Rationale: Giant keloids often have indications for surgical resection, but postoperative reconstruction of the skin and high recurrence of keloids are a challenge for clinical treatment. This article reports a rare successful treatment of a giant keloid in the anterior chest wall by multistage surgery combined with radiotherapy, which is why this case is meaningful. Patient concerns: A 66-year-old woman presented a giant keloid with ulcerations and severe itching on the anterior chest wall. She had a history of keloid disease for more than 10 years, and had been treated by multiple operations, with no success. Diagnoses: The patient was diagnosed as keloid based on her history and symptoms. Histopathology findings supported our diagnosis. Interventions: We successfully excised the keloid after 5 operations and 2 rounds of electron-beam radiotherapy, which was applied at 24 hours after the 4th and 5th operation. Outcomes: There was no sign of recurrence over the follow-up period of 24 months. Lessons: The combination of multistage surgery and radiotherapy presents as a good choice for the treatment of giant keloids.