A report describes a 27-year-old man of African descent who came to the radiotherapy clinic with a 5-year history of a recurrent 15 × 8 × 4 cm keloidal tumor (i.e., acne keloidalis nuchae) on his posterior neck. He received previous unsuccessful treatments with systemic isotretinoin, antibiotics and surgical excision without adjuvant radiotherapy, and he was ineligible for re-excision, given the lesion size. The appearance of the lesion made him minimize social contact, further affecting his ability to work.

He underwent definitive radiotherapy using volumetric modulated arc therapy (35 Gy in 5 weekly fractions) to reduce the keloidal tumor size. After radiotherapy, he needed regular wound care during the regression of the lesion and showed no recurrence at 19 months.

Acne keloidalis nuchae with mild presentations are curable with steroids, retinoids or antibiotics. Laser and light therapy help reduce the number or size of lesions. For fibrotic or persistent lesions, excision may be helpful; however, surgery alone may lead to a higher recurrence rate. Adjuvant steroids or radiotherapy may reduce the risk of recurrence after balancing against risks.

Source: Kwan JYY, Tsao M, Barnes EA. Hypofractionated radiotherapy to treat acne keloidalis nuchae. CMAJ. 2021;193(41):E1595.