Shoulder Keloids – Case Study 4 – Upper Arm Keloid:
This 30-year-old female presented with a large and bulky keloid in her left upper arm. This keloid first developed when she was 17 as a pimple that gradually grew larger. Prior to visiting Dr. Tirgan, this keloid was treated with intralesional steroid injections, however, not only it did not respond to steroid injection, but it grew larger.
Subsequently, she underwent surgery. The keloid re-grew soon after surgery, at which point she was retreated with intralesional steroid injections again and was once again advised to have repeat surgery by the first surgeon. Patient refused undergoing surgery. The image below depicts her upper arm keloid when she came to our practice in February 2014.
Treating such large keloids is rather challenging. It is always easier to treat a keloid when it is very small, as opposed to treating a keloid this size. The most important lesson to be learned from this case is that early-stage keloid lesions should NOT be treated with surgery.
Combination of cryotherapy, intralesional steroids and if needed, intralesional chemotherapy should be used aggressively in order to induce a remission in small keloids. Having a small keloid on your arm is not a good thing to have, but making that worse with surgery, and then having to live with this very large keloid is lot worse.
This keloid was first treated with cryotherapy in order to reduce the bulk of her keloid. Due to the large size of her keloid, cryotherapy was first applied to one half of her keloid, and then to the other half. She achieved a reasonable tumor reduction yet needed ongoing medical care in order to maintain the response that was achieved.
Currently, Dr. Tirgan treats such large keloids with a multi-modality plan that includes skin expansion, followed by surgery, followed by injecting the line of surgical wound with intra-lesional chemotherapy. This approach results in much better esthetic outcome,
Cryotherapy was continued and keloid continued to respond, yet we never achieved total clearance of the keloid.
Over the next few months, the deep layer of keloid started to slowly re-grow.
At this point, we decided to treat the remnant of her keloid with intra-lesional chemotherapy, to which she has had a noticeable response.
From this point on, the remnant of the keloid needs more treatment to remain in remission.