Keloids form most often among young and dark skinned people, but others may also share a genetic disposition to form the overgrown scars. Similar to other types of scar tissue, keloids usually require medical treatment in order to improve their appearance, although there are documented cases of them diminishing in size on their own. However, not all people believe that keloids should be removed. In some cultures, the raised scars are created deliberately through controlled burning and cutting of the skin. This custom is often religious in nature and may serve as a rite of passage, signifying status of members within the group.