Outcomes of Surgical Excision and Brachytherapy in Intractable Keloids

BACKGROUND: Keloids as unusual scars are injury remnants characterized by bizarre cosmetics and painful itching. This study assessed outcomes of surgical excision and brachytherapy in intractable keloids. METHODS: Six patients with 10 keloid lesions were followed up. Surgical excision was done with 1-2 mm margin, and then radiotherapy was undertaken in 3 divided fractions on days 0, 1 and 2 after surgery. Scar improvement was evaluated by patients and observer with scar assessment scale (POSAS) RESULTS: Median age of patients was 38.3±6.4, while 40% were male and 60% were female. The mean primary size of the lesion before brachytherapy was 325.18±426.16 mm(2) and the median size was 153.48 mm(2). The mean primary size of the lesions with recurrence before brachytherapy was 150.50±124.78 mm(2). The clinical improvement of the scars with POSAS scoring by the observer was 17.1±3.2 and by the patients was 20.8±11.5. In 5 patients who were evaluated, two keloid lesions showed recurrence (20%), and 8 lesions had no recurrence (80%). No patients reported side effects, but only one patient, a 43 years old woman with 5 keloid lesions, suffered wound infection and local dehiscence of the wound, followed by the second session of brachytherapy. The average time of relapse was 26.3±0.9 months. CONCLUSION: The use of surgical resection in combination with brachytherapy was demonstrated as a modality for treatment of refractory keloid scars that can be recommended to surgeons who deal with these patients.