Clinical improvement in the therapy of aural keloids.

BACKGROUND: Keloids have a predilection for the aural region because of the special shape of the pinna. It is difficult to resect keloids entirely and maintain a satisfactory pinnal shape. Surgical excision in combination with radiotherapy is considered to be the most efficacious treatment available for severe keloids. This study was conducted to evaluate the treatment of aural keloids with intralesional excision and immediate postoperative adjuvant radiotherapy. METHODS: Forty-six patients with a combined total of 74 aural keloids were treated by intralesional excision and immediate postoperative adjuvant radiotherapy. All patients received a total dose of 20 Gy in 10 consecutive days. The time interval between keloid excision and delivery of the first radiotherapy fraction was < 24 hours in all cases. The median follow-up was 2.2 years. RESULTS: Twenty-nine patients with 48 keloids (64.9%) were highly satisfied with their outcome, and were rated as good by the surgeon. Six patients with 12 keloids (16.2%) showed general satisfaction but wanted aesthetic refinement, and these patients were rated as fair by the surgeon. Three patients with four keloids (5.4%) showed no evidence of recurrence after surgery, but disliked the result because of the discoloration and irregularity of the scar surface. These patients were rated as poor by the surgeon. Partial recurrence occurred in 8 patients with 10 keloids (13.5%). No major complications were observed. CONCLUSION: Intralesional excision and immediate postoperative adjuvant radiotherapy is well tolerated and very effective in preventing recurrence of aural region keloids.