Keloids: Which Types Can Be Excised without Risk of Recurrence? A New Clinical Classification.

Area of Science:

• Plastic Surgery
• Dermatology
• Global Health

Background:

• Keloids are common benign skin tumors, particularly prevalent in certain ethnic groups and geographical regions.
• Surgical excision is a primary treatment for keloids, but recurrence rates can be high.
• Limited treatment options, such as triamcinolone acetonide (TAC) injections, are available in resource-limited settings.

Purpose of the Study:

• To evaluate surgical outcomes and recurrence rates of different keloid types treated in Goma, Democratic Republic of the Congo.
• To compare the efficacy of surgical excision with adjuvant therapies for keloid management.
• To establish a classification system for keloids to guide treatment strategies.

Main Methods:

• A surgical team performed 387 keloid removals on 302 patients over four visits (2015-2018).
• Preoperative/postoperative photographs and patient histories were collected.
• Histological examination of 18 keloid biopsies was conducted.
• Keloid recurrence rates were assessed using questionnaires, photographs, and histology.

Main Results:

• Keloids were classified into four types: fresh nodular (30% recurrence), superficial spreading (treated with TAC only), mature (4.5% recurrence), and multiple.
• Earlobe keloids showed the lowest recurrence after complete excision with negative margins.
• Triamcinolone acetonide (TAC) injections were used as adjuvant therapy, primarily at the onset of treatment or recurrence.

Conclusions:

• Approximately 50% of keloids in this African population may be surgically removed without recurrence risk, based on the proposed classification.
• Treatment strategies should be tailored to keloid type, with surgical excision suitable for certain types.
• Adjuvant therapies like TAC injections or radiation should be initiated at the first sign of recurrence, not as a general measure.