Keloids are laterally growing fibroproliferative skin disorders. Severe
keloids spread widely, sometimes over joints, thus significantly limiting motor function. They are associated with recurrent, very painful draining
infections. Here, we report a case of a giant
keloid that was successfully treated by combination
therapy comprising surgery (partial resection followed by local flap transposition) and subsequent
radiotherapy and
steroid-plaster
therapy. The
keloid was first noticed when the patient was 7 years old at the site of a Bacille Calmette-Guérin vaccination she had received on her left shoulder in infancy. The
keloid grew rapidly and widely after adulthood. A malignant
tumor was suspected at another hospital, but a biopsy at age 45 years indicated the lesion was a
keloid. Later, the
keloid grew from the shoulder onto the chest and back and over the anterior axilla. At age 62 years, the patient was referred to our hospital. Under
general anesthesia, the
keloid was partially resected and the
wound was covered with a local flap. Postoperative
radiotherapy was performed 1 week later. The residual
keloid was treated for 18 months with
steroid tape. At 18 months after surgery, no recurrence of the
keloid was observed. The patient had no
pain or movement restriction. She was extremely satisfied with the results and considered the treatment to have improved her quality of life. While a standard strategy for severe
keloid remains to be established, combination
therapy comprising surgery, postoperative
radiotherapy, and
steroid-plaster
therapy that aims to reduce
inflammation and skin tension may be an option.