Keloid involvement of the neck skin is fairly uncommon and occurs in approximately 10% of patients with keloid disorder. This pattern of presentation is somewhat race specific. In a recent analysis of data from 1,088 consecutive patients seen by Dr. Tirgan is his keloid specialty medical practice, there were 104 ( 9.6%) patients with neck involvement. Among these patients: 47 (46%) were female and 57 (54%) male; and 78 (85%) were African American, 9 (9%) were Caucasian, and 7 (7%) were Asian.
Clinical presentation of keloid disorder in the neck varies by the ethnic background. The tumoral neck keloids are almost exclusively seen among African Americans. Fifty-seven of the 60 patients who presented with tumoral keloids were African American.
The two most common triggering factors for the formation of neck keloids are acne among Asians and Caucasians and ingrown neck hair among African American men. Proper management of these two factors should be incorporated in the plan of care for all patients.
Involvement of the neck as the only site of keloid disorder is uncommon. Of the 104 cases seen by the author, 91 (87.5%) of these patients had keloid lesion(s) elsewhere on their skin. As with other keloids, the clinical presentation, size, and shape of neck lesions vary from patient to patient. Neck keloids in their early-stages are small and few in number. As time passes, the lesions grow in size and spread to involve larger areas of the neck.
Early-stage Neck Keloids:
Neck keloids at their earliest stages appear in three distinct manners:
- Protruding papule(s) that often form in the submental area of neck and are triggered by acne or ingrown neck hair (Figure 1). If left untreated, these lesions can grow to become nodular keloids.
- Linear If left untreated, these lesions can grow to form thicker linear lesions.
- Nodular If left untreated, these lesions can grow to form tumoral lesions.
Early Stage, Papular Neck Keloid
Early-stage papule keloid in a 32-year-old African American female with a 10-year history of keloid disorder, involving her chest and shoulders as well.
Early Stage, Linear Neck Keloid
Early-stage linear neck keloid in young Asian male. This lesion was triggered by surgical removal of a mole. A keloid formed at the site of mole removal surgery. The keloid was then excised and the surgical wound was treated with steroid injection, yet the lesion shown here evolved despite adjuvant interventions. This patient had no other keloids.
Early Stage, Nodular Neck Keloid
Early-stage nodular neck keloid in a 24-year-old African American male with a four-year history of keloid disorder also involving his face, anterior neck, ears, and chest. This lesion was treated twice with cryotherapy. Figure 3b was taken two years after treatment, showing minimal skin scarring at the site of the treated keloid.