Consult Keloid

Counseling
Natural history of Keloidal scarring was discussed with Patient Name including tendency for recurrence and growth. Adjuvant treatment regimens were discussed including: intralesional steroids, radiation therapy, compression earrings, and silicone gel sheeting. Potential advantages and disadvantages were outlined. The risks and benefits of radiation therapy were discussed in detail. Adjuvant radiation has recurrence-free rate of ~75% in long term follow-up. Despite the theoretical risk of cancer and a few documented cases, no association of radiation therapy for keloids and carcinogenesis has been found in large clinical trials, totaling thousands of patients treated. Patient was also informed of the acute and long term side-effects of radiation to area to be treated. All of Patients name questions were answered to his/her satisfaction.

Plan
I recommended 12 Gy of radiation in 3 fractions with 6 MeV electrons with 1 cm bolus to be started less than 24 hours after surgical excision. Patient will be simulated clinically on the treatment table. Customized electron blocking will be used to minimize radiation to the normal tissue while covering the post-surgical bed with margin.

Thank you Ref. MD again for asking us to see Patient Name
Best Regards,

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