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Topical mitomycin C in the prevention of keloid scar recurrence
Kenneth W Sanders1, Linda Gage-White, Fred J Stucker
1Department of Otolaryngology--Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, USA.
Objective:
To assess the ability of mitomycin C to prevent the recurrence of surgically excised keloid scars. Mitomycin C has been successfully used to prevent scar tissue formation at the site of subglottic stenosis in the field of pediatric otolaryngology. It appears that mitomycin C interferes with the ability of fibroblasts to produce a scar without causing changes in epithelialization.
Design:
We excised keloid scars from various sites in the head and neck and then applied mitomycin C to the resected bed prior to closure of the wound at a concentration of 0.4 mg/mL for 5 minutes. All patients had multiple keloids and acted as their own control. At 1 month after the procedure both wounds were started on a regimen of triamcinolone acetonide, 40 mg/mL injections, repeated every month for 6 months. At the end of the study, photos and measurements were again taken.
Results:
Fifteen patients (13 female and 2 male) ranging in age from 10 to 55 years enrolled in the study. No infections or nonhealing wounds were seen. There was no difference in postoperative pain. Eight patients completed the triamcinolone injections, 5 had fewer than 6 injections, and 2 patients had no steroid injections. Twelve patients completed follow-up and were evaluated for surgical complications and recurrence of the keloids at either site. Two patients had partial postoperative follow-up in person and then completed follow-up via telephone. One patient could not be found for follow-up. Four patients had recurrence of both excised lesions. Ten patients had no recurrence of their keloids at either site.
Conclusion:
Mitomycin C made no difference in the prevention of keloid recurrence after excision when topically applied.
Insights
Topical mitomycin C (MMC) did not prevent keloid scar recurrence after surgical excision. This study found no significant difference in keloid recurrence rates when MMC was applied to the wound bed.
Area of Science:
- Dermatology
- Surgical Oncology
- Wound Healing
Background:
- Keloid scars are benign fibrous growths resulting from abnormal wound healing.
- Mitomycin C (MMC) is an antimetabolite agent with antifibrotic properties.
- Previous research suggests MMC efficacy in preventing scar tissue formation in conditions like subglottic stenosis.
Purpose of the Study:
- To evaluate the effectiveness of topical mitomycin C in preventing the recurrence of surgically excised keloid scars.
- To assess if mitomycin C application impacts fibroblast activity and scar formation post-excision.
- To determine the recurrence rates of keloids treated with and without topical mitomycin C.
Main Methods:
- Surgical excision of keloid scars from the head and neck region.
- Application of topical mitomycin C (0.4 mg/mL for 5 minutes) to the wound bed before closure.
- Patients served as their own controls, with multiple keloids treated differently.
- Postoperative management included triamcinolone acetonide injections for all patients.
- Follow-up involved photographic and measurement assessments of keloid recurrence.
Main Results:
- Fifteen patients (13 female, 2 male; ages 10-55) were enrolled.
- No surgical site infections or wound healing complications were observed.
- No significant difference in postoperative pain was reported between treatment sites.
- Ten out of twelve evaluated patients showed no keloid recurrence.
- Four patients experienced recurrence of both excised keloid lesions.
Conclusions:
- Topical mitomycin C application did not demonstrate a significant benefit in preventing keloid recurrence after surgical excision.
- Further research may be needed to explore alternative antifibrotic agents or treatment protocols for keloid prevention.
- The study suggests that current topical mitomycin C protocols may not be effective for keloid scar management.
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