Scar Rivision Surgery And Radiation Treatments

[April2]

Hello. I would just like another expert opinion. My daughter has a pretty bad scar that is keloid. It's over 3 years old so it doesn't look like it's going to improve anymore. We've tried the laser treatments for over 4 months 2 years ago and that did little to make it look better. We've tried Vitamin E and scar creams.
We are now considering scar revision surgery. We've talked with the plastic surgeon and he says if he does it then she must get radiation treatments immediately following the surgery to keep the scar from becoming upraised again (keloid). Then we talked with the Radiologist and he said that the treatments usually work, and she'd need about 3 of them. He did say, though, that there's a small risk, maybe 1 to 5% chance of her getting skin cancer in that area 20, 30 or 40 years down the line. He said it's not the cancerous kind, though.The plastic surgeon won't consider the surgery without the radiation because he says the scar will just raise right back up again.
We are now trying to decide what to do. It's in a pretty noticeable place and she's always been self-conscious about it. She wants to try to make it look better.
Can I please get your opinion on this? Do you think it's worth getting the surgery? Is what he says about the radiation true? Does that sound about right?
We've been told by doctors even that she could always just get a tattoo over the scar when she's older but I would think that would even not look very good since it's bumpy. I do want to leave the decision up to her since she's 17 now and she's thinking about it.
I just wanted another doctor's opinion on all of this. Thank you so much!
I look forward to hearing back from you.
April

[April2]

Thank you for answering, doctor. Do you think we should do the radiation or talk to another doctor? This one won't consider the surgery unless we do the radiation because he says the keloid will just come back. Is it worth the small risk of skin cancer? Can it still come back even with the radiation treatments?

You mentioned the steriod shots. Now, that's not something we tried. Would that work instead of surgery, do you think, or does it have to be combined with surgery?

[Howard Rosenberg, MD]

I have done many scar revisions for true keloids or hypertrophic scars.  I personally have never used radiation therapy as adjuct to excsion of the scar, although is it a well recognized procedure.  I use steroid injections immediately before and at the time of surgery along with careful follow-up with additional injections as appropriate.  I will also leave a small rim of keloid tissue at the time of the surgery to "fool" the area that the keloid is still present.  Use of silicone gel sheeting with or without a pressure dressing can also be helpful.  There is still no certainty that regrowth will not occur.