Should adjuvant irradiation to prevent keloidal fibroproliferative growth, be standard of care?

Abstract

After cutaneous injury, cytokine mediators recruit an inflammatory infiltrate that stimulates migration of keratinocytes and fibroblasts; subsequent proliferation of fibroblasts and keratinocytes begins 4 to 5 days later [1]. The formation of a keloid is dependent upon fibroblast migration, proliferation and type III collagen production [1].

First{\hyphen}line treatment of keloids involves topical or intralesional steroids. Recurrent or resistant keloids are managed by surgical excision or cryotherapy, followed by steroidal application, that presumably limits inflammation and cellular migration. Adjuvant irradiation to surgical excision is an alternative but underutilized modality that has demonstrated superior patient satisfaction and local control compared to post{\hyphen}cryotherapy or resection intralesional steroids, respectively [2, 3].

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