title: Analysis of the surgical treatments of 63 keloids on the cartilaginous part of the auricle: effectiveness of the core excision method.
abstract: BACKGROUND
  Treatments for keloids on the cartilaginous part of the auricle (i.e., the upper part of the ear excluding the earlobe) include surgical excision, cryosurgery, postoperative radiation therapy, steroid injection, taping stabilization, and pressure therapy. However, to date, there is no universally accepted treatment strategy for auricle keloids.
  
  
  METHODS
  In this retrospective cohort study, the 63 primary auricle keloids in all 57 patients who underwent surgery from 2006 to 2012 were included. Mild scars such as hypertrophic scars were excluded. All 63 scars were treated with surgery, namely, total excision or intralesional excision (core excision method), and postoperative adjuvant radiation therapy and self-managed scar stabilization with surgical tape. The postsurgical radiation therapy consisted of 15 Gy administered in three fractions over 3 days. The recurrence rates associated with the two surgical methods over 18 months of follow-up were recorded.
  
  
  RESULTS
  Of the 57 patients, 91.2 percent were women. Of the 63 lesions, 95.2 percent and 4.8 percent were caused by piercing and trauma, respectively. All were primary keloids. Before 2009, all lesions (n = 37) were treated by total excision. After 2009, all lesions (n = 26) were treated by core excision. These methods were associated with recurrence rates of 8.1 percent and 0 percent, respectively, although this difference did not achieve statistical significance (p > 0.05). The overall recurrence rate was 4.8 percent. Complications such as wound dehiscence and pigmentation during the 18-month follow-up period were not observed.
  
  
  CONCLUSIONS
  Auricle keloids can be treated by customized plans consisting of appropriate surgical modalities, postoperative radiotherapy, and self-management.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Tokyo, Japan From the Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School; and the Department of Radiation Oncology, Nippon Medical School Hospital.
authors.forename: Rei
authors.initials: R
authors.lastname: Ogawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Akaishi
authors.forename: Teruyuki
authors.initials: T
authors.lastname: Dohi
authors.forename: Shigehiko
authors.initials: S
authors.lastname: Kuribayashi
authors.forename: Tsuguhiro
authors.initials: T
authors.lastname: Miyashita
authors.forename: Hiko
authors.initials: H
authors.lastname: Hyakusoku
mesh_terms: D054644:Ear Auricle / Q000473:pathology / Q000601:surgery*; D004425:Ear Cartilage / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007627:Keloid / Q000175:diagnosis / Q000532:radiotherapy / Q000601:surgery*; D008297:Male; D011182:Postoperative Care / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome