Keloid Intralesional Excision (KILE) Technique To Decrease Recurrence: Truth Or Myth? A Case Series Analysis

Background: Keloids are fibroproliferative scars resulting from abnormal wound healing, disproportionately affecting African American and Hispanic patients. Conventional excision is known to be associated with recurrence rates as high as 45-100%, prompting the use of adjunctive therapies such as intralesional steroids, 5-fluorouracil (5-FU), interferons, cryotherapy, laser, and radiation. Core excision, also known as keloid intralesional excision (KILE), has been widely employed outside the United States with recurrence rates reported as low as 13%. The technique preserves a peripheral "keloid shell," minimizing trauma to surrounding normal skin and potentially altering fibroblast activity. Despite promising international data, U.S. case series are limited. We present outcomes from a single-surgeon case series evaluating the efficacy and safety of KILE in a high-risk patient population. Methods: A retrospective review of patients treated with KILE between 2022 and 2025 in our institution was conducted. Surgical technique included intralesional excision, closure with resorbable sutures and intralesional injection of steroids. Demographics, anatomic sites, operative technique, follow-up time, and outcomes were recorded. Recurrence was defined as clinically appreciable regrowth within the excision site. Follow-up duration was calculated from surgery to last clinic visit. Descriptive statistics were performed. Results: A total of 30 patients with 43 keloids were included in this study. The cohort was 47% male and 53% female, with a mean age of 12.9 years (range 2-18 years). Ethnic distribution included 29% Hispanic and 58% African American, with the remainder belonging to the other/unknown ethnicity category (13%). The most common anatomic sites were retroauricular (17/43, 39.5%) and earlobe (14/43, 32.6%), followed by auricular helical/cartilage (5/43, 11.6%) regions and preauricular (3/43, 7.0%). Isolated lesions occurred on the upper extremity/forearm (1/43, 2.3%), knee (1/43, 2.3%), and midline back (1/43, 2.3%). The study cohort included patients followed up to 17 months. Seven keloids recurred during the follow-up period, resulting in a recurrence rate of 16.3%. All recurrences occurred within the first year postoperatively and were managed with adjunctive intralesional corticosteroid injections. Two patients required re-excision, and none required radiation therapy or 5-FU. Cosmetic outcomes were favorable, with linear scars replacing bulky lesions. Compared to excision with adjuvant radiation or chemotherapy, KILE reduced treatment burden and eliminated exposure to potentially harmful agents. No wound infections, dehiscence, or flap necrosis were observed. Conclusions: The KILE technique provides a simple and reproducible technique for keloid management in high-risk populations, achieving a recurrence rate of 16.3% in our cohort, substantially lower than traditional excision and leading to high patient satisfaction. By preserving a keloid shell and minimizing collateral dermal injury, the technique addresses a long-standing clinical challenge while avoiding the expense, toxicity, and logistical barriers of radiation or toxic chemotherapeutic agents, particularly important in the pediatric population. Larger prospective studies with extended follow-up are warranted to validate long-term efficacy, optimize patient selection, and elucidate the biological mechanisms underlying reduced recurrence. *Source: https://ps-rc.org/meeting/Program/2026/EP106.cgi*