Keloid Recurrence after Surgical Excision: Current Evidence and Adjuvant Treatment Strategies

Abstract

Keloid recurrence remains a major challenge after surgical excision, particularly when surgery is performed without a postoperative treatment plan. This narrative review examines clinical evidence for radiotherapy, intralesional corticosteroids and 5-fluorouracil, silicone sheeting, and compression as adjuncts to excision. Selected studies suggest that postoperative radiotherapy and multimodal treatment can achieve favorable local control, although recurrence estimates differ considerably across treatment protocols and anatomical sites. In a retrospective radiation cohort involving 250 lesions, recurrence was 1.6% after 20 Gy in five fractions and 9.6% after lower-dose schedules. A comparative auricular study reported recurrence in 21.7% of patients treated with 5-fluorouracil plus triamcinolone and compression, compared with 38.3% receiving triamcinolone and compression. Interpretation is constrained by differences in recurrence definitions, follow-up, and whether outcomes are reported per patient or per lesion. For clinical practice, the available literature favors planning adjuvant treatment alongside excision, while tailoring the choice of therapy to lesion location, previous treatment, adverse effects, and the feasibility of follow-up.