Keloid+(Benign)

"Side effects of radiation terapy include transient erythem and hyperpigmentation. The risk of carcinogenesis from radiation therapy of keloids is likely to be extremely low, especially with modern techniques." However, because the risk is uncertain, some recommend that radiotherapy only be used on those who have failed previous excisional treatments and to patients that are 21 or over. 1 || -** Surgical excision followed by corticosteroid injections or radiation. - Postoperative irradiation is effective and seems to be more comfortable for the patient. 2 - Post operative radiation should be started within in 24 hours. - 100-140 kV x-rays with 1-7 mm aluminum HVL or low-energy electrons(6MeV) with bolus are commonly used. - Each field is customized to treat the surgical scar with 0.5 cm margin. - Total dose is 10 -15 Gy delivered in 2-3 fractions. - If the keloid is around the ear, the earlobe should be tapes away from face. - Figure 1.1 shows before and after photo of a keloid near the ear. 3 Figure 1.1 Keloid before and after treatment. 3 || Skin 2 --15-20Gy ---30-40Gy Eye(Lens) 2 --2-10Gy 6-12Gy Ear (middle) 4 ---50Gy Ear( Vestibular) 4 ---60Gy || References: 1. Dermatology Online Journal. //Keloids: Pathophysiology and Managment.// Available at : []  Accessed: February 16, 2010. 2. Chao KS, Perez CA, Brady LW. //Radiation Oncology - Management Decisions, // 2nd edition. Philadelphia, PA //: // Lippincott, Williams & Wilkins, 2002. 680-681. 104, 680. 3. The Aesthetic Institute website available at http://www.skinkeloids.com/keloid_photos.htm. Accessed on Feb. 18, 2110. 4. Washington CM, Leaver D. //Principles and Practice of Radiation therapy//. Second Edition. St. Louis, Missouri: Mosby Inc, 2004; 80. 5. Wound Healing, Widened, and Hypertrophic Scars. eMedicine. Available at: []. Accessed on: February 21, 2010.
 * Epidemiology: || Some people have a tendancy to react to skin trauma with excessive production of fibrous tissue that extends beyond the wound, becomes hyalinized, and does not regress spontaneously. This excess tissue is known as a keloid. It can be an unsightly mass that can cause itching and pain. 2 Keloids are more prevalent for people between the ages of 10 and 30 years of age. 5 ||
 * Etiology: || They may occur in susceptible individuals after infection or burns, but mostly after a traumatic injury or surgical wound. <span style="color: #008080; font-family: 'Times New Roman',Times,serif; font-size: 77%; vertical-align: super;">2 ||
 * Signs & Symptoms: || <span style="color: #ff00ff; font-family: 'Times New Roman',Times,serif;">Excessive production of fibrous tissue that extend beyond the wound, it becomes hyalinized and doesn't regress. The mass usually becomes unsightly. The mass often becomes painful and itchy. <span style="color: #ff00ff; font-family: 'Times New Roman',Times,serif; vertical-align: super;">2 ||
 * Diagnostic Procedures: || <span style="color: #ff00ff; font-family: 'Times New Roman',Times,serif;">Keloids are diagnosed by their appearence. ||
 * Histology: || <span style="color: #ff00ff; font-family: 'Times New Roman',Times,serif;">Keloids are comprised of fibroblasts, fibrous tissue, and irregularly arranged thick bands of collagen in the dermis and subcutaneous tissue. <span style="color: #ff00ff; font-family: 'Times New Roman',Times,serif; vertical-align: super;"> 1 ||
 * Lymph Node Drainage: || Keloids are benign tumors which are cosmetically disfiguring. They can occur on any part of the body and do not travel by the lymphatic system. ||
 * Metastatic Spread: || Keloids are benign and do not metastasize to other areas of the body. ||
 * Grading: || <span style="color: #008000; font-family: 'Times New Roman',Times,serif; font-size: 110%;">There is no grading system used for Keloid's. Upon looking for information for this subject, I found many different sites that used their own grading system for their research but there is nothing universally used. The different factors that were used for individual grading systems were things such as size and texture. ||
 * Staging: || <span style="color: #008000; font-family: 'Times New Roman',Times,serif; font-size: 110%;">There is no staging system used for Keloid's. ||
 * Radiation Side Effects: || <span style="color: #008000; font-family: 'Times New Roman',Times,serif; font-size: 110%;">Side effects of radiation therapy are limited to the area being treated.
 * Prognosis: || <span style="color: #008080; font-family: 'Times New Roman',Times,serif; font-size: 110%;">Using post-op radiation therapy elevates the prognosis, as compared to surgery or cortazone injections alone. ||
 * Treatments: || **Keloids:
 * TD5/5: || **Organ TD5/5****single dose Fractionated dose**