Should a Tissue Cuff Be Preserved During Auricular Lobule Keloid Excision to Reduce Recurrence?

Keloids of the auricular lobule remain difficult to manage because recurrence is common after excision alone. Traditional surgical teaching has supported intralesional or "core" excision with preservation of a peripheral cuff of keloid tissue, based on the premise that avoiding injury to adjacent keloid-prone skin may reduce recurrence and allow lower-tension closure. More recent histopathologic and clinical studies challenge this approach, suggesting that residual keloid tissue, particularly the peripheral rim, may contain proliferative fibroblasts and profibrotic signaling associated with recurrence. However, concurrently, other recent systematic reviews suggest that core excision can achieve acceptable outcomes when combined with adjuvant therapy. Current evidence does not support a universal approach. For small to medium auricular lobule keloids, complete excision of clinically abnormal tissue with tension-minimized closure is reasonable. For large auricular lobule keloids, limited cuff-preserving core excision, staged serial excision, or stellate excision may be considered to minimize the risk of high-tension closure. Regardless of technique, postoperative adjuvant therapy, particularly serial corticosteroid injection, should be strongly considered.