P190 A single-institution review of the use of same-day radiation and surgery in the definitive management of keloids

Abstract

Keloid scars are often seen as minor issues. However, they have significant cosmetic and psychological impact and are often resistant to simple treatment (excision or intralesional corticosteroid). A combination of surgery and immediate postoperative radiotherapy (iPORT) appears to reduce recurrence rates, but there are little data on this approach. Here we report data on demographics, treatment and outcomes of patients treated with surgery and iPORT for keloid scars. A retrospective review was performed of patients treated with iPORT for keloids between 2013 and 2023 at our institution. Patients were identified from the radiotherapy database, and data were extracted from hospital records. Patients were manually contacted to enquire about recurrence. We identified 132 keloids in 47 patients. The median age at treatment was 35 years. The most common sites were the ears (36%, n = 17), with common precipitating factors including piercings (36%) and previous surgery (25%). Among evaluable lesions, 36% (n = 17) showed no recurrence, 32% (n = 15) partially recurred and 36% (n = 17) completely recurred. The average time to recurrence was approximately 1 year. Both acute and late toxicities were mild. Reported side effects included hyperpigmentation (57%) and alopecia (26%). Patient satisfaction was high, with 70% indicating they wished they had received radiotherapy earlier, and 79% identifying it as their most effective treatment. Surgery and iPORT appears to be well tolerated and appreciated by patients. Around 36% of patients who are treated for keloids will develop a new lesion, mostly within 1 year. Our estimate of lesions recurrence is biased by the fact that follow-up of patients was challenging and is an area of ongoing work. Based on these data, we would suggest that routine review of patients treated for keloids at 1 year may be clinically useful to allow easier access to further treatment.