Most keloid lesions start as a small spot on the skin. Over time, the small lesions grow in size and become bigger. Some keloid lesions, have a tendency to grow into round lesions and raise above the skin level. Tumoral keloid lesions grow in size and become larger than 2 centimeters in diameter. Most large earlobe keloids are by definition "tumoral'. Treatment of these keloids is often complicated by performing a wrong first treatment procedure. It is by gut feeling that most surgeons jump into cutting a tumoral keloid. Surgery for keloids often results in formation of a new keloid. This is due to the fact that surgeon's scalpel will induce a new skin injury in a patient who is already prone to keloid formation. Skin injury from surgery will trigger formation of a new keloid. Jumping into surgical removal of nodular or tumoral keloid is not scientific, and is done based on a gut reaction from surgeons more than being based on scientific facts.
Cryotherapy is safest and most effective method of treating tumoral keloids. Ear tumoral keloids respond very very to cryotherapy.