SKIN November 2018 Volume 2 Issue 6 Copyright 2018 The National Society for Cutaneous Medicine 402 RESEARCH LETTER Low Rate of Keloid Recurrences Following Treatment of Keloidectomy Sites with a Biologically Effective Dose 30 of Superficial Radiation Brian Berman MD, PhD1, Mark S. Nestor MD, PhD1, Michael H. Gold MD2, David J. Goldberg MD, JD3, Joshua Fox MD4, George Schmieder DO5 1Center for Clinical & Cosmetic Research, Aventura, FL 2Gold Skin Care Center, Nashville, TN 3Skin Laser & Surgery Specialists of NY/NJ 4Advanced Dermatology, NY, NY 5Park Avenue Dermatology, Orange Park, FL The potential for recurrence of keloids at the sites of previously excised keloids is a well- recognized consequence following keloidectomy, and based on the published literature, has been reported to occur approximately in 71% of cases.1 Superficial radiation reduces wound fibroblast proliferation and enhances apoptosis.2 In this multi-center, case series, we determine the recurrence rate of keloids post keloidectomy with peri-operative treatment with a biologically effective dose 30 of superficial radiation.3 297 keloids were surgically completely excised. Starting on post-operative day (POD) 1 the suture closure line, with a 5 mm margin, received a total biologically effective dose 30 (BED 30), either 70 kV or 100 kV, of superficial radiation delivered by an SRT-100 (Figure 1). One of the following superficial radiation BED 30 fractionation protocols was employed post keloidectomy: one fraction of 13 Gy on post-operative day 1; or 2 fractions of 8 Gy on post-operative days 1 and 2; or, in the majority of cases, 3 fractions of 6 Gy on post-operative days 1, 2 and 3. Radiation dermatitis was not reported. The most common adverse local skin reaction was transient (3-6 months) hyperpigmentation, occurring in Fitzpatrick Skin Type V-VI individuals. Hypo- pigmentation was noted to occur rarely. The follow-up period ranged from 1 month to 3 years, with the majority having been followed for more than 1 year. There were 9 clinical keloid recurrences in the 297 keloidectomy sites for a recurrence rate of 3.0%. The observed 3.0% rate of keloid recurrence following surgical keloidectomy and treatment of the excision site with superficial radiation therapy (BED 30) is markedly lower than that reported in the literature following keloid excision alone. A prospective study, with longer follow-up to assess any long term adverse events and late recurrences, is warranted. SKIN November 2018 Volume 2 Issue 6 Copyright 2018 The National Society for Cutaneous Medicine 403 A) Baseline. B) Post- excision. C) SRT 6Gy x 3 sessions. D) 6 months post treatment. E) 12 months post treatment. Conflict of Interest Disclosures: Drs. Berman, Nestor, Gold, and Goldberg are consultants for Sensus Healthcare. Funding: Sensus Healthcare funded the $400 Institutional Review Board submission fee. . Corresponding Author: Brian Berman, MD, PhD 2925 Aventura Boulevard, Suite 205 Aventura, FL Email: bbmdphd@gmail.com References: 1. Mustoe TA, Cooter RD, Gold MH, Hobbs FD, Ramelet AA, Shakespeare PG et al. International Advisory Panel on Scar Management. International clinical recommendations on scar management. Plast Reconstr Surg 2002; 110: 560–571 2. Liu X1, Liu JZ, Zhang E, Li P, Zhou P, Cheng TM, Zhou YG. Impaired wound healing after local soft x-ray irradiation in rat skin: time course study of pathology, proliferation, cell cycle, and apoptosis. J Trauma. 2005 Sep;59(3):682-90. 3. Kal HB and Veen RE. Biologically Effective Doses of Postoperative Radiotherapy in the Prevention of Keloids. Dose-Effect Relationship. Strahlentherapie und Onkologie November 2005, Volume 181, Issue 11, pp 717–7 A B C D E mailto:bbmdphd@gmail.com https://link.springer.com/journal/66 https://link.springer.com/journal/66 https://link.springer.com/journal/66 https://link.springer.com/journal/66 https://link.springer.com/journal/66/181/11/page/1