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,