Surgical excision of Keloid scars with Radiotherapy
Keloid scars, or simply keloids, are a type of scar tissue that are raised above the skin surface. They can be formed after injury to the skin, from acne or other skin diseases and ailments. Even though these scars can be removed relatively easily via surgical excision, it is not uncommon for them to recur. To truly prevent them from coming back, surgical excision should be coupled with radiotherapy. This is a treatment regimen involving controlled dose of radiation at targeted areas that can permanent remove keloids with minimal chances of recurrence.
Wound healing and formation of Keloid scars.
To understand how keloid scars form, we should first take a look at our skin’s natural wound healing process, which is divided into 4 main stages:
1. Haemostasis Phase
Haemostasis literally means “stopping of bleeding” and is the first stage of wound healing, starting immediately after injury. At this stage, platelets in the blood react with collagen in the skin and begin to coagulate, forming a clot that eventually stops the bleeding
2. Inflammatory Phase
After the wound clots, immune cells like neutrophils and macrophages (different types of white blood cells) travel to the wound to kill bacteria, pathogens and eliminate any other debris that have entered the wound. These cells also secrete certain growth factors that promote tissue repair. This is the stage where the wound can feel warm, sore or itch.
3. Proliferative Phase
This is the stage where tissue repair begins. Our body fills the wound with connective tissue and forms new blood vessels in the region. The margins of the wound contract towards the centre and eventually covers it entirely in epithelium.
4. Maturation Phase
In the final stage, collagen fibres begin to form in the dermis and reorganise, while other skin tissue remodels and matures, gradually restoring the strength and elasticity of the skin.
Keloid scar formation is usually associated with stages 3 and 4 of wound healing, caused by excess tissue and collagen proliferation in the Proliferation phase, combined with improper reorganisation and remodelling of collagen fibres and skin tissue in the Maturation phase. The excess tissue forms a visible raised region or lump at the previous wound, resulting in a keloid scar.
Why should you remove keloids?
Although largely harmless, it is good to remove keloids early because of the following reasons:
- Keloids can become infected, especially when it forms in a region with high density of hair follicles. The scar tissue can trap the hair inside the follicles, causing them to swell and become pus filled.
- People with keloids have a slightly higher risk of developing skin cancer as compared to those without
- Keloids can become itchy or painful for various reasons, making it bothersome in daily lives
- Most keloids are very conspicuous and is a big aesthetics concern for many people
There are many approaches to remove keloid scars. Out of all these, surgical excision is the most effective. Still, as mentioned, surgically removed keloids are prone to recurrence at the same location. By treating the surgical wound with radiotherapy however, the recurrence rate can be significantly reduced.
Radiotherapy of keloid scars after excision
Radiotherapy involves careful, controlled exposure of the treatment area to specific types of radiation. It is mostly used as form of cancer treatment to kill cancer cells and control tumour growth by damaging their DNA.
Similarly, radiotherapy can use this same mechanism to control the formation of keloid scars. The surrounding tissue around the treatment area will usually be protected with lead shields before the treatment commences. The controlled exposure to radiation partially damages the DNA of the scar-forming cells, controlling their growth and preventing keloid scars from forming.
Radiotherapy is most effective when paired with surgical excision of the keloid scar. The surgeon will first carefully cut out the scar tissue with a sharp scalpel. Occasionally some of the surrounding skin will be removed as well. The wound is carefully dressed and stitched as necessary without subjecting it to excessive tension, as tension stimulates the formation of abnormal scar tissue, increasing chances of recurrence. Radiotherapy should commence immediately after excision of the scar tissue and usually invoice daily sessions of around 30 to 45 minutes until the wound has healed, or when the doctor recommends to stop.
Side effects and complications
Radiotherapy is generally a very safe treatment with minimal side effects. The most common complications seen in patients are erythema and hyperpigmentation, which can be easily addressed with laser treatments. Otherwise, most patients do not experience any severe side effects.
In very rare cases, more severe complications like ulcers and necrosis can occur. However, this usually happens in inexperienced hands when the radiation dosage is not controlled well, and can be avoided easily by consulting an experienced doctor.
Keloid scar removal at The Clifford Clinic
If you are bothered by keloid scars and wish to remove them, you can contact us at 6532 2400 to schedule a consultation with our doctors. We offer surgical excision of keloid scars with radiotherapy, with personalised procedures and treatment regimens that are tailored to each patient’s needs. Our doctors and surgeons are highly skilled and experienced, and will provide you with high quality professional advice and treatments.
How long does the treatment take?
Typically, surgical excision of the keloid takes between 30 to 90 minutes, depending on the size and complexity of the operation.
Radiotherapy will usually commence immediately after the surgery, with daily 30 to 45-minute sessions lasting for several days. The frequency and number of the sessions can differ between patients however.
What is the recovery like? Is there any downtime?
Depending on the size of the keloid removed, the wound may take 1 to 2 weeks to completely heal.
The radiotherapy sessions have no downtime. You can resume daily activities immediately after the session.
Is radiotherapy safe?
Despite the potentially harmful effects of radiation, radiotherapy is extremely safe as the dosage is carefully and precisely controlled. Precautions are also made to shield the rest of the body from the radiation to prevent any unnecessary complications.
Is the treatment painful?
The surgical excision will be performed under local anaesthesia so there will be minimal pain or discomfort.
There is usually no sensation experienced during radiotherapy. Patients may feel a mild tingly or heating sensation, but this is usually negligible.