Sternal Keloids

These firm, pink keloids were noted on the chest of a 29-year-old man. He reported that the slightly pruritic lesions had developed over the past year.

The sternal location is highly characteristic of keloids, although they can form anywhere. Other areas at increased risk for keloid formation include earlobes, beard area, upper back, and shoulders. Darker skin also predisposes to keloid formation, which—as in this case—can occur without the usual precipitating trauma.

Keloids represent excessive collagen deposition. They can be distinguished from hypertrophic scars with biopsy, which shows larger eosinophilic collagen fibers and more abundant mucin in true keloids. The other differentiating feature is that hypertrophic scars do not extend beyond the boundaries of the original traumatic wound, unlike keloids, which often take on bizarre shapes that bear no resemblance to the original wound.

This patient chose to leave his keloids alone. Had he elected treatment, there would have been a number of options including cryotherapy, intralesional injection with corticosteroids, and surgical excision followed by periodic corticosteroid injections. Radiation therapy has also been used with mixed results. ■