The patient presented with a large pedunculated keloid measuring approximately 2 cm in diameter, attached by a narrow stalk to the posterior surface of the upper helix. The lesion was deep pink with a vascular surface and projected well beyond the auricular silhouette. Treatment was complete excision at the base of the stalk under local anaesthesia, with careful re-approximation of the helical perichondrium and a layered skin closure aligned to the natural curve of the rim. The healed photograph shows the upper auricle restored to a smooth, flat contour with no perceptible scar from a normal viewing distance and full retention of the helical shape. Performed by Dr. Pongsak at Pongsak Clinic, Hua Hin Road 55.