Overview

A keloid is a raised scar on the skin. As a wound heals, scar tissue forms and can become raised. It often looks and feels different from the surrounding skin. Keloid scars are often painless but they can be tender and itchy.

Keloids can be removed by having surgery. However, it may grow back. The benefit of having radiotherapy after surgery may prevent it from growing back in the future. Radiotherapy for keloid scar is a treatment that has been used for many years.

Risks of having radiotherapy

Radiotherapy is a treatment that uses beams of radiation to treat specific areas of the body. There are various kinds of radiotherapy that can be used to treat different conditions in different ways. Keloid scars are treated with a low dose of radiation so that the risk of side effects is low.  

To treat keloids, we use either superficial X-rays or electron beam radiotherapy. They are low dose X-rays to treat the area of the scar. The low dose means that healthy tissues underneath your scar are not likely to be affected.

There is a very small risk of radiation causing tumours in the future. It is very rare, and if it does happen, it is likely to be many years after treatment.  

Side effects of having radiotherapy

Any side effects will mostly affect the skin around the area you have treated. These include:

• If the scar is in an area where there is hair growing, there may be some hair loss, although hair will usually re-grow.
• The skin in the treatment area may change in colour, becoming more pink or red, and darker. Changes in skin colour may be more difficult to notice on darker skin. The skin may also be dry, flaky, sore, itchy and sometimes painful to touch. This slowly gets better about 6 weeks after treatment.
• It is important to look after the skin around the treated area. If the area needs a dressing, only use dressings given to you by the dermatology team, as not all dressings are suitable. The radiographers can also give you a dressing request form to give to your GP if you need additional dressings.
• Over time, the skin around the treatment area may become discoloured and darker or lighter than it was before the radiotherapy. The area will also be more sensitive to the sun. Make sure that you use a sunscreen on this area.

Other treatment options

You can have steroid injections, but these cannot be used too often.

Your radiotherapy appointment

You need to start radiotherapy treatment ideally 24 to 48 hours, and a maximum of 72 hours, after surgery.

As soon as you know the date for your surgery, please contact the radiotherapy appointment team, phone: 020 7188 3160 to arrange an appointment for your radiotherapy treatment.

Giving your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you understand what it involves and agree to have the treatment.

You can read more about our consent process.

Planning radiotherapy treatment

The number of radiotherapy sessions needed will depend on the extent and location of the keloid scar. Usually only 1 treatment session is needed. In some cases people may need 3 radiotherapy treatments.

Your doctor will tell you how many treatments you need and explain more about what will happen.

To plan the treatment, you may need to lie on a couch and any wound dressings you have will be removed. A radiographer, and your doctor, will use a bright light to look at the area that needs to be treated. They will use a marker pen to draw marks on your skin to identify the area to be treated.  

The radiographer will record the treatment area by taking measurements and, with your consent, a photograph of the area. The radiographer will also ask to take a photo of your face. The radiotherapy team will use this as a form of identification when you attend for your treatment.  

What happens during the treatment

Radiotherapy for keloid is usually quick and takes between 2 to 8 minutes.

Sometimes we may need to use shielding to protect the skin around the scar. This is made from a thin sheet of lead which is laid on the skin.

The radiographer will move the machine to rest on your skin, and a small amount of pressure may be used to keep this in place. A lead apron will be placed across your body during treatment to protect you. Treatment is painless and you will not feel anything when the machine is switched on.

The radiographers will leave the room during the treatment, but will watch you on closed circuit television (CCTV). It is important that you keep as still as possible. The radiographer can stop the treatment if you need assistance at any time.

When your treatment has finished, the radiographers will apply a dressing to the area, if necessary. You can then go home.

When you get home

Follow any advice you were given after your surgery about dressings or the removal of stitches.

If you have been using any creams in the area, you should check with your dermatologist if you should continue with these.

Do not apply any creams or products on the open wound unless advised to do so.

Do not use cotton wool on the open wound.

Looking after your skin

• Skin around the treated area can be washed daily using plain lukewarm or tepid water. Avoid scrubbing, rubbing and exfoliating around the area.
• Pat your skin dry with a soft towel. Do not rub.
• We recommend using non-adhesive or dressings made with a suitable adhesive coating. Please check with your dermatology team.
• Change the dressing every 1 to 2 days if your wound is weeping or until the wound is dry.
• Do not wet shave or use hair removal creams or wax around the treated area. You can use sterile scissors to keep hairs around the treated area low while the wound is healing.
• You should continue with these instructions until any skin reaction settles.

Follow-up appointment

You may have a follow-up appointment with the dermatologist you originally saw.

You will receive an appointment for a follow-up call with an advanced practice radiographer about 2 weeks after your treatment has finished. The appointment will be given to you on the last day of your radiotherapy. You will then be discharged to your GP and day surgery team.  

Useful information

British Association of Dermatologists have more information about keloids.