A patient develops a hypertrophic scar 3 months after a chest burn injury. Which of the following best distinguishes a hypertrophic scar from a keloid?

• A Hypertrophic scars are more common in dark-skinned individuals
• B Hypertrophic scars remain within the original wound boundary and tend to regress over time; keloids extend beyond the wound margin, rarely regress, and frequently recur after excision ✓
• C Keloids respond well to excision alone without adjuvant therapy
• D Hypertrophic scars have a higher rate of malignant transformation than keloids

Explanation

The defining distinction: hypertrophic scars remain confined within the original wound boundaries (do not invade surrounding normal skin), are raised and erythematous, and typically regress over 12–24 months. Keloids extend beyond the wound margin into surrounding normal skin (tumor-like), do not regress spontaneously, are more common in pigmented skin (Black, Asian, Hispanic), and recur in 45–100% after excision alone. Keloids require adjuvant treatment (intralesional steroids, silicone gel, pressure therapy, radiotherapy). Both have increased collagen deposition but differ in collagen organization and biological behavior.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.