A primary protocol for the management of ear keloids: Results of excision combined with intraoperative and postoperative steroid injections

Background: Keloids of the ear are a challenging problem, with many treatment modalities advocated. The primary determinant in choosing a treatment protocol should be a low recurrence rate. Most reports in the literature suffer from small numbers of patients and inadequate follow-up. Methods: This study presents a retrospective analysis of 64 patients representing 92 ear keloids treated between 1982 and 1997. The treatment protocol consisted of excision with an intraoperative and two postoperative steroid injections. All patients were treated by a single physician. Long-term follow-up was obtained at a minimum of 5 years. Results: Protocol success was achieved in 74 of 92 keloids (80 percent) excised. Prior excision of the keloid was significantly associated with protocol failure (p = 0.0068). Keloid recurrence was seen in 10 of 43 (23 percent). Statistically significant differences were noted in keloids that had undergone prior excision as compared with those presenting for initial treatment. These differences included growth rate (p = 0.0026), protocol failure (p = 0.0149), and total postoperative steroid injections administered (p = 0.0104). Conclusions: The primary protocol presented for the treatment of ear keloids produces durable results, with an acceptably low recurrence rate. Stratification of keloids based on an assessment of aggressiveness may allow for a more informed choice in their optimal treatment.