Prevention and management of keloid scars.

A 31-year-old woman, gravida 3, para 2, at 30 weeks of gestation was referred to our institution with the symptom of rapid growth of her keloid scars during her current pregnancy. She was black and had a surgical history of a cesarean delivery and a right vulvar excision for a benign inclusion cyst. The keloid scarring was present at her pfannenstiel incision and also at the site of her right vulvar excision. The scarring was cosmetically disfiguring and physically painful (Fig. 1). At the time of her repeat cesarean delivery, the keloid scars were excised with assistance from the plastic surgery team (Fig. 2). Immediately after surgery, she was treated by radiation oncology with four daily fractions of radiation therapy. The first dose was administered on the day of surgery to limit risk of recurrence. The radiation therapy consisted of 450–500 cGy fractions with a 1to 2-cm margin, using 6–9 MeV electrons and appropriate bolus material to ensure adequate dose from skin to depth. The patient did well and was discharged after 4 days. Her postoperative course was uncomplicated and she had good wound healing with no recurrence of the keloids at her 15-month postoperative visit (Fig. 3). The patient also had a left preauricular keloid that was excised by plastic surgery 8 months after her delivery, and it was also treated with adjuvant external beam radiation therapy with good cosmetic result.