Umbilical Keloid

A 3-month-old female infant presented with a mass in the umbilical area. During the neonatal period, an infection of the umbilical cord had resulted in the formation of exuberant granulation tissue at the base of the umbilicus. The granuloma pyogenicum so formed was cauterized with silver nitrate on several occasions. This resulted in the keloid seen here.

A sharply demarcated, benign, dense growth of connective tissue in the dermis, a keloid consists histologically of whorled and interlaced hyalinized collagen fibers. Keloids are usually induced by trauma and commonly follow ear piercing, surgical procedures, burns, and scalds. They are most common in dark-skinned persons.

Keloids should be differentiated from hypertrophic scars, which remain confined to the site of injury and gradually involute over time. In contrast, keloids usually outgrow the boundaries of the original insult; they also are more often pedunculated.

Keloids may be effectively treated with intralesional corticosteroids. Large lesions may require surgical excision followed by intralesional corticosteroid.