Pilonidal Carcinoma

Is this something I need to worry about?

Often patients ask if they need to worry that untreated pilonidal cysts or sinuses will turn into cancer. The short answer is “probably not”. But there are some things to consider, and if this is something that you are concerned about, here are some facts of which you should be aware.

• The incidence of carcinoma developing from pilonidal disease is very rare. The actual incidence is not really known, but I have not seen a case of this in 30 years.
• When cancer develops it is usually in a patient who has had untreated pilonidal disease for several decades, typically around 25 years.
• It is believed that prolonged chronic inflammation predisposes to malignant degeneration. But not all patients with untreated pilonidal disease for 25 years or more will develop cancer – so there may be a genetic predisposition for this to occur.
• When it turns into cancer, it is a skin cancer (and most often squamous cell carcinoma).
• Often, the appearance of pilonidal carcinoma is different than the usual findings with pilonidal disease, and your surgeon may suspect it based on physical examination.
• When we perform a cleft lift, the pilonidal disease is removed and always sent to the lab for examination. If there was a cancer present, it would be identified.

There are many reasons for a patient to decide to have surgery for symptomatic pilonidal disease, but in most situations any concern regarding the development of cancer should not really be part of that consideration.

The only times that it should be a factor is if the pilonidal