sum of the largest diameter of all keloids measures greater than 50 centimeters.

Stage IV C: At least one keloid measures greater than 10 centimeters in its largest diameter; the sum of the largest diameter of all keloids to measure greater than 50 centimeters.