Chest Wall Keloids
Chest wall is the most common location for development of keloids. The triggering factor is often wounding of the skin, acne and other skin infections or surgery. The keloid shown below was triggered by a minor wounding of the skin from a sharp object injuring the skin. Surgery always results in worsening of the chest lesions. Best treatment option for cases like this are Steroid or chemotherapy injections and cryotherapy. In the case depicted below, the original lesion was removed surgically, which lead to formation of a much larger lesion at the site of surgery.
The size and shape of chest wall lesions vary from patient to patients. Some patients only have one very small spot on their chest wall; while others may have numerous spots.
Chest wall keloids tend to be thicker in African Americans, and thinner and more flat in individuals with light color skin. They tend to be irritated, itch or even become painful. Exercise, running, sweating can result in temporary expansion and enlargement these keloids and make them more symptomatic.
Cryotherapy for chest wall keloids can be painful and has to be done gently and in small segments divided in multiple sessions. The image below shows the extent of the keloid that can be comfortably frozen in one session of cryotherapy. Although the whole keloid can be treated in one session, such a treatment will make most patients quite miserable for 1-2 days.
The video below also shows the extent of the keloid that comfortably frozen in one session of cryotherapy. This patient required local anesthesia in order to be cofortably treated
These keloids should not be treated with radiation therapy, as radiation imposes an unacceptable risk of causing cancers or damage to the heart or thyroid gland. The patient below had surgery followed by radiation therapy to the keloid in her upper chest, lower neck area. The treatment not only did not help her, but resulted in recurrence of a worse keloid. Radiation therapy also caused a permanent damage to her thyroid gland, made her hypothyroid. She will have to take thyroid supplement medications for rest of her life.