Pilonidal sinus is a benign inflammatory disease characterized by fistulas with exudative discharge. This disease is commonly seen in areas rich in hair follicles that penetrate the skin under direct pressure such as the sacrococcygeal region in the predominantly male population. Pilonidal sinuses can be transformed to malignancies in untreated, chronic conditions. Squamous cell carcinoma (SCC) is the most reported malignant alteration of pilonidal sinus with 20 years of mean onset. We present a SCC case with 35 years of unhealed pilonidal sinus history.
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