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 by either intralesional
or extralesional excision. There has been no consensus regarding the optimal treatment for reducing recurrence and complications.

Objective: 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, from April 2018 to April 2020.

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

Conclusion: There was no difference in the outcome of keloid excision between the two treatment modalities. We concluded that both modalities can be utilized in managing keloids. Further research should be done to compare both treatment methods with other adjunct therapies, such as steroids and cytotoxic agents.

Key words: Keloids excision intralesional extralesional recurrence