Report on the Success of Combination Therapy for Giant Recalcitrant Keloid of the Neck and a Literature Overview

Introduction
Keloid scars are a frustrating benign dermatologic condition for both the patient and the clinician. Despite the availability of a wide range of therapeutic options, the outcome remains unpredictable, and recurrence can occur after years.

Objective
The present clinical case aims to highlight the most effective brachytherapy regimen in the treatment of recalcitrant giant keloids while emphasizing a new procedural contribution using an immobilization device. An overview of the pathophysiology of keloid is provided, as well as a literature update.

Case report
A 48-year-old man suffered from an exuberant keloid of the neck that recurred after combined medical and surgical treatment. Wound closure following extramarginal excision was performed above a brachytherapy catheter, allowing high-dose-rate brachytherapy within 4 hours. An immobilization device was placed at the end of the procedure to avoid traction forces due to cervical movements and kept for 2 months. The aesthetic result was satisfactory without relapse after 18 months of follow-up.

Conclusions
Adjuvant brachytherapy should be strongly recommended for recalcitrant keloids. The use of immobilization devices is mandatory and unavoidable in areas with continuous mobility, such as the neck and joints, to avoid traction forces that are favorable for recurrence. New multicenter prospective studies with control groups are needed as a case study.