Keloids are pathological scars originating from connective tissue characterized by excessive growth that extends beyond the original edges of the wound. They occur significantly more often in skin areas exposed to increased mechanical tension during the wound-healing process and up to fifteen times more frequently in individuals with darker skin pigmentation. The underlying mechanism of keloid formation is driven by an inflammatory response triggered by skin injury extending into the reticular dermis, leading to fibroblast accumulation and neovascularization. The management of keloids remains challenging, as the recurrence rate is high when surgical excision is performed as a standalone treatment. Evidence indicates that combining surgical resection with adjunctive modalities results in superior clinical outcomes and may significantly lower recurrence rates compared with monotherapy. Adjuvant radiotherapy plays a key role in this approach, as it has been shown to reduce recurrence rates to below 10%, primarily through suppression of inflammation and inhibition of fibroblast activity. This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A systematic search of the PubMed and Web of Science databases identified 22 studies comprising more than 2219 patients treated with surgical excision followed by postoperative radiotherapy. Reported recurrence rates ranged from 1.6% to 55.2% and were influenced by total radiation dose, fractionation schedule, radiotherapy technique, and duration of follow-up. Despite its proven effectiveness when combined with surgery, radiotherapy has certain limitations, including the lack of standardized guidelines regarding dose, fractionation, and timing of administration. Most reported adverse effects were mild to moderate and localized to the treated area, while a direct causal relationship between postoperative radiotherapy and secondary malignancy development could not be established. The variability in treatment protocols highlights the need for further studies to support more effective, evidence-based decision-making in the treatment of keloids.

Background: Keratinocyte carcinomas (KCs), including basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), are the most prevalent malignancies globally, particularly affecting sun-exposed facial areas. Achieving clear surgical margins in these regions is essential to ensure oncologic control while preserving cosmetic outcomes. Reflectance confocal microscopy (RCM) is a noninvasive imaging technique that enables real-time, high-resolution visualization of skin structures and may aid in margin assessment during KC surgery. This systematic review aims to evaluate the role of in vivo RCM in the surgical treatment of KCs. Methods: This review followed PRISMA guidelines. A comprehensive search of PubMed, Scopus, Web of Science, Medline, and EBSCO databases was conducted for studies published between January 1992 and December 2024. Inclusion criteria focused on clinical studies utilizing in vivo RCM for diagnostic or surgical applications in KC management. Results: Eighteen studies involving 1112 patients were included. RCM was used preoperatively in 5 studies and intraoperatively in another 5. Nine studies assessed margin delineation, while eight focused on diagnostic accuracy. RCM improved diagnostic confidence and allowed for more precise margin assessment, potentially reducing the extent of surgical excision in cosmetically sensitive areas. However, its broader clinical adoption is limited by operator dependency, procedural complexity, and lack of standardization. Conclusions: RCM shows promise as a supportive tool in KC surgery, particularly for preoperative planning. While its diagnostic utility is well established, its intraoperative role requires further validation. Larger, standardized, and cost-effective studies are needed to confirm its impact on surgical outcomes and patient quality of life.

Background and Objectives: Keloids are fibroproliferative disorders marked by excessive fibroblast activity, abnormal collagen deposition, and impaired wound healing. They are frequently associated with pain, pruritus, and significant aesthetic concerns, leading to reduced quality of life. Surgical excision alone is burdened by high recurrence rates, underscoring the need for effective adjuvant therapies. This systematic review aimed to assess the effectiveness of surgical excision combined with adjuvant physical and pharmacological therapies in keloid management, with particular emphasis on recurrence rates. Materials and Methods: The review was conducted in accordance with PRISMA guidelines. A systematic search of PubMed and Web of Science identified studies evaluating surgical excision of keloids with adjunctive therapies. Twenty-one studies involving more than 8627 patients met the inclusion criteria. Extracted data included study design, patient and lesion characteristics, treatment modalities, and recurrence rates. Due to marked heterogeneity among treatment protocols, a meta-analysis was not performed. Results: Among physical adjuvant therapies, postoperative brachytherapy showed the lowest recurrence rates (3.1–15%), outperforming radiotherapy and external-beam radiation therapy (14–29.3%). Compression therapy achieved recurrence rates of 10.66% and 14%, particularly effective in auricular keloids. Pharmacological adjuvant therapies demonstrated variable efficacy. Triamcinolone acetonide injections were associated with recurrence rates ranging from 6.6% to 33%, depending on the protocol. Adjuvant 5-fluorouracil reduced recurrence compared with surgery alone, whereas imiquimod 5% showed higher and less consistent recurrence rates. Combination pharmacological therapies consistently yielded better outcomes than monotherapy. Conclusions: Surgical excision combined with adjuvant therapy is the most effective strategy for keloid treatment. Multimodal approaches significantly reduce recurrence compared with surgery alone. However, substantial heterogeneity in lesion characteristics, treatment timing, and therapeutic protocols limits comparability between studies. Further high-quality, standardised clinical trials are needed to optimise management strategies and develop evidence-based guidelines.