Published 2026-10-30
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Abstract
Introduction: Malignant degeneration of pilonidal disease is an extremely rare complication, estimated at 0.17% of cases, with squamous cell carcinoma representing 94.6% of malignant transformations. Basal cell carcinoma (BCC) arising from a pilonidal cyst is an exceptional entity with no published case series.
Objective: To report a case of invasive mixed-type basal cell carcinoma arising from a chronic sacro-coccygeal pilonidal cyst.
Case report: A 61-year-old male with chronic sacrococcygeal pilonidal cyst underwent complete surgical resection with bilateral VY flap reconstruction. Biopsy revealed an invasive mixed-type BCC, nodular, nodulo-cystic and adenoid patterns, pigmented, arising from the pilonidal cyst wall, with free surgical margins. Staging workup showed no metastatic disease. The patient had a favorable outcome with complete wound healing at one month.
Discussion: Pilonidal BCC is not represented as an independent entity in published pilonidal carcinoma series, evidencing its exceptional rarity. Diagnosis relies exclusively on histopathological examination. Complete resection with free margins is the treatment of choice.
