Keloids of the Lower Abdomen, Mons and Vulva: Several Case Studies Highlighting a Successful Approach to Treatment

Paris D Butler,Cassandra A Ligh,Katie Magoon

doi:10.31487/j.rco.2020.01.01

Abstract

Background: Perineal keloids can have an overwhelming impact on patients’ lives including pain, skin breakdown, infection, and interference with intercourse. There is a paucity of literature addressing the effective treatment techniques. Cases: Three case of perineal keloid treatment, with at least 13-month follow up, are presented. All patients are African American females who were recommended a treatment plan that combined surgical wide local excision and radiation therapy. All patients had aesthetically acceptable outcomes with recurrence-free results at least 13-months post procedure. Conclusions: These three cases describe the successful treatment of perineal keloids that utilize a combination of surgical excision with targeted radiotherapy. This approach can be offered to patients with recurrent keloidal masses and the presented principles can be utilized to achieve recurrence-free results. Teaching Points: 1. Readers will understand the basics of the pathophysiology of keloid formation and their effect on patients who experience them in sensitive areas such as the mons, vulva, and/or lower abdomen. 2. Readers will be able to describe and implement the described technique for management of keloids in these potentially sensitive areas.

Highlights

Keloid formation is abnormal fibro-proliferative growth resulting from chronic inflammation and increased collagen deposition in the reticular dermis that potentiates beyond the original boundaries of a wound [1,2,3]
A 37-year-old African-American female with history of a Cesarean section with a low Pfannenstiel incision presented to clinic 18 months after an abdominoplasty with rectus plication and liposuction complicated by keloid formation along the length of the abdominal incision (35 x 1.5 cm) and the umbilicus (3.5 x 3 cm)
A 37-year-old African-American female with history of three Cesarean sections with low Pfannenstiel incisions presented to clinic with a 5-year history of recurrent keloid scarring along the central portion of her incision

Summary

Background

Perineal keloids can have an overwhelming impact on patients’ lives including pain, skin breakdown, infection, and interference with intercourse. All patients had aesthetically acceptable outcomes with recurrence-free results at least 13-months post procedure. Conclusions: These three cases describe the successful treatment of perineal keloids that utilize a combination of surgical excision with targeted radiotherapy. This approach can be offered to patients with recurrent keloidal masses and the presented principles can be utilized to achieve recurrence-free results. Readers will understand the basics of the pathophysiology of keloid formation and their effect on patients who experience them in sensitive areas such as the mons, vulva, and/or lower abdomen. 2. Readers will be able to describe and implement the described technique for management of keloids in these potentially sensitive areas

Introduction

Intraoperative

Postoperative

Findings

Discussion