Keloid scarring or disease: unresolved quasi-neoplastic tendencies in the human skin

Keloids are benign fibroproliferative dermal scars of unknown aetiopathogenesis resulting in an exophytic protuberant growth with persistent and progressive perilesional expansile behaviour. Keloids are likened to benign neoplastic lesions due to their aggressive clinical behavior, genotypic-phenotypic tissue-characteristics and resistance to treatment. Keloids are traditionally viewed as scars on the healing spectrum, however keloids are a distinct pathology provoked by cutaneous injury rather than a continuum. In order to elucidate the aetiopathogenesis of keloids, the distinction between scar and disease must be made. Therefore, we hypothesize that the link between keloids and their quasi-neoplastic tendencies distinguish it as a disease rather than a scar alone. The biomarker expression profile in these diseases highlights the striking parallels between keloids and both benign and malignant mesenchymal tumors. Signaling pathways common to these diseases have been found to guide the matrix composition of keloids. This hypothesis underscores the need to identify keloids as a disease in order to develop targeted therapy, which can lead to enhanced diagnosis and theranosis.