For Marcus, the treatment discussion reaches a difficult point: what happens when a keloid has become too large for steroid injections to flatten it? In this Baldcast chapter, Dr. Sanusi Umar explains that removal itself is only part of the problem. The larger challenge is reducing the risk that the keloid returns after surgery.
When Steroid Injections May Not Be Enough
Dr. Umar explains that when keloids reach the size shown in Marcus’s case, steroid injections are not expected to flatten them. At that stage, he says surgery is required. The discussion places the size of the keloid at the center of the treatment decision rather than presenting injections as a solution for every case.

Removal Is Only One Part of Keloid Surgery
Dr. Umar says the central problem with keloids is not simply removing them. He notes that tissue can be removed using different surgical methods, including a knife or scalpel, electrocautery, or laser. The more difficult issue comes afterward: preventing the keloid from coming back.
That distinction matters in a severe case. The procedure can address the existing growth, but Dr. Umar emphasizes that recurrence is the major challenge that must be considered when planning treatment.

Why Recurrence Can Make Surgeons Hesitate
According to Dr. Umar, the difficulty of preventing recurrence is why many surgeons may not want to take on a patient with a keloid of this severity. His explanation shifts the question from whether the growth can be cut away to how the case should be managed with recurrence in mind.
For people dealing with a Keloid or bumps on the back of the head, this chapter illustrates why evaluation and treatment planning need to account for the individual case. It does not show Marcus’s later outcome or make a prediction about what happens next.
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Medical Disclaimer
This article is for educational purposes only and does not replace individualized medical advice, diagnosis, or treatment. Keloid treatment should be based on evaluation by a qualified healthcare professional. Individual cases and outcomes vary.
Further Reading
- https://dru.com/marcus-new-chapter-keloid-family-support/
- Umar, Sanusi, et al: Patient Selection Criteria and Innovative Techniques for Improving Outcome and Cosmesis in Acne Keloidalis Nuchae Lesion Excision and Primary Closure. JAAD Case Reports; vol. 5, no. 1, 2019.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6280636/



