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Tam I, Sun L, Patel A, Woo L, Weaver J, Shah SD. Penile keloid formation post-circumcision: A case series and review of literature. Pediatr Dermatol 2024; 41:483-489. [PMID: 37983948 DOI: 10.1111/pde.15473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 10/29/2023] [Indexed: 11/22/2023]
Abstract
The formation of penile keloid after circumcision is an uncommon complication. Herein, we report two pediatric cases of large circumferential keloids that developed post-circumcision and were successfully treated by surgical excision and intralesional triamcinolone injections. In addition, we provide a comprehensive review of the reported cases of penile keloids that developed after circumcision in the literature to highlight the various presentations, treatment options, and outcomes for this condition.
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Affiliation(s)
- Idy Tam
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Lillian Sun
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Anish Patel
- Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Lynn Woo
- Department of Pediatric Urology, Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
| | - John Weaver
- Department of Pediatric Urology, Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
| | - Sonal D Shah
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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2
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Isoldi FC, Garcia A, Vieites L, Ferreira LM. Keloids in male genitalia-Systematic review and illustrative case report. Wound Repair Regen 2024; 32:171-181. [PMID: 38351501 DOI: 10.1111/wrr.13157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 01/03/2024] [Accepted: 01/16/2024] [Indexed: 03/12/2024]
Abstract
Keloid is the maximum expression of pathological fibroproliferative skin wound healing, whose pathophysiology is not yet fully understood. Its occurrence in the perineum and genitalia is uncommon. A systematic review was carried out regarding the occurrence and treatment of keloids on the penis. An illustrative case was also reported. The review used the PRISMA checklist and was registered in PROSPERO. The entire literature period up to April 2023 was searched in the EMBASE/Elsevier, Cochrane, Scopus, Medline, BVS, SciELO, and Lilacs databases. The inclusion criteria embraced primary studies, clinical trials, prospective or retrospective cohorts, case series, case-control studies and case reports. Three hundred and sixty-one studies were found and 12 of them were included, consisting of 9 case reports and 3 case series. The most common triggering factor for keloid formation was circumcision, in 11 of the cases, of which more than half occurred in prepubescent children. Several therapies, associated or isolated, were used to treat the cases. Only one of the reported patients had scar recurrence after surgical treatment. Studies with better scientific evidence are needed to understand the involvement of keloids in male genitalia. However, keloid formation in this topography is rare, making it difficult to carry out more elaborate studies.
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Affiliation(s)
- Felipe Contoli Isoldi
- Postgraduate Program in Translational Surgery at Universidade Federal de São Paulo - Escola Paulista de Medicina (Unifesp/EPM), São Paulo, Brazil
| | - Ariane Garcia
- Postgraduate Program in Translational Surgery at Universidade Federal de São Paulo - Escola Paulista de Medicina (Unifesp/EPM), São Paulo, Brazil
| | - Luiza Vieites
- Postgraduate Program in Translational Surgery at Universidade Federal de São Paulo - Escola Paulista de Medicina (Unifesp/EPM), São Paulo, Brazil
| | - Lydia Masako Ferreira
- Postgraduate Program in Translational Surgery at Universidade Federal de São Paulo - Escola Paulista de Medicina (Unifesp/EPM), São Paulo, Brazil
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3
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The Role of Plastic Surgery in the Treatment of Recurrent and Large Penile Keloid. Plast Reconstr Surg Glob Open 2022; 10:e4052. [PMID: 35186620 PMCID: PMC8849309 DOI: 10.1097/gox.0000000000004052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/16/2021] [Indexed: 10/26/2022]
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Hamzan MI, Jeffrey MJ, Halim AS. RARE PENILE KELOID AFTER CIRCUMCISION: CASE REPORT AND LITERATURE REVIEW. SANAMED 2020. [DOI: 10.24125/sanamed.v15i2.404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Abdelhalim A, Atwa AM, Soltan MA, Edwan M, Helmy TE, Hafez AT, Dawaba ME. Are Prophylactic Measures Necessary to Prevent Recurrence of Penile Keloids? Urology 2020; 141:147-149. [PMID: 32304683 DOI: 10.1016/j.urology.2020.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2020] [Indexed: 10/24/2022]
Abstract
Keloid scars result from excess collagen deposition in the dermis or subcutaneous tissue in response to surgery or tissue trauma. The penis is a rare site for keloid formation, even in predisposed individuals. Only few cases of penile keloids have been reported so far. In this report, we present penile keloids complicating neonatal circumcision in twin brothers. Risk of recurrence in previous reports and measures to guard against its occurrence are also discussed.
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Affiliation(s)
- Ahmed Abdelhalim
- The Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
| | - Ahmed M Atwa
- The Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mohamed A Soltan
- The Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mohamed Edwan
- The Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Tamer E Helmy
- The Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ashraf T Hafez
- The Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mohamed E Dawaba
- The Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Buick TA, Abbas W, Munro FD. Literature review and case report of post-circumcision keloid management. Arab J Urol 2019; 17:314-317. [PMID: 31723449 PMCID: PMC6830255 DOI: 10.1080/2090598x.2019.1651016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/20/2019] [Indexed: 10/28/2022] Open
Abstract
Keloid following circumcision has been described in the literature despite the rarity of its occurrence in penile skin. In this paper, we review the literature and report the successful management of post-circumcision keloid scarring in a 2-year-old boy. After circumcision a 2-year-old boy of African origin developed keloid scarring at the circumcision site. This was treated with three intralesional injections of triamcinolone acetate over 3 months, followed by surgical excision. There was no recurrence at 6 months after excision. To our knowledge this is the 12th case of keloid following paediatric circumcision described in the literature. There is a wide range of techniques described but all are recurrence free at 6 months following repeated intralesional triamcinolone acetate injection and surgical excision. While there is no current consensus in treating post-circumcision keloid, we find that intralesional injection followed by surgical excision provides an acceptable aesthetic result, which is recurrence free.
