In his most recent publication, Neck Keloids: evaluation of risk factors and recommendation for keloid staging system" Dr. Tirgan has designed a staging system that allows for proper categorization and grouping of keloid patients into various stages. It is common sense that a patient with only one small keloid lesion will have a different outcome than one who has numerous large keloid lesions.Staging systems have been used in management of cancer patients. It is common sense that a patient with very small, stage one breast cancer will have a different outcome from patients with metastatic, stage four breast cancer. Dr. Tirgan, in devising his #Keloid Staging System has followed the same methodology that is utilized in staging cancers. TNM cancer staging system has been used for several decades and allows proper stage grouping of cancer patients. A great majority of caner treatments, clinical trials, and standard treatments are guided by the TNM staging of the cancer at any given time. Conduct and interpretation of the result of oncology clinical trials are virtually dependent on this staging system. Without such a staging system for Keloid Disorder, the interpretation of all published keloid study results is very difficult. For example, when a study looks at the rate of recurrence of ear keloids after surgery, common sense tells us that patients who only have one keloid on one ear, will have a different rate of recurrence from those who have numerous keloids on their skin. Also, those who have had prior surgical removal of their keloids will have a much higher rate of recurrence than those patients who have never had surgery before. To assess each keloid patient properly, to better understand the natural history of this disorder, and to be able to compare future keloid study results among various patients groups, we clearly need a staging system that can allow us to describe the severity keloid disorder based on the size, location and/or extent of the keloidal lesions; as well as history of surgery or radiation therapy, and perhaps other factors that are currently unknown to us. It is quite conceivable that proper management of keloid patients could be guided by such a staging system. Dr. Tirgan's staging system for keloid disorder is a method that can stratify for such preexisting inherent risks of recurrence, such as response to prior treatments, positive family history, age, gender, race, and so forth. A well-designed clinical staging system will need to be validated by review of retrospective studies as well as planned prospective clinical trials. Dr. Tirgan is leading the efforts to refine this staging system. KRF invites collaborations to implement and refine this proposed staging system.