Earlobe keloids are commonly encountered in dermatological practice and often prove to be recurrent, despite a variety of treatment options. Recurrent keloids, particularly in the head and neck, are associated with unsightly cosmetic consequences, particularly in younger patients. There is no consensus regarding the optimal treatment for recurrent keloids. However, re-excision accompanied by adjuvant treatment is often recommended. Low-dose fractionated radiotherapy (12 Gy in three fractions) delivered within 24 hours of excision remains an effective adjuvant option, although due consideration needs to be given to the small risk of radiation-induced malignancy. We aim to discuss the role of adjuvant radiotherapy for recurrent keloids and present the relevant literature.