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Keloids and Keloid Surgery

I saw a patient in the office who has very large keloids in both ears. Keloids are basically an exaggerated scar response resulting in like a tumor formation of scar that extends outside the natural borders of the initial injury. This is different than a hypertrophic scar in which the scar tends to enlarge but stays basically within the area of injury.  They are generally very firm, rubbery-like lesions or shiny, nodules, and can vary in color  from pink to flesh-coloured tor red or dark brown.  A keloid scar is benign (not cancerous), and  non-contagious, but can be accompanied by itchiness and pain.  Insurance generally covers keloid excisions.

Keloids often occur to people with darker skin such as African-American, Latino, or Asian people. They are generally not found in lighter-skinned people. Usually when I see patients with keloids, they have already had two or three surgeries and they have a history of recurrence. Upon discussion of the prior therapies or surgeries, I always ask about prior steroid injections, interferon, or even radiation therapy.  Excision alone in a recurrence has an incredibly high recurrence rate.  In stubborn, recurrent keloids, combination therapy is the best approach, and can include surgery, intra-operative steroid injections, post op radiation, silicone sheeting, and compression.   This regimen can significantly reduce keloid formation particularly in a person who has had multiple prior surgeries.