Kesho Conference 2014

2. PRESENTED BY LOREH PETER

3. INTRODUCTION
Keloid 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.

4. 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

5. Keloid induced by ear piercing Keloid induced by scratching

6. 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.

7. 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.

8. Materials and methods
Between 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.

9. 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

10. 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.

12. Pt.
number
Se
x
Age Keloid
area
Excision
date
Radiatio
n date
Time btw
excision
and
radiatio
n
Duration
since
radiation
Nu
mbe
r of
kelo
ids
Recurre
nce/ No
recurre
nce
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 ABDOME
N
20/6/2012 22/6/2012 36 Hours 2 years 4
months
1 Yes
PT 05/13 F 16 RT&LT
EARLOBE
S
20/8/2013 20/8/2013 Within 24
Hours
1 year 2 No
PT 06/13 F 20 RT UPPER
ARM
24/12/2013 24/12/201
3
Within 24
Hours
11 months 1 No
PT 07/14 M 53 OCCIPU
T
03/02/20
14
03/02/20
14
Within
12 Hours
6 months 1 No
TABLE 2: FINDINGS

13. Results
All 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.

14. 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.

15. References
Principles and practice of radiation oncology by Perez and
Brady’s
Keloid research foundation
Thank you!!!