For severe cases, the keloid can surgically excised and given x-ray treatments to the site immediately afterwards, usually the on the same day. This works in about 85% of the most severe cases. Electron beam radiation can be used, which will not go deep enough to affect internal organs. Orthovoltage radiation is more penetrating and slightly more effective. There have not been any reports of this causing any form of cancer in many years of use, but it is very expensive. Silicone pads and creams are sold over the counter for use on keloids. These do benefit hypertrophic scars but will not cure a true keloid. However, they can reduce pain, swelling and itching from a keloid. They usually take 3 months or more to work.
As others have noted, effective treatment of keloids can be very difficult. The reason for this is that keloids are an abnormal response to injury, and area of scar tissue that grows beyond its natural boundaries. On examination of a piece of Keloid tissue under a microscope, it looks substantially different than the average scar. The initial phase of treatment is to slow the inflammation, ergo the use of several spaced injections. The next option is to excise the scar surgically (50% recurrence rate) or to treat with radiation. After excision, the area can be radiated and/or re-injected with steroid. Some Surgeons advocate placement of topical mitomycin and/or topical 5 flurouracil at the time of excision. Despite all of these options, keloids can and do recur.