Patient, Lesion, and Surgical Predictors of Keloid Recurrence After Excision: A Systematic Review

Abstract

Keloid recurrence after surgical excision remains a significant clinical challenge due to its multifactorial nature involving patient susceptibility, lesion characteristics, and perioperative factors. This systematic review aimed to identify and synthesize prognostic factors associated with keloid recurrence following surgical excision. The review was conducted according to the PRISMA 2020 guidelines, including primary human studies published from January 2020 to September 2026. Relevant studies were retrieved from Scopus, PubMed/MEDLINE, Embase, Web of Science, and CENTRAL. Eligible studies included observational cohorts, case-control studies, and clinical studies reporting postoperative recurrence and prognostic factors. Risk of bias was assessed using the Quality In Prognosis Studies (QUIPS) tool, and findings were synthesized across patient, lesion, and surgical domains. The evidence indicates that recurrence risk is associated with multiple factors, including family history, age, lesion size, clinical activity, anatomical location, mechanical tension, postoperative infection, and wound-related complications. Lesion-related and perioperative factors demonstrated more consistent prognostic relevance than isolated systemic biomarkers. Postoperative therapies appeared mainly as treatment modifiers rather than intrinsic predictors of recurrence. This review provides an integrated prognostic framework by combining individual susceptibility, lesion characteristics, and modifiable surgical factors