Keloids

1. The Nairobi Hospital Oncology and Cancer center Management of Keloids

2. What is a Keloid? Non-cancerous fibrous proliferations that occur in the dermis after trauma or injury to the skin Keloids grow beyond the boundaries of the original wound site (vs. hypertrophic scar) Etiological factors that determine how a scar becomes a keloid remain unknown

3. Who and Why? Individuals with darker-pigmented skin or who freckle are more predisposed Seen largely in Africans, African-Americans, Hispanics, and Asians Can be a familial/genetic predisposition Can be due to immunological causes Bottom line… No one knows!

4. How? (Pathophysiology) A result of an overactive inflammatory response and fibroblast proliferation A result of an abnormal collagen deposition in healing skin wounds Skin wound tension is a contributing factor in keloid formation Individuals with an inflammatory or infectious element are at a predisposition for keloids

5. Ready for the Pictures?

6. Anterior Chest

7. Where? Mandibular angle

8. Where? Shoulder

9. Where? Earlobes

10. Where? Upper Arms & Upper Back

11. Where? Posterior Neck Lateral Neck

12. One More

13. symptoms Patient morbidity related to keloids includes pruritus, pain, tenderness, burning, secondary infection, ulceration, and restriction of motion. Patients prone to keloids are prophylactically treated with radiation post surgery to avoid any future keloid formation C osmetic appearance is the most disturbing one.

14. T reatment Keloids are often resistant to treatment and have a high recurrence rate. Multiple treatment modalities have been advocated, including pressure therapy, cryotherapy, intra- lesional corticosteroids, radiation treatment, topical silicone, and laser treatment. Radiation therapy has evolved as an important adjuvant therapy for keloid scars

15. T reatment Numerous treatment protocols have been developed over the years, with none showing universally accepted superiority. The combination of surgical excision followed by radiotherapy was found to be effective in the management of keloid scars, with a recurrence rate between 10 and 20 percent .

16. Treatment Our protocol of extralesional excision, and postoperative radiotherapy has shown success, with a low complication rate, low recurrence rate, and a favorable cosmetic outcome. In Oncology and cancer center, treatment is administered by calculated doses of radiation called Grays( Gy ).

17. Treatment Treatment should be delivered between 24/72 hrs. post surgery. Any treatment beyond the 72 hours period will compromise the efficacy of treatment. Treatment is done in single or spread to 3 sessions depending on clinical evaluation Treatment cost ranges from Ksh.10,000