2. We see what we want?
Common things are usually very rare to spot.
3. History
A 23 year old female was referred by
plastic surgeons for radiotherapy to the
posterior ear lobe, following the
development of a Keloid Scar, three
years after an ear piercing
No family history of keloids
4. Pathology
Keloid is a unique human dermal
fibroproliferative disorder that occurs after injury,
inflammation, surgery,and burn.
Commonly causes of keloids include acne,
folliculitis, chicken pox, vaccinations and trauma
(such as, earlobe piercing, lacerations, or surgical
wounds).
It is a benign growth, well-demarcated area of
fibrous tissue overgrowth that extends beyond the
original defect
11. Surgery Drawbacks
Painful
Difficult reconstruction with large keloids
Utilizes normal surrounding tissue – limiting later
reconstructive options
Low long term success as monotherapy
16. Diminishes size and induration (HTS >Keloid) when
used as monotherapy
<10% Recurrence when combined with surgery
Photos Courtesy of Dr. Redett
Pressure Therapy
19. In this case…
Plastic surgery was carried out to remove the Keloid
Scar. The patient attended the following day for a
single dose of radiotherapy to the scar, plus a small
margin of 5mm. The pinna was taped forward to
expose the effected posterior section of the lobe.
20. Radiotherapy prescription
12Gy in single fraction.
HVL 0.2mm Cu
Energy used was:- 100kv.
Actual Field size:- 3.5 x 1.5 cm –margins of
2mm
Cone size used:- 4 X 6cm
Shielding :-A lead cut out was used to
define the field size and protect the
surrounding
tissue.
22. A case to think
A 32 year old
female
Para 1+0
No family history
of keloid
Developed keloid
after c-section
Had steroidal
injection 4
courses.
