“TIRGAN” KELOID STAGING SYSTEM:
In his 2016 publication, Neck Keloids: evaluation of risk factors and recommendation for keloid staging system" Dr. Tirgan introduced a staging system to accurately categorize and group keloid patients into various stages."
To validate this staging system, clinical records from a large cohort of keloid patients treated by Dr. Tirgan were analyzed. An independent colleague conducted a repeat analysis of this clinical dataset, leading to a revision of the staging criteria. The findings of this study were published in 2021 under Cartesian Model of Keloid Growth.
Staging systems have long been employed in cancer management, as they provide valuable insights into patient outcomes. For instance, a patient with very small, stage one breast cancer will likely have a different prognosis compared to someone with metastatic, stage four breast cancer. Dr. Tirgan has developed a Keloid Staging System based on the same methodology used in cancer staging. The TNM cancer staging system has been utilized for decades to categorize cancer patients effectively, guiding many cancer treatments, clinical trials, and standard therapies. The conduct of oncology clinical trials and the interpretation of their results depend heavily on the TNM staging system.
In the absence of a similar staging system for Keloid Disorder, interpreting the results of published keloid studies has proven challenging. For example, when assessing the recurrence rates of ear keloids after surgery, it stands to reason that patients with a single keloid on one ear will have different outcomes compared to those with multiple keloids on various parts of their bodies. Additionally, individuals who have undergone prior surgical removal of their keloids typically experience a higher rate of recurrence than those who have never had surgery.
To adequately assess keloid patients, we require a staging system that describes the severity of Keloid Disorder based on factors such as size, location, and extent of keloidal lesions. Dr. Tirgan's Keloid Staging System facilitates a better understanding of the natural history of this disorder and allows for meaningful comparisons of future keloid study results across various patient groups. Other prognostic factors, such as a history of surgery or radiation therapy, may also influence outcomes. Additionally, there may be other, currently unidentified factors that play a role. Implementing such a staging system can guide the proper management of keloid patients by stratifying inherent risks of recurrence, including responses to prior treatments, family history, age, gender, and race.
A well-designed clinical staging system must undergo validation through reviews of retrospective studies and planned prospective clinical trials. Dr. Tirgan is at the forefront of these efforts, refining his staging system based on his experiences with 1,088 patients. Following this evaluation, the staging system underwent slight revisions in 2018. The current revision of the Tirgan Staging System is presented here.
