Earlobe keloids are a challenging management problem. These benign, fibrous proliferations develop in predisposed persons at sites of cutaneous injury or as the result of ear piercing, burns or surgical procedures. Earlobe keloids usually appear as shiny, smooth, globular growths on one or both sides of the earlobe. Patients frequently complain of cosmetic embarrassment, but also may report pruritus, pain or paresthesias. No single therapeutic modality is best. The location, size, depth and duration of the earlobe keloid influence the choice of therapy. Surgical treatment for earlobe keloids generally includes core excision with low-tension wound closure, and shave excision. Surgical repair with corticosteroid injections and postoperative pressure on the incision site usually provide good cosmetic results. Patients must be counseled about recurrence, palpable postoperative nodules and the need for close monitoring.