title: Treatment of earlobe keloids by extralesional excision combined with preoperative and postoperative "sandwich" radiotherapy.
abstract: BACKGROUND
  Earlobe keloids can form after cosmetic ear piercing, trauma, infection, or burns, or spontaneously. These keloids are highly resistant for treatment and are followed by severe cosmetic implications. There are various surgical and nonsurgical treatment modalities for earlobe keloids, with no universally accepted treatment policy and a wide range of reported recurrence rates. The authors present their experience of treating earlobe keloids using the "sandwich" technique protocol; extralesional excision and external-beam radiotherapy are given a day before and a day after the operation.
  
  
  METHODS
  The authors retrospectively reviewed all patients with earlobe keloids treated by the "sandwich" technique between the years 1996 and 2005. Patients were categorized into two groups: a high-risk group for previously treated patients and patients with a tendency for hypertrophic scars and keloids, and a low-risk group for the others. All patients underwent extralesional excision of the keloid and local radiotherapy before the excision and following it. Follow-up was a minimum of half a year and included a patient satisfaction questionnaire and documentation of keloid recurrence or cure.
  
  
  RESULTS
  A total of 23 patients were treated by this protocol; 57 percent were male. Patients had an average age of 24 years. The most common keloid etiology was earlobe piercing. Recurrence rates for the low-risk and high-risk groups were 25 and 27 percent [percent of the patients], respectively. Overall patient satisfaction was high.
  
  
  CONCLUSIONS
  The combined excision and "sandwich" radiotherapy technique is a simple and effective method for treating earlobe keloids, with high patient satisfaction and low recurrence and complication rates.
authors.affiliation: Tel-Aviv, Israel From the Department of Plastic and Reconstructive Surgery and The Radiation Therapy Institute, Division of Oncology, Tel-Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University.
authors.forename: Shy
authors.initials: S
authors.lastname: Stahl
authors.forename: Yoav
authors.initials: Y
authors.lastname: Barnea
authors.forename: Jerry
authors.initials: J
authors.lastname: Weiss
authors.forename: Aharon
authors.initials: A
authors.lastname: Amir
authors.forename: Arik
authors.initials: A
authors.lastname: Zaretski
authors.forename: David
authors.initials: D
authors.lastname: Leshem
authors.forename: Ehud
authors.initials: E
authors.lastname: Miller
authors.forename: Raphael
authors.initials: R
authors.lastname: Shafir
authors.forename: Rami
authors.initials: R
authors.lastname: Ben-Yosef
authors.forename: Eyal
authors.initials: E
authors.lastname: Gur
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D046288:Body Piercing / Q000009:adverse effects; D002648:Child; D003131:Combined Modality Therapy; D004431:Ear, External / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007627:Keloid / Q000209:etiology / Q000532:radiotherapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D055815:Young Adult