Management of Squamous Cell Carcinoma in a Chronic Sacrococcygeal Pilonidal Cyst: A Case Report
2020
Introduction: Pilonidal disease is a chronic inflammatory process resulting from impaction of natal cleft
hair into the subcutaneous tissues creating an abscess or a draining sinus over the sacrococcygeal area.
Malignant transformation occurs in around 0.1%, mainly into squamous cell carcinoma (SCC) type. Wide
excision with tumor-free margins remains the treatment of choice. Multiple closure techniques were settled
and the best one ought to be chosen in a context malignancy and future radiological treatment.
Case Presentation: We describe the management of a case of a 69-year-old male with chronic pilonidal
disease, recurrent after 25 years found on final pathology to undergo malignant transformation into SCC.
Wide and aggressive excision were performed with new margins and with periosteal excision of the sacrum
and coccyx. rotational myocutaneous gluteal flap was done for closure of the wound in order to ensure better
satisfactory esthetic results without a delay in future treatment.
Conclusion: The progression of a chronic pilonidal disease into SCC is a rare but serious complication. The
diagnosis is confirmed by biopsies. Workup for metastasis should be made before aggressive surgical
excision. Oncoplastic surgeries is recommended for satisfactory results. Routine follow-up postoperatively
should be considered due to high rate of recurrence by physical examination and imaging.
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