Low Rate of Keloid Recurrences Following Treatment of 
Keloidectomy Sites with a Biological Effective Dose 30 of 

Superficial Radiation

Brian Berman, M.D., Ph.D
Mark S. Nestor, M.D., Ph.D

Joshua Fox, M.D.
Michael Jones, M.D.

George Schmieder, D.O.
Eduardo T. Weiss, M.D.

PURPOSE

DESIGN

Recurrences of keloids at sites of previously 
excised keloids is a well-recognized common 

occurrence following keloidectomy, and 
based on review of the published literature, 
has been reported to occur approximately in 
71% of cases. Superficial radiation therapy 

(SRT) reduces wound fibroblast proliferation 
and enhances apoptosis. In this multicenter, 

case series report the recurrence rate of 
keloids post keloidectomy with perioperative 
treatment with a biological effective dose 30 

of superficial radiation was determined.

132 keloids in 104 patients were surgically 
excised. On postoperative day 1 the suture 
closure line with a 5 mm margin received a 

biologically effective dose 30 (BED 30), either 
70 kV or 100 kV, of superficial radiation. One 
of the 3 following superficial radiation BED 
30 fractionation protocols was employed 

post keloidectomy: one fraction of 13 Gy on 
postoperative day 1; or 2 fractions of 8 Gy 

on postoperative days 1 and 2; or 3 fractions 
of 6 Gy on postoperative days 1, 2 and 3. 
Keloidectomies and superficial radiation 

therapy (SRT) treatments were performed at 
one of 5 facilities from 

November 2013-January 2017.

RESULTS
The 132 SRT-treated keloidectomy sites 

were in 6 anatomical sites: ear (40), 
head/neck (23), arm/shoulder (17), back/

buttocks (9), chest/abdomen (34), and 
scalp (9). The follow-up period ranged 

from 3 months to 3 years, with the 
majority (83/104) have been followed for 

more than 1 year.

Two (1.9%) keloids recurred at excision 
sites. One recurrence occurred in a 
patient who had received a single 

fraction of 13 Gy. The second recurrence 
occurred in a woman following 

excision of her chest keloid and SRT 
treatment, and wound dehiscence 10 

days postoperatively and subsequently 
let to heal by secondary intent. 

Hyperpigmentation in the irradiated field 
was the most common adverse event, 

noted in a minority of patients and which 
tended to resolve after several months 

posttreatment.

Left Earlobe Keloid. Pre-Excision

Post-Excision

SRT 6 Gy on POD 1, 2, 3

Suture Removal at Pod 7

CONCLUSION
The observed 1.9% rate of keloid recurrence following keloidectomy and excision site 
treatment with superficial radiation therapy (BED 30) is markedly lower than that reported in 
the literature following keloid excision alone.

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	FC17PosterSensusBerman.pdf