Case report and summary of literature: giant perineal keloids treated with post-excisional radiotherapy

We present a patient with a history of recurrent keloids arising in the absence of an ascribed trauma and a maternal familial history of keloid formation, whose physical examination several large perineal keloids of 6-20 cm in the largest dimension. The patient was treated with surgical extirpation and adjuvant radiation therapy. Radiotherapy was delivered to the scar bed to a total dose of 22 Gy over 11 daily fractions. Acute radiotherapy toxicity necessitated a treatment break due to RTOG Grade III acute toxicity (moderate ulceration and skin breakdown) which resolved rapidly during a 3-day treatment break. The patient demonstrated local control and has remained free of local recurrence for more than 2 years.Radiotherapy for keloids represents a safe and effective option for post-surgical keloid therapy, especially for patients with bulky or recurrent disease.Keloids are benign, common, fibroproliferative dermal tumors which usually occur as a result of trauma to the skin[1], though their pathogenesis is distinct from hypertrophic scars [2]. Keloids are often refractory to treatment, recurring frequently. While the precise etiology and genetic mechanism of this pathology is unknown, keloids are believed to be more prevalent in patients of African descent. While most keloids are sporadic, familial keloids seem to represent an incomplete penetrance autosomal dominant disease, with varying degrees of clinical severity within a pedigree [3]. An association with diabetes, which was noted in the medical history of our patient and her maternal line, has also been observed in at least one series [4]. Additionally, this case is remarkable for the fact that few keloids form in the female genital region in comparison to other high-skin tension regions, for unknown reasons [5]. While not frequently considered as candidates for oncologic therapies, severe lesions may require radiotherapy or intralesional injection of interferon and flourouracil in addition to surgical extirpat