Neck keloids: evaluation of risk factors and recommendation for keloid staging system

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Knowing that keloid is a genetic disorder of wound-healing processes, it is counter-intuitive to resort to surgery as the mainstay of treatment. Surgical removal of keloid lesions is an intervention that is commonly practiced, defies the very basic principals of keloid formation. It is the injury to the skin of a genetically susceptible person that triggers keloidal wound healing response and formation of keloidal lesions. Surgical removal of neck or other keloids results in wounding of the skin and triggering of the same pathological wound-healing response that resulted in the formation of the keloid lesions that often leads to formation of a much larger keloid. Given the potential for greater harm from surgery, I propose non-surgical approach for treatment of all primary keloids. Also, attempts to properly categorize keloid lesions and to group keloid patients is hampered by the lack of a previously defined methodology. A clinical staging system is proposed to address the deficiency in grouping of keloid patients according to the size and extent of skin involvement with keloid lesions.

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