Surgical Removal of Keloids
Surgical removal of keloids is an area of great controversy. The biggest risk associated with keloid removal is the risk of recurrence after surgery. Keloids that re-occur after surgery are often bigger in size and much harder to treat.
The onset of a keloid is triggered by a minor wound in the skin. In surgically removing a keloid, a much bigger wound is induced by the surgeon. This new and larger wound will obviously result in formation a much larger keloid. An online survey study was launched in November 2011. As of December 15, 2012, 670 patients have responded to this survey among whom 193 had surgery for their keloids. The graphs below show the outcome of surgery for this patient group. This study shows that surgery carries a very high risk of worsening the keloids. Only 5% of patients are cured with surgery. 10.4% relapse yet the keloid remains smaller. 11.4% relapsed and their keloids returned to the same size as before surgery. 73.1% (141 patients) noticed worsening of their keloids after surgery. So if you are thinking of having surgery for your keloid, study this chart carefully.
Predicting the risk of recurrence of a keloid after surgical removal is impossible. What is greatly needed is a methodology to make a risk determination as to which keloids will recur and which will not. This is an area that needs to be properly researched.The risk of recurrence after surgery for certain keloids such as chest wall, shoulder keloids is near 100%. Local injection of steroids after surgery reduces the risk of recurrence of certain keloids in the earlobe, not in other parts of the body. The degree of benefit from this intervention is unclear.Radiation therapy is also utilized to reduce the risk of recurrence. Although it can reduce the risk of recurrence to some extent, Radiation carries a major risk of causing cancers and should not be used to treat keloids in young and healthy individuals.Picture below depicts how a simple earlobe keloids can react to surgery.
Flat, small and minor keloids should never be treated with surgery. We see over and over, that a surgeon has cut out a small keloid from the skin, and the result has been worse than the condition prior to surgery.It is well understood that keloid is a genetic and an inherited disorder of the wound healing mechanisms of the skin. Surgery cannot change the genetic makeup of the person. Surgery only triggers the abnormal wound healing response, which is the core problem in keloid formation, and commonly results in development of a much more complex and bigger keloid.
Radiation can damage the organs that are under the area where keloid is locates. Radiating neck will result in total loss of thyroid function, making the person hypothyroid, requiring lifelong thyroid supplement medications. Radiation to the chest area can damage the heart and lungs. Radiating abdomen can damage the liver. Radiation the pelvis can damage the bone marrow, ovaries in women and testicles in men, potentially causing infertility.
The treatment is very often ineffective : Despite all these risks, there is no guarantee that the addition of radiation can prevent recurrence of keloid.
Risk of surgery and general anesthesia : Every surgical procedure has a risk, especially when performed under general anesthesia.
Certain keloid patients may benefit from surgery. To date we do not have a method of predicting who will benefit and who will not. Pedunculated Earlobe Keloids (those with a stalk) in patients who are lowest risk of recurrence, i.e. those with no other keloids on their skin, and those with negative family history of keloid, can be considered for surgery. There are reports from Far East, of successful multimodality treatments of earlobe keloids, using surgery, steroid injections, magnetic pressure earrings, etc. These results are very encouraging, yet they need to be re-produced in individuals who are from African ancestry. If you have a keloid that is other that type, think twice before opting for surgery. Below are few images of what surgery can do to keloids.
Treatment of keloid disorder is an area of unmet medical need. Much more research is needed to figure out what drives this disorder and how best to treat it. Our current treatments for keloids are the same as they were 30 years ago. We have not made any progress in treating this condition.If you have keloid, I urge you participate in this study survey. Your participation will help us to better understand not only the true rate of efficacy of surgery in keloid, but also numerous other aspects of this disorder. [www.KeloidSurvey.com] .