A patient develops a large symptomatic keloid after ear piercing and requests simple excision. What counselling is most accurate?
Keloids extend beyond the original wound and commonly recur after excision. Intralesional corticosteroid, pressure therapy and selected postoperative radiotherapy are considered according to size, site and patient factors.
A. Excision alone has a high recurrence rate and should be combined with an adjuvant strategy: Keloids extend beyond the original wound and commonly recur after excision. Intralesional corticosteroid, pressure therapy and selected postoperative radiotherapy are considered according to size, site and patient factors.
B. Simple excision guarantees cure: Recurrence after surgery alone is common.
C. The lesion is a hypertrophic scar because it extends beyond the wound: Extension beyond the original boundary favours keloid.
D. No discussion of pigment change is needed: Steroids and radiotherapy can alter pigmentation, particularly in darker skin.
E. Radical auriculectomy is first-line: This creates disproportionate deformity.
If the scar remained within the wound boundary and gradually regressed, hypertrophic scarring would be more likely.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
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