Long-term follow-up in the treatment of keloids by combined surgical excision and immediate postoperative adjuvant irradiation.

Aprospective study on the result of surgical excision and adjuvant irradiation for therapy-resistant keloids was conducted by van de Kar et al. (Plast. Reconstr. Surg. 119: 2248, 2007). This approach to keloids follows the International Clinical Recommendations on Scar Management based on retrospective studies that do not define recurrence. Moreover, the significant variations in methodology of most of the studies is well highlighted; many of them, being retrospective, refer to a treatment that is not standardized, and inclusion/exclusion criteria were set afterward (subjecting the study to bias), making it difficult to compare results. What is really clear is that there is still no consensus on the optimal treatment of keloids. After a mean follow-up of 19 months, van de Kar et al. had a cure rate of 28 percent, compared with the 78 percent average of previous studies. They ascribed their low rate to the “long” follow-up and the strict inclusion criteria of their study.