title: Case report and summary of literature: giant perineal keloids treated with post-excisional radiotherapy.
abstract: BACKGROUND
  Keloids are common benign tumors of the dermis, typically arising after insult to the skin. While typically only impinging on cosmesis, large or recurrent keloids may require therapeutic intervention. While no single standardized treatment course has been established, several series report excellent outcomes for keloids with post-surgery radiation therapy.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Radiotherapy for keloids represents a safe and effective option for post-surgical keloid therapy, especially for patients with bulky or recurrent disease.
authors.affiliation: Department of Radiation Oncology, University of Texas Health Science Center- San Antonio, San Antonio, USA. joneskc@uthscsa.edu
authors.forename: Kristin
authors.initials: K
authors.lastname: Jones
authors.forename: Clifton D
authors.initials: CD
authors.lastname: Fuller
authors.forename: Join Y
authors.initials: JY
authors.lastname: Luh
authors.forename: Craig C
authors.initials: CC
authors.lastname: Childs
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Miller
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Tolcher
authors.forename: Terence S
authors.initials: TS
authors.lastname: Herman
authors.forename: Charles R
authors.initials: CR
authors.lastname: Thomas
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007627:Keloid / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D010502:Perineum / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011859:Radiography