Does keloid history nix earrings forever?

DEAR DR. ROACH: Around 4-6 years of age, I got the chickenpox and, of course, had a lot of itchy bumps on my body. One bump in particular did not heal right; I scratched it so much that it formed into a small (smaller than a dime) keloid on my inner thigh. This happened no place else.

This was confirmed by my former pediatrician, who also told my parents and I that I should never get my ears pierced.

Since then, I have never attempted to have anything pierced on my body nor get any tattoos.

I am now 30 and I was really wanting to pierce my ears. I have never had any major surgeries or huge cuts, so I’m not sure how my skin will react if I decide to get my ears pierced.

I played sports my entire life, so I have had floor burns, minor cuts and bruises, and a gash on my face without developing a keloid. I would really appreciate your insight. I’ve always wanted my ears pierced, but I also don’t want to risk my outer appearance changing because of a decision that could have been avoided.

ANSWER: Because of your previous keloid, you are going to be at higher-than-average risk for developing a keloid, but I can’t even offer a guess on what the likelihood might be of getting one. The advice not to get your ears pierced remains the most conservative option, and the only one to guarantee you won’t get a keloid from piercing.

However, if you choose to try piercing, I can offer some advice on how to minimize your risk. Keeping the area meticulously clean with alcohol and sterile cotton and never touching it with your bare hands are good ideas. Pressure earrings reduce the risk, but they need to be worn at least 16 hours a day for six to 12 months for maximum effectiveness. Age seems to be important: Getting ears pierced between age 11 and 30 may have lower risk.

DEAR DR. ROACH: I have a small but persistent scab on my thumb, and my primary care doctor referred me to a dermatologist. A biopsy showed squamous cell cancer and I was scheduled for Mohs surgery. A friend recommended I see a radiation oncologist. He told me the treatment with radiation would be a “piece of cake” and no surgery is necessary. He also advised that radiation would be easier than surgery for a person of my age (68). The dermatologist said the recurrence rate is higher for radiation than for surgery, but the radiation oncologist said that was “patently untrue.” Is there a correct answer?

ANSWER: Both surgery and radiation treatment are considered reasonable for squamous cell cancer on the skin. The recurrence rate in a large series of pooled studies was similar: 5.4 per cent for surgery and 6.4 per cent for radiation.

Radiation may have better cosmetic results. However, most authorities recommend surgery as the first choice for squamous cell cancer on the hand. Radiation can damage blood vessels, and the wear and tear on the skin of the hand makes it more likely to have skin breakdown with radiation.

Radiation should be avoided in people under 40 due to the risk of secondary cancers years later.

Readers may email questions for Dr. Roach to ToYourGoodHealth@med.cornell.edu.