<prompt> Most appropriate management of Recurrent Keloid is?Excisional surgeryIntramarginal excision followed by radiationCryosurgerySilicone gel sheeting  <response>: Treatment: Keloids rarely regress with time, often refractory to medical and surgical intervention First line treatment: silicone in combination with pressure therapy and intralesional coicosteroid injection Refractory cases after 12 months of therapy: excision post op radiotherapy external beam or brachytherapy New treatment modalities: internal cryotherapy and 5 imiquimod 