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.
Dr. Tim Neavin is a board-certified plastic surgeon located in Beverly Hills, California.
