Skin Cancer Removal and Keloids: How Do They Relate?

A scar from your skin cancer removal is not exactly what you look forward to, but it's not typically the scariest part of the experience. But what if it were? Some people suffer from overactive scar tissue that can make skin cancer removal more frightening than cancer itself. That overactive scar tissue can manifest in the form of a keloid.

They're called keloids!

A keloid is an overgrowth of scar tissue. They are not cancerous, and they don’t affect your physical health. However, they can be harmful to your mental health and extremely sensitive or uncomfortable.

How do keloids form?

A keloid is the product of excess collagen production, and the scar grows out of control, creating thick, irregular, raised skin. They can form as a result of injury to the skin, like surgery or biopsy. The size of a keloid can vary greatly; they may be small and flat, not much different than a typical scar, or they can continue to grow and create a problem.

We're not entirely sure why

Aside from a complication of wound-healing, there isn’t a clear understanding of why keloids form. There also is not a guaranteed way to get rid of them. Therapies that eliminate one keloid may not be as effective on another. Some may respond to basic wound care, cortisone creams, cryotherapy, and lasers, while others may need regular injections or surgical removal followed by radiation therapy.

How likely is keloid formation post-excision?

The combination of skin cancers and keloids is a less common occurrence. Those prone to keloids and skin cancers are two very different groups of individuals based on what we know about risk factors of each concerning age and skin type. That doesn’t mean the groups never overlap, and it doesn’t mean it never happens.

Patient experiences with keloids

I recently encountered a patient in this situation. The patient was a 77-year-old caucasian male with a history of keloids and skin cancers. He has had many skin cancers surgically excised without issues. This past summer, he had a squamous cell carcinoma surgically removed from his chest, which resulted in a keloid on the excision site. It was raised and extremely sensitive to the touch. After attempting to reduce the size of the keloid with injections without success, he returned to the office four months post-excision to have the keloid removed surgically and treated with superficial radiation. The radiation post-excision is done as a preventative measure to inhibit the regrowth of a keloid. Without radiation, there is a high chance of keloid regrowth; with radiation, that chance lowers to less than 8%. It has been four months since the removal, and he currently shows no signs of regrowth.

Treatment in retrospect

Hindsight is always 20/20, so what could we have done differently? Knowing that our patient was prone to keloids, we could have just opted for treatment with superficial radiation therapy (SRT) on the squamous cell carcinoma instead of the excision. The radiation would have had the same effect in eliminating the skin cancer but done non-surgically with minor trauma to the skin. The radiation would also stunt the growth of any overactive scar tissue from the biopsy and reduce the likelihood of keloid formation!

What questions do you have about keloids?