Background
Keloids are dermato-fibroproliferative skin disorders that extend beyond the original wound and are often characterized by benign overgrowth in response to skin injury. Surgical management of keloids has been performed through either intralesional or extralesional excision, but there has been no consensus regarding the optimal treatment for reducing recurrence and complications.

Objective
The aim of this study was to determine the outcome of keloids managed with intralesional or extralesional excision followed by post-excision superficial radiotherapy.

Design
This was a comparative study.

Setting
Department of Surgery, Kenyatta National Hospital, University of Nairobi, Kenya.

Subjects/Participants
Patients with keloids managed in the Department of Surgery, Kenyatta National Hospital, between April 2018 and April 2020.

Results
A total of 90 patients with 104 keloids were managed during a two-year prospective study. Of these, 56 keloids were operated on in the intralesional group and 58 in the extralesional group. The post-surgery pruritus score after one year of follow-up was 1.98 in the intralesional group and 1.86 in the extralesional group. The recurrence rate was 21% in the intralesional group and 18.9% in the extralesional group. Overall, patient satisfaction was high.

Conclusion
There was no significant difference in the outcome of keloid excision between the two treatment modalities. Both intralesional and extralesional excision can be utilized in managing keloids. Further research should compare these methods with other adjunct therapies, such as steroids and cytotoxic agents.