Keloid Treatment With Excision and Radiation Achieves 90% Cure Rate

William Posten, MD, a dermatologist and Mohs surgeon at Advanced Dermasurgery Associates in Dallas, Texas, and the chief dermatologist of Sensus Healthcare, has practiced surgical dermatology for more than 22 years. In a recent interview, he outlined the limitations of traditional keloid treatments and described how combining surgical excision with immediate postoperative radiation has transformed outcomes at his clinic. He noted many dermatologists remain unfamiliar with this approach despite its growing evidence base.

Limitations of Traditional Keloid Therapies

Posten recalled learning only 2 treatment options for keloids during his training nearly 30 years ago: intralesional corticosteroid injections and surgical excision. Neither offered reliable results. "Textbooks will say they work 5% or 10% of the time, and they kind of shrink it a little bit, but they wouldn't get rid of the keloids," Posten said, referring to steroid injections. Excision presented a different problem: keloids frequently worsen following surgical trauma, and approximately half recurred larger than before treatment.

Excision With Immediate Radiation

Over the past 5 to 10 years, Posten said his practice has adopted excision paired with immediate postoperative radiation as a standard approach. The technique involves removing the keloid with a precise surgical margin and then applying radiation to suppress inflammation and inhibit fibroblast proliferation, the mechanism underlying keloid reformation.¹ "By doing that, there have been studies showing we have a 90% cure rate with doing this, and this is what we've seen in our clinic," Posten said.

Site-Specific Outcomes and Patient Selection

Posten noted that anatomic location influences recurrence risk even with this combined approach. Areas under high tension, such as the chest and back, carry a higher likelihood of recurrence, consistent with the inherent surgical challenges those sites present, regardless of keloid involvement. Ear, facial, and neck locations tend to yield the highest success rates with this technique. Regarding skin type, Posten acknowledged keloids occur most frequently in patients with Fitzpatrick skin types IV, V, and VI, but said the modality performs equally well across all skin types. "We've used this modality with all types of skin types, and it tends to be equally effective with all," Posten said.

Posten emphasized the procedure is now performed daily at his clinic and expressed strong confidence in its durability as a solution for a condition once considered difficult to manage effectively. He described the availability of this technology as a significant shift from what was accessible during his training.

Reference

1. Ogawa R, Tosa M, Dohi T, Akaishi S, Kuribayashi S. Surgical excision and postoperative radiotherapy for keloids. Scars Burn Heal. 2019;5:2059513119891113. doi:10.1177/2059513119891113