This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Wound Healing, Tissue Repair and Scar, Subject name: Surgery
Most appropriate management of Recurrent Keloid is? 
Select and explain. 
A. Excisional surgery, B. Intramarginal excision followed by radiation, C. Cryosurgery, D. Silicone gel sheeting
B: Intramarginal excision followed by radiation
Answer: B: Intramarginal excision followed by radiation 
Explanation: 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