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Affiliation(s)
- Tim A Buick
- Royal Hospital for Sick Children, Edinburgh, Scotland
| | - Wisam Abbas
- Royal Hospital for Sick Children, Edinburgh, Scotland
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A rare presentation of penile keloids after traditional circumcision: Case report. Int J Surg Case Rep 2019; 60:261-264. [PMID: 31261043 PMCID: PMC6610228 DOI: 10.1016/j.ijscr.2019.05.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/28/2019] [Accepted: 05/28/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Only few cases of penile keloids have been reported in the literature. There have been no published reports on penile keloids following traditional circumcision in Africa. CASE REPORT We present a case of a 13-year-old boy with penile keloids following traditional circumcision. The patient was successfully treated with complete excision of the keloid followed by a course of adjuvant treatment with corticosteroid injection. DISCUSSION Penile keloids are a rare complication despite penile surgery being common. Male circumcision is a standard operation performed worldwide for medical, religious as well as cultural reasons. Traditional circumcision continues to be practised in many African countries. Keloids are a benign hyperproliferative growth of scar tissue that can complicate wound healing. Successful treatment is classically multimodal. CONCLUSION This case highlights one of the more serious complications of circumcision. Although penile keloids are rare, the techniques involved in traditional circumcision potentially predispose to keloid formation in a genetically prone population.
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Alyami F, Ferandez N, Koyle MA, Salle JP. Keloid formation after pediatric male genital surgeries: an uncommon and difficult problem to manage. J Pediatr Urol 2019; 15:48.e1-48.e8. [PMID: 30206024 DOI: 10.1016/j.jpurol.2018.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/01/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Penile and genital keloids are uncommon despite frequent surgeries in the genital area. Keloid scar pathogenesis is not well understood, and a uniform effective therapeutic regimen for keloids has not yet been established. In the present study, the clinical features and subsequent management in cases of severe keloid formation after pediatric genital surgery are described. METHODS A retrospective review of keloid cases that had developed after genital procedures between 2000 and 2017 was conducted. Pre-operative characteristics, operative procedures, postoperative management, and follow-up were reviewed for each case. All cases were managed by a multidisciplinary team that included plastic surgeons and dermatologists. RESULT Six cases developed genital keloids. The mean age at surgery was 5.6 years (± standard deviation 4.6 years). Procedures included phalloplasties, penile curvature correction, penoscrotal transposition, redo hypospadias repair, and circumcision. Treatment options included excision of the keloid ± topical steroid injections and postoperative use of silicone gel. Two cases of severe keloid lesions developed after using posterior auricular grafts. Ultimately, a successful outcome was achieved in all cases. CONCLUSION Genital keloids are rare and difficult to treat. Many therapeutic options are available with varying degrees of proven clinical success. As a result, pediatric urologists must be aware of advances in other fields such as plastic surgery and dermatology to treat and ideally prevent the occurrence of this serious complication.
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Affiliation(s)
- F Alyami
- Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada; Urology Division, Department of Surgery, King Saud University, King Saud University Medical City and College of Medicine, Riyadh, Saudi Arabia.
| | - N Ferandez
- Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - M A Koyle
- Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - J P Salle
- Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Division of Urology, Sidra Medical and Research Center, Doha, Qatar
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Ozakpinar HR, Sari E, Horoz U, Durgun M, Tellioglu AT, Acikgoz B. Keloid of the circumcision scar: a rare complication. Int Wound J 2014; 12:611-2. [PMID: 24750852 DOI: 10.1111/iwj.12163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 08/29/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hulda R Ozakpinar
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Elif Sari
- Plastic, Reconstructive and Aesthetic Surgery Department, Kirikkale University Faculty of Medicine, Kirikkale, Turkey.
| | - Ugur Horoz
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Mustafa Durgun
- Plastic, Reconstructive and Aesthetic Surgery Department, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Ali T Tellioglu
- Plastic, Reconstructive and Aesthetic Surgery Department, Yildirim Beyazit Faculty of Medicine, Ankara, Turkey
| | - Bilgihan Acikgoz
- Pathology Clinic, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
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Tempark T, Wu T, Singer C, Shwayder T. Dermatological complications of circumcision: lesson learned from cases in a pediatric dermatology practice. Pediatr Dermatol 2013; 30:519-28. [PMID: 23683078 DOI: 10.1111/pde.12140] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We discuss 11 cases of boys who presented with dermatologic complications of circumcision in an outpatient pediatric dermatology clinic. A medical practitioner had previously circumcised all patients during the newborn period. The majority of cases were found incidentally during initial thorough dermatologic examination. Late cutaneous complications included penile skin bridge, glandular adhesion of remnant foreskin, concealed penis, and a penile epidermal inclusion cyst. Minor surgical procedures under local anesthesia were performed in all but two cases. These cases should help dermatologists recognize the common late cutaneous complications of male newborn circumcision and provide insight into potential options for early intervention and management.
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Affiliation(s)
- Therdpong Tempark
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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11
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Combined treatment of penile keloid: a troublesome complication after circumcision. Asian J Androl 2013; 15:575-6. [PMID: 23584379 DOI: 10.1038/aja.2013.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 01/31/2013] [Accepted: 03/06/2013] [Indexed: 11/09/2022] Open
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