OSCE — Keloids & Hypertrophic Scars

Brief (to candidate)

You will assess a patient with a presentation consistent with Keloids & Hypertrophic Scars.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Keloids and hypertrophic scars are fibroproliferative disorders of wound healing characterised by excessive collagen deposition in response to skin injury. The pivotal distinction: hypertrophic scars stay within the original wound boundaries and often regress spontaneously, whereas keloids extend beyond the wound margins into surrounding normal skin, do not regress, and recur after excision. Risk factors include darker skin (Fitzpatrick IV-VI, up to 15-fold higher risk), age 10 to 30, genetic predisposition, wound tension (chest, shoulders, upper back, jawline, earlobes), infection, burns, foreign body, and piercings. Diagnosis is clinical. First-line treatment is intralesional corticosteroi

Candidate tasks

1. Clarify onset, severity, associated features, and red-flag symptoms.
2. State focused examination priorities.
3. List first-line investigations and any named score/criteria.
4. Give immediate resuscitation steps.
5. Outline definitive management with doses/routes where standard.
6. Name complications and disposition (ward / HDU / theatre / discharge safety-net).
7. Mention one special-population modifier (pregnancy, child, elderly, CKD).

Examiner checklist

Model outline

Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.^[1]