CLINICAL PRACTICE ARTICLE Massive ear keloids are keloids that measure greater than the surface area of the corresponding ear. Semi-massive ear keloids are those ear keloids that measure smaller than massive ear keloids, yet they are are is at least 50% of the surface area of the corresponding ear.
By far, the most important factor in development of all primary keloidal lesions is the initial wounding injury of the skin. However, the surgical removal of ear keloids that is commonly performed by ENT specialists, plastic surgeons and general dermatologists, defies this very basic principal of keloid formation. The extent of the injury to the surrounding skin when an ear keloid is surgically removed is obviously several fold greater than the primary injury sustained from the piercing procedure. This iatrogenic injury will undoubtedly trigger a keloidal wound healing response that is not only more intense than the one triggered by the original piercing event but also much greater in magnitude and distribution. Studies have indicated that almost all ear keloids and almost all other keloid lesions will relapse after surgery; hence, the need for adjuvant treatment has been emphasized by almost every author who has published on this topic. Adjuvant treatments in the form of post-operative steroid injections, pressure devices or even radiation therapy are often incorporated in management of ear keloids in order to counteract the fully expected keloid recurrence after surgery. However, despite the meticulous use of all available adjuvant treatments, a large number of patients will suffer from recurrent ear keloids and undergo second, third or fourth surgeries. Unfortunately, the ear keloids will continue to relapse in many instances. At some point, the surgeon, the patient, or even both will abandon therapeutic interventions.
This page focuses on these unfortunate cases; instances of recurrent large, semi-massive, and massive ear keloids among mostly young patients who ultimately accept the reality that surgery and/or adjuvant radiation therapy cannot treat their keloids, thereby resigning themselves to living with huge tumoral keloids hanging from their ears, an unwanted and unpleasant outcome that impacts every aspect of their daily lives.
Massive Ear Keloids
This a case of 23 year old female with massive/very large keloids on both her ears. Her first keloid occurred at age of 5. She has had numerous treatments, several attempts at surgical removal, steroid injections as well as radiation therapy to her ears. None of these helped her with her keloids to a point that she, and her family simply gave up on treatment. She came to our practice in November 2013. Treatment with cryotherapy was chosen as the first step to reduce the mass of her keloids. The video depicts application of cryotherapy to her left ear, as well and the interim treatment results.