Radiotherapy in Keloid Treatment

Dr. KWAN Wing Hong

Director, Department of Radiotherapy

Associate Director, Comprehensive Oncology Centre

Honorary Consultant in Clinical Oncology

Specialist in Clinical Oncology

Keloids are usually found on earlobes, chest, arms, etc. If they are treated with surgery alone, the rate of recurrence can reach 80%.

Radiotherapy is effective in treating not only malignant tumours but also keloids.  The latter are usually surgically removed and sutured. While fibroblast will create new cells to repair the wound after surgery, new scars are most likely to occur upon healing if fibroblast becomes hyperactive. With radiotherapy, the radiation can inhibit cell growth and reduce the chance of recurrent scar formation when the wound heals.

In combination with surgery, radiotherapy can obtain the best treatment outcome. By complementing surgery with radiotherapy, the rate of keloid recurrence can reduce from up to 80% to merely 20%.

Ideally, the first dose of radiotherapy should be given within 24 hours after surgery, and for total of four to five times within a week after surgery. This treatment regimen gives the best outcome in preventing keloid recurrence.

Superficial radiotherapy is used to treat keloid, i.e. a relatively low dose of about 1,500 CentiGray in total is delivered to 1 to 2mm beneath the skin surface to minimise damage to deep tissues and other organs.  The risk of superficial radiotherapy is low: in the short run patients may feel tired after treatment. The treated skin may get darker over time, and in rare cases skin cancer developed in the treated area in 10 to 20 years after treatment.

Sutures are usually removed in 10 to 14 days after surgery. Consultation is arranged to follow up on radiotherapy a month later to examine the wound and skin condition. Further follow-up may be necessary. 

To prevent hypertrophic scar or keloid formation, patients should refrain from scratching the treated area. In case of recurrence and you choose not to remove the new scar again, repeated radiotherapy can relieve itchiness. But the size of keloid will remain the same.