Journal of Clinical and Aesthetic Dermatology

AUG 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

Issue link: http://jcadonline.epubxp.com/i/870497

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12 12 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY august 2017 • volume 10 • number 8 R BACKGROUND: Radiotherapy has been used historically to treat a wide variety of dermatologic conditions, including nonmelanoma skin cancers, lymphomas, and inflammatory skin conditions. Recently, radiotherapy has been used increasingly as a valuable tool in the postsurgical treatment of large or recalcitrant keloids. OBJECTIVE: the objective of this review was to explore the use of radiation therapy as an adjuvant to surgically excised keloids. DESIGN: a pubmed search of all published english literature regarding the applications of radiotherapy for the treatment of keloids was performed using a combination of keywords including radiation, radiotherapy, brachytherapy, electron beam, superficial radiation, orthovoltage radiation, and keloid. the results were analyzed and collated. RESULTS: a comprehensive review of radiotherapy for the adjuvant treatment of keloids was outlined. CONCLUSION: Radiotherapy appears useful as an adjuvant therapy to surgically excised keloids. dermatologists should be well versed in radiotherapy to provide optimal care for patients with recalcitrant keloids. KEY WORDS: Radiotherapy, brachytherapy, keloid, electron beam, superficial radiation, orthovoltage radiation a B s t R a C t R e v i e w RADIATION THERAPY for the adjunctive treatment of surgically excised Keloids: a Review by NIKOO CHERAGHI, MD; ARMAND COGNETTA, Jr., MD; and DAVID GOLDBERG, MD dr. Cheraghi is with the university of minnesota, dermatology, minneapolis, minnesota. dr. Cognetta is with Florida state university College of medicine, dermatology, tallahassee, Florida. dr. Goldberg is with skin laser & surgery specialists of new york and new Jersey, new york, new york; icahn school of medicine at mount sinai, new york, new york; and university of medicine and dentistry of new Jersey-Rutgers medical school, newark, new Jersey. J Clin Aesthet Dermatol. 2017;10(8):12–15 FUNDING: no funding was provided for this study. DISCLOSURES: dr. Cognetta was an early advisor on the medical advisory board for topex (now known as sensus healthcare) during the sale of the company, and organized an advisory board composed of a dermatologist, radiation oncologist, and medical physicist. he was given a stock option for his advisory role during the company's formative stages in 2012. drs. Cheraghi and Goldberg have no conticts of interest relevant to the content of this article. AUTHOR CORRESPONDENCE: nikoo Cheraghi, md, nikoo.c@gmail.com RadiotheRapy is used pRimaRily in dermatology to treat nonmelanoma skin cancers, mycosis fungoides, lymphomas, and keloids. Keloids can be diRcult to treat, and treatment with excision often leads to recurrence. adjuvantly, keloids are treated with postexcisional radiation therapy with excellent results and minimal complications or recurrences. as such, radiation therapy should be kept in a dermatologist's repertoire of treatment options for diRcult-to-treat keloids. in this review, the use of various types of radiation therapy for keloids is highlighted. KELOIDS Keloids can be distressing for patients, as they can cause pain and itching and are also aesthetically displeasing. the current treatment options for keloids are limited. these include intralesional corticosteroids, silicone-based products, 5- tuorouracil, bleomycin, imiquimod, laser therapy, pressure treatments, surgical removal, cryotherapy, and radiotherapy. 1 the recurrence rate using surgical excision alone is 45 to 100 percent. 2 surgical excision followed by radiotherapy is a helpful treatment option for large and more diRcult-to-treat keloids that cannot otherwise be treated by or have failed more conservative measures. 1 the balance between proliferation and apoptosis is impaired in keloid sbroblasts, and because keloid sbroblasts are sensitive to x-ray irradiation, it is thought that x-ray radiation may prevent the recurrence of keloids by controlling sbroblast proliferation, arresting the cell cycle, and inducing premature cellular senescence. 3–5 the most commonly used radiotherapy modalities include electron beam irradiation, superscial and orthovoltage radiation therapy, and brachytherapy (Figures 1 and 2). although there may be no signiscant difference in eRcacy between the different radiotherapy modalities, each modality has its own advantages and drawbacks (table 1). 6 ELECTRON BEAM RADIOTHERAPY electron beam radiotherapy (eBRt) uses a linear accelerator to deliver energy levels to a depth of 2 to

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