Keloids Growing Back After Removal

Question

I have keloids that were surgically removed. Within a year, they grew back even larger. If I get them removed again, will they keep growing back? What causes this?

Young R. Cho, MD, PhD · Answer

Keloids do recur with some frequency.  Surgery alone may only be successful half the time.  If this is your 2nd attempt, I would strongly suggest you add compression therapy, steroid therapy and radiation therapy to the regimen.  Even despite all this, it may still come back, but the likelihood diminishes considerably. 

	1) Compression earings:  For a good year - worn all the time (except for showering)

	2)  Steroid injections:  Once every 4-6 weeks.  Would recommend 6 treatments if there is no recurrence.

	3)  Radiation therapy:  Usually done the same or next day.  Three treatment cycles is usually sufficient, but I would talk to a radiation oncologist to verify.  The overall dose is considerably less than cancer treatment.  And just to reassure you:  Keloids are not cancerous.  But they are aggressive.

	Good luck.

Steven H. Williams, MD · Answer

Thank you for your question.

	Keloids are formed as a result of irregular, dense collagen redistribution after injury or surgery and have a high recurrence rate.

	Ways to help minimize the rate of recurrence following surgical removal of keloids are steroid injections at the time of removal and subsequently at 4 week intervals, silicone sheeting, and pressure dressings. Other common treatment options for recurrent keloids are cryotherapy (freezing), radiation, and laser treatment.  A multitude of additional, less common treatment options exist if traditional methods fail.

	I hope this helps.

Raffy Karamanoukian, MD, FACS · Answer

Keloids do have a high recurrence rate. Surgery is not an end-all cure for keloids. I would advise you to undergo a similar procedure followed by a closer follow-up. I also recommend Melarase creams for darkened or pigmented keloid scars.

Farbod Esmailian, MD · Answer

Removal of keloids is very difficult task. Some patients are more prone to developing keloids and some areas are more at risk, like the earlobe, shoulder, upper back, midline of the chest. Keloids typically run in the family and it is a problem with wound healing. So just by excising it, yes likely it will come back. There are some special things that can be done like steroid injections at the time of removal with follow ups every 6 weeks. Also radiation to the area as well as compression garments. Doing all this this can lead to a high rate of recurrence which is upwards to about 50% chance it will come back.

Sam Jejurikar, MD · Answer

Keloids have a biologic behavior much similar to tumors.  Excision alone often time leads to recurrence.
The next incision should be accompanied by a corticosteroid injection at the time of removal, as well as corticosteroid injections every 4-6 weeks for the next 3-6 months.  You should also wear a compression earring all day and night if the keloid is on your earlobe.  Should that be unsuccessful, the next treatment can incorporate fractionated external beam radiation treatment.  Over 3-4 treatments, you would receive localized radiation, significantly diminishing the incidence of recurrence.
Best of luck!

Otto Joseph Placik, MD · Answer

I've written a paper on keloids and no one to date really knows how to control their growth and prevent recurrence.
Its probably worth another try. This time consider intraoperative steroids, postoperative compression and steroids every month for at least 3 months, The use of 5 FU is anectodal and may be an option. Do not pierce the ears again and if you consider ever doing this use pure metals such as gold only and avoid alloys which may contain nickel which triggers allergic reactions which may initiate hypertrophic or keloid scars.
If this doesn't work, one last excision with radiation is your last option.

Hisham Seify, MD, PhD, FACS · Answer

Keloids have a tendency for reccurence. The reccurence rate decreases with using kenolog intralesional injection intra operative as well as post operative. In severe cases radiation could be used. External compression and silicone sheets are very useful as well. Best of luck!

Bryan K. Chen, MD · Answer

Keloids generally have a high recurrence rate after surgical removal.  Some people simply have a genetic tendency to form excessive scar tissue in response to trauma.  Sometimes certain additional measures including cortisone/5-fluorouracil injectdions postoperatively, application of Aldara cream and compression (for ear-lobe keloids) can reduce the risk of recurrence.
Good luck.

Theodore Katz, MD, FACS (retired) · Answer

Unfortunately under the best of circumstances only about 70% of keloids can be "cured". You do not state where your keloid is and what other modalities, if any, were used. I almost always use a combination of excision, immediate kenalog injections (with a series of subsequent injections), compression garments or compression earrings for the earlobes, and silicone sheeting. Radiation is also a consideration with the above. In the past I have used the CO2 laser to excise the keloids and in some areas used the laser to "vaporize" the keloid and allow it to heal secondarily, with compression and local care. Research is being done in wound healing which will be applicable to keloids as well, but there is nothing in the immediate future to add.

Arnold R. Oppenheim, MD (retired) · Answer

This happens quite frequently. In fact I saw a patient this afternoon with the same story. It is very important that steroids be injected into the keloid on a regular basis. ( Curiously her physician told her that her keloid on her ear did not need steroid injections).
     You should be assiduous in having this done. I also find that the steroid should be Kennalog 10 and not weaker. There is some evidence that compression, if the keloid involved the ear, helps. 
   There is evidence that 5-FU ( a drug we use to treat actinic keratosis, pre skin cancers) might help prevent recurrence.
    While a pilot study showed Aldara helped, a recently published study by the same authors ( Berman et al) showed that Aldara was not particularly helpful.

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