Outcomes of Surgical Excision and High-Dose-Rate Brachytherapy for Earlobe Keloids

Abstract

Background: Radiotherapy as an adjuvant therapy to surgical resection has shown variable rates of recurrence treating earlobe keloids. The purpose of this study was to describe our experience with surgical excision followed by high-dose-rate brachytherapy and present our outcomes after 24 months of follow-up.

Methods: Retrospective chart of 14 patients with 14 earlobe keloids treated with surgical excision followed by high-dose-rate brachytherapy, between January 2015 and May 2016 were enrolled. Database included demographics, Fitzpatrick skin type, laterality, lesion size, and follow-up visits information. Outcomes were assessed in terms of keloid recurrence rates, complications, and patient subjective aesthetical result satisfaction after 24 months of follow-up.

Results: All procedures were completed without complications. Three patients experienced keloid recurrence after 6 (14.28%) and 12 months (7.14%). Three patients experienced mild signs of self-limited post-radiation dermatitis. Self-assessment of aesthetical result was considered "very good" in 71.43% of patients.

Conclusion: Surgical excision followed by high-dose-rate brachytherapy is secure and effective to treat earlobe keloids, and can be considered a first line combined treatment. Larger clinical trials comparing different irradiation protocols are still needed.

Keywords: Earlobe keloid; Excision; High-dose-rate brachytherapy; Plastic surgery.

Fig. 1

1a. Preoperative views. 1b. Is important to completely remove dumbbell-shaped keloids that literally perforate the earlobe. 1c. Immediate postoperative views. Healthy skin spared from the lateral aspect of the earlobe is used to create a rotational flap to reconstruct the earlobe. 1d. Contralateral earlobe for aesthetical comparison. 1e. Postoperative views 3 months later

Fig. 2

2a. Preoperative views. 2b. Completely resected dumbbell-shaped keloid. 2c. Immediate postoperative views, showing earlobe reconstruction. 2d. Contralateral earlobe for aesthetical comparison. 2e. Postoperative views 1 month later