Location Propensity for Keloids in the Head and Neck.

Importance: The difficulty associated with concealing keloids located in the face and neck regions often results in disfigurement and psychological stress for patients. Objective: The purpose of this review is to determine if specific regions on the head and neck have a greater propensity to develop keloids to alert the facial plastic surgeon of regional keloid risk. Evidence Review: PubMed, Ovid, Cochrane, and Embase computerized searches were performed through January 2020. Two independent reviewers conducted data extraction following a predetermined protocol identifying 1445 keloid studies. Findings: The prevalence of keloids in different regions of the head and neck was evaluated among 1598 head and neck keloids in the final analysis. Three of nine studies evaluated keloids specific to the ear and described a combined 1194 ear keloids locations (53.0% lobule, 22.9% cartilaginous region, 0.3% both, and 23.7% unspecified). One study reported exclusively on 82 neck keloids 72% of which were located in the submental or submandibular region. The remaining five studies evaluated 322 head and neck keloids more generally and showed 70.2% ear, 9.6% unspecified, 6.5% peri-/postauricular, 5.6% beard area, 2.2% scalp/forehead, 2.2% chin, 1.6% lateral face, 1.6% neck, and 0.3% central face keloids. Conclusions and Relevance: The ear, periauricular regions, bearded facial regions, and submandibular and submental sites show the highest propensity for keloid development in the head and neck region. The lowest keloid risk occurred in the central face region. Risk factors in relation to facial and neck regions associated with the formation of keloids should be taken into consideration before performing elective procedures in keloid susceptible individuals.