Living with Keloids..Things You Should Know!

Surgery to cut keloids or Keloid surgery is often not used as a first option, as although it may initially provide the patient with a good result, studies have demonstrated that between 45-100% of patients have recurrences of the keloid, it is also possible that the keloid which forms after excision may be larger than the original keloid scar. This is as surgery would inevitably involve cutting of the skin, which itself precipitates Keloids. Surgery undertaken in conjunction with other therapies has been shown to reduce the rates of recurrence. An operation can be used to either totally cut the keloid out or to just reduce its size. If choosing to totally cut the keloid out then surgery is combined with another form of therapy to reduce the rates of recurrence.

Types of operation?

Intralesional excision

This type of surgery is used to de-bulk and reduce the size of the keloid. Intralesional exicision leaves the outer segment of the keloid which is still growing with the surgeon cutting out the central portion of the scar, this reduces its size. The borders of the scar are then brought together forming a far smaller scar, this is known as direct closure. If the edges are unable to be brought together then a split skin graft may be used to cover the exposed area. This type of surgery can be undertaken if parts of the scar are particularly symptomatic or infected.

Often this type of surgery will be combined with Steroid Therapy, the combination of both surgery and steroids results in a reduced rate of recurrence. It is important to note that combining these therapies means that patients may be at risk to the adverse effects of steroids described above.

Excision + Radio Therapy

Surgical excision combined with radiotherapy has also demonstrated good results, various studies report different timings with regard to when radiotherapy may be best suited, ranging from directly after surgery to two weeks post operatively. Radiotherapy combined with total resection has been shown to be effective in reducing the rates of recurrence although there are only a few studies showing its benefits the cure rate varies between 65-99%. It is important to note that radiation therapy carries a number of risks, including a risk for developing cancer and as such is not recommended for children or pregnant women. Other problems with radiotherapy may include changes in the piment of the skin and telangiectasia.

What happens on the day?

Elective Operations take place at the operating theatres at hospital which was completed last year. Operations may often be Day cases and can be carried out under local or general anaesthetic. You will be given more information about what will happen on the day of your operation closer to the time of it.