Q. I had a mole removed from my chest by my dermatologist. I now have a keloid that is worse than when I started. What do you think went wrong and what can I do to correct it?
I don't think that your dermatologist did anything wrong. The areas around the chest and shoulders tend to be areas with high propensity for keloids, a proliferation of scar tissue, often after surgery. If in the future you decide to remove another mole, I would ask your doctor if he or she uses deep sutures. Taking the tension off the skin with deep sutures and with superficial skin sutures will decrease the likelihood that you will get a keloid. Because of the high propensity for keloids in this area, I recommend that patients not remove moles unless they are highly suspicious for cancer. These moles can be very difficult to remove without a scar.
What can you do to fix your problem? My first step would be to use a silicone sheeting along with a kenolog injection directly into the keloid. It is important that the injection be directly into the keloid and not the surrounding area as it may cause the area to atrophy and make it look worse. If the kenolog injection does not work, then an injection of 5- fluorouracil (an anti-cancer drug) would be warranted. If none of the above treatments are successful, a direct surgical excision would be warranted. The scar excision would require wide undermining (freeing up the tissue edges) then a two-layer closure with deep and superficial sutures. The excision would be followed by silicone sheeting or an anti-scar cream to maximize results.
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Dr. Carlos Wolf is a partner in Miami Plastic Surgery and is board certified. Email questions to Cwolf@miamiplasticsurgery.com.