Keloids and hypertrophic scars present a major therapeutic dilemma to the dermatologist because of frequent recurrences. A better understanding of keloid pathogenesis may lead to improved therapies by which keloid growth and regrowth may be obviated. Although optimal treatment for keloids remains undefined, successful treatment can be obtained through a multimodality approach. Regardless of the technique employed, an observation period of at least 2 years is necessary to rule out recurrence.