KAUAI, HAWAII – The truth about keloids is that most affected patients are not surgical candidates and thus, need to be convinced to pursue nonsurgical options, according to Hilary Baldwin, MD, medical director of the Acne Treatment and Research Center in Morristown, N.J.
“Virtually all patients arrive saying, ‘I want this cut off. I want this gone today, or even better, yesterday,’ ” she said at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.
Bruce Jancin/MDedge News
Dr. Hilary Baldwin
“Removal without adjunctive therapy is a guaranteed failure – about 100% of the time in my experience. ‘I don’t want injections’ is not the answer. They always say they don’t want injections, but regardless of what else I do, they’re going to get shots,” stressed Dr. Baldwin, who is also a dermatologist at the Rutgers Robert Wood Johnson Medical School in New Brunswick, N.J.
With earlobe keloid surgery alone, the recurrence rate is less than 50%. With surgery, followed by a program of corticosteroid injections, the recurrence rate plummets to 1%-3%. And, with surgery followed by adjunctive radiotherapy, the rate is close to zero.
In contrast, keloid surgery at sites other than the earlobe has roughly a 50% recurrence rate if followed up with corticosteroid injections and 20% with radiotherapy. Patients need to understand this upfront. They also need to be told that, while treatment can improve appearance, the site will never look normal.
Pedunculated lesions are quite amenable to surgery. They are often mushroom shaped, with a narrow base that doesn’t contain keloidal tissue. “Pedunculated lesions are the maximum benefit with least risk scenario,” Dr. Baldwin commented.