Case report and summary of literature: giant perineal keloids treated with post-excisional radiotherapy

Abstract

Background: Keloids are common benign tumors of the dermis, typically arising after insult to the skin. While typically only impinging on cosmesis, large or recurrent keloids may require therapeutic intervention. While no single standardized treatment course has been established, several series report excellent outcomes for keloids with post-surgery radiation therapy.

Case presentation: We present a patient with a history of recurrent keloids arising in the absence of an ascribed trauma and a maternal familial history of keloid formation, whose physical examination several large perineal keloids of 6-20 cm in the largest dimension. The patient was treated with surgical extirpation and adjuvant radiation therapy. Radiotherapy was delivered to the scar bed to a total dose of 22 Gy over 11 daily fractions. Acute radiotherapy toxicity necessitated a treatment break due to RTOG Grade III acute toxicity (moderate ulceration and skin breakdown) which resolved rapidly during a 3-day treatment break. The patient demonstrated local control and has remained free of local recurrence for more than 2 years.

Conclusion: Radiotherapy for keloids represents a safe and effective option for post-surgical keloid therapy, especially for patients with bulky or recurrent disease.

Figure 1

Pre-therapy photograph of giant perineal keloid, showing lobulated appearance.

Figure 2

Low (right)- and high-power histology of excised keloid, showing characteristic grayish-colored lobular tissue with fibrous polypoid whorls.

Figure 3

Three-month follow-up appearance after surgical excision and radiotherapy.