Purpose: Vulval keloids are morbid conditions, with significant impact to patients due to pain, mobility, appearance and impact on intercourse and micturition. Limited reliable therapies are described, especially when disease is recurrent. We present a case of recurrent vulval keloids managed with excision, local flap coverage and adjuvant radiotherapy. Methodology: A 40 year old female of east Asian descent presented with extensive keloids to her mons, clitoral hood, left vulva and lower abdomen, symptomatic with pain, itch and impaired mobility. Her disease had been present 20 years related to underlying hidradenitis suppurativa and C-section scars. The perineal disease measured 7x16cm, the C-section keloid measured 23cmx2cm. Her keloids recurred weeks after prior excisions and did not respond to corticosteroid injections. She underwent resection and the vulva and clitoral hood were reconstructed with a bilobed flap from the mons, and an infra-umbilical abdominoplasty was used to close her superior wound line. 19Gy superficial external beam radiotherapy was given in 4 fractions in the initial 48hours post-op. Results: The patient healed without complication. The patient did not experience local radiotherapy toxicity. At 6 months post-op there was no recurrence of keloids. Her pre-operative pain, itch and mobility issues had resolved and her quality of life dramatically improved. Conclusion: This case presents a potential solution to this problematic clinical scenario, and should be considered in similar cases, particularly in recurrent disease.