PRESENTED BY LOREH PETER

INTRODUCTIONKeloid is a benign tumor, which arises from scar tissue is

response to trauma.

Although keloids have varying growth patterns, they are considered benign tumors, because the development of malignant cells in keloids is very rare. In fact, most patients seek treatment for cosmetic concerns.

Most keloids are hard, raised and sometimes irritating or painful.

Keloids have a tendency of recurring after surgical excision; the recurrence is usually seen within six months after excision. (Principles and practice of Radiation Oncology by Perez and Brady’s)

As such, simple removal or plastic repair alone for keloid treatment is not always sufficient.

What are the causes of keloids?Cuts

Scratches

Insect bites

Iatrogenic trauma as in vaccinations or surgical procedures

Thermal or chemical burns

And skin eruptions such as chicken pox

Keloid induced by ear piercing Keloid induced by scratching

Who is at risk?The risk of developing a keloid or keloids is equal for males

and females.The most consistent risk factor for keloid development is a

previous keloid.Hereditary: Analysis of patients history show that majority

of people with keloids also had family members with them. Skin color/ethnicity: Keloids reportedly develop more

often in people with darker skin pigmentations while they are NEVER seen in people without skin pigment (albinos).

Blood type: People with blood type A have been linked with higher rates of keloid development.

Age: Younger people (ages between 10 and 30) are more prone to keloids than older adults and the elderly.

Endocrine factors: Pregnant women are more prone to keloid formation or worsening keloids whereas post-menopausal women rarely develop keloids.

How to prevent keloids

People who are at risk of developing keloids should not get body piercing or tattoos.

If you need surgery, you need to let your doctor know that you may develop keloids.

Starting certain keloids treatments such as corticosteroid shots and pressure dressing immediately after surgery may help prevent keloids.

Materials and methodsBetween Jan, 2011 to date, forty seven (47) patients with a

total of sixty one (61) keloids have been treated at Cancer Care Kenya.

Out of these, forty (40) patients (85.25 %) were female between the ages of sixteen (16) and thirty four (34) years, three (3) patients (6.5 %) were male adults and four (4) patients (8.25 %) children below the age of ten.

For the purpose of this study, keloids that occurred at different sites in the same patient were considered as different keloids.

The keloids were surgically removed and patients treated post-operatively with 9 Gy electron beam irradiation in a single fraction.

Table 1:Showing causes of keloids amongst the patients we treated

Stated cause of keloids Number of patients Number of keloids

Surgery 12 15

Ear piercing 30 39

Burn 03 05

Unstated 02 02

Total 47 61

Materials and methods cont.Radiotherapy was initiated in forty three (43) patients, (91%)

within twenty four hours after excision. Four patients, (9%) were treated between 48 – 72 hours after the surgery.

Treatment fields were strictly confined to the keloid region. A skin area of 5 mm at each margin of the skin surface was included in the irradiation field as a safety margin. The fields were bound laterally by individually tailored blocks consisting of a lead alloy to shield the surrounding skin.

All the patients were treated with 6 MeV electrons with a 0.5 cm surface bolus to achieve a homogenous dose distribution and also increase the surface dose.

Electron is preferred because it can be used to treat superficially without interfering with underlying organs.

Pt. number

Sex

Age Keloid area

Excision date

Radiation date

Time btw excision and radiation

Duration since radiation

Number of keloids

Recurrence/ Norecurrence

PT 01/11 F 29 RT PINNA 2/5/2011 2/5/2011 Within 12 Hours

3years 4 months

1 No

PT 02/11 F 22 BOTH CHEEKS

15/11/2011 15/11/2014 Within 12 Hours

3 years 2 No

PT 03/12 M 31 CHEST 4/01/2012 6/01/2012 48 Hours 2 years 10 months

1 No

PT 04/12 F 27 ABDOMEN

20/6/2012 22/6/2012 36 Hours 2 years 4 months

1 Yes

PT 05/13 F 16 RT&LT EARLOBES

20/8/2013 20/8/2013 Within 24 Hours

1 year 2 No

PT 06/13 F 20 RT UPPER ARM

24/12/2013 24/12/2013

Within 24 Hours

11 months 1 No

PT 07/14 M 53 OCCIPUT

03/02/2014

03/02/2014

Within 12 Hours

6 months 1 No

TABLE 2: FINDINGS

ResultsAll the patients came for review by their respective

oncologists one month after the radiation.

None of them reported any recurrence within this time.

Phone call follow up six months later however revealed that two (2) keloids had recurred. Four patients (8.5%) with a total of five (5) keloids could not be reached for follow up while 54 keloids (88.7%) were reported to have healed completely.

The two recurrences were observed in patients who had their radiation more than 24 hours after excision.

The keloids related symptoms like itching and pain also improved in majority of the patients.

Conclusion and recommendations

CONCLUSION

Surgical excision of a keloid followed by immediate, single-fraction, high-dose radiotherapy is both safe and effective in preventing recurrence of therapy-resistant keloids.

RECOMMENDATIONS

The results above show that all the recurrences were observed in patients who showed up for radiation more than 24 hours after excision.

This points to increase in recurrence as the time increases. We could however not make concrete conclusion on this due to limited sample size.

I therefore recommend that more research be carried out to determine if delaying post operative radiotherapy would increase recurrence rate for keloids.

References

Principles and practice of radiation oncology by Perez and

Brady’s

Keloid research foundation

Thank you!!!