Craniofacial Keloid Management Using Post-Excisional Adjuvant Brachytherapy: A Case Report

Abstract

Introduction: Keloids are fibroproliferative scars that that can range from mildly abnormal wound healing to significant and excessive outgrowth of skin beyond the area of the wound. They may be associated with microtrauma, and surgery is a well-recognized risk factor in patients with predisposition keloid scars formation. Treatment options can range from minimally invasive medical therapy to surgical excision of the keloid. Methods: In this paper, we present an interesting case of craniofacial keloid likely secondary to microtrauma, treated with surgical excision, split thickness skin graft, and adjuvant brachytherapy. Given that keloid secondary to surgical wounds tend to most commonly occur at the skin edges, brachytherapy was applied at the wound margins in addition to the wound bed to reduce the risk of keloids recurrence. Results: Post-operative results at 2 years demonstrated no recurrence in the treated area, thus decreasing the overall keloid burden in the patient. In addition, patient reported high overall satisfaction with the outcomes. Conclusion: This paper demonstrated that brachytherapy can be an effective adjunct treatment following excision of keloid scars, with no evidence of long-term recurrence.