Ear Keloids – Case Study 13- Recurrence Despite Radiation Therapy:
This gentleman first came to see Dr. Tirgan in March 2012 with having keloids on both his ears. At that time, he stated that the keloids had started in 2008 following bilateral earlobe piercings, and prior to his 2012 visit, he had surgery on both his ears, followed by several steroid injections, however, there was recurrence on both ears. He traveled from long-distance to come to see Dr. Tirgan for consultation. Images below show the status of his ears in 2012.
Bilateral Ear Keloids
Both ear keloids were treated during the same visit in 2012. Keloids like the ones depicted here often require 3-4 rounds of cryotherapy given once every 6-8 weeks. This patient, however, returned in April 2014, at which time his keloids had somewhat grown and become larger. Both ear keloids were treated with cryotherapy during this visit.
Bilateral Ear Keloids - Follow Up
Patient, returned in April 2015, at which time his keloids were once again treated with cryotherapy.
Bilateral Ear Keloids - Follow Up 2
After the last cryo treatment in April 2015, the patient did not return to Dr. Tirgan. He was happy with the improvement that was achieved with cryotherapy for his right ear keloid. However, he decided to undergo surgery followed by radiation therapy to his left ear. This was done in 2018.
In May 2020, he returned to Dr. Tirgan as he had noticed another recurrence at the site of the 2018 surgery. He was quite disappointed with the outcome of surgery and the monies that he had paid to a plastic surgeon who had promised him excellent outcome at an out-of-pocket cost of over $10,000.
The images below were taken in May 2020 and show the keloids on both his ears. The recurrence in the left ear was much worse this time than it was in 2012. He had re-contacted the same plastic surgeon, who had advised him to undergo another surgery and repeat radiation therapy with an additional exuberant cost. Luckily, he realized that this surgeon lacked an understanding of the natural history of keloid disorder, but fully understood the income potential from re-operating on his ear.
The patient decided to return to Dr. Tirgan for re-evaluation and re-treatment with cryotherapy. During this visit in May 2020, the left ear was found to be involved with a significant amount of keloid tissue that had now involved the deep tissues of his ear, and all around the surgical incision. The keloid was once again treated with cryotherapy and the gentleman was advised to return in two months.
Left Ear - May 2020
Left Ear - May 2020
Keloid Recurrence after repeat surgery and radiation therapy
This case is an example of how harmful surgery may be for treatment of ear keloids. Surgery alone will result in nearly 100% recurrence. Steroid injections reduce this chance somewhat, so does radiation, however, close to 25-50% of patients will eventually have a recurrence that will act much worse and will grow with a vengeance. in 2020 and with our current methods, It is rather impossible to predict who will benefit and who will have a recurrence after surgical removal of all keloids, including ear keloids. Therefore, operating on ear keloids exposes patients to a significant risk of worsening of their keloids.
Cryotherapy is by far the best method of treating almost all ear keloids.