“It keeps growing back bigger every time someone treats it — can you just get rid of it?”

KELOID scarring is scar tissue that grows BEYOND the boundary of the original wound, often itchy or tender, with a strong predilection in people with darker skin (African, Caribbean, Asian heritage) and at sites such as the chest, shoulders, upper back, earlobes and jawline — distinguished from a HYPERTROPHIC scar, which stays within the wound margins and tends to regress. The central, examinable honesty is that simple surgical EXCISION ALONE has a high recurrence rate and can make a keloid worse/larger (because the fresh wound itself keloids), so the natural request to "just cut it off" must be addressed directly rather than agreed to; any surgery must be combined with adjuvant therapy (intralesional steroid, pressure, selected radiotherapy) under specialist care. Realistic options are control-focused: intralesional corticosteroid injections (± cryotherapy) to flatten/soften and reduce itch — with side effects of skin thinning and hypopigmentation that are more visible on darker skin — silicone gel/sheets, and pressure devices (e.g. pressure earrings), often combined with each other or with specialist excision (BAD keloids leaflet, 2017) — with the explicit expectation that the aim is control, not guaranteed cure, and that recurrence is common. Give prevention advice for a keloid-prone individual (avoid non-essential trauma/piercings on prone sites, treat new lesions early, silicone/pressure after wounds) without blame, and refer to dermatology (± plastics for selected earlobe keloids). Throughout, handle the consultation with cultural sensitivity — keloids disproportionately affect people with darker skin — and take the cosmetic and emotional impact (here, an upcoming wedding and self-consciousness) seriously, communicating honest limits with empathy rather than minimising or over-promising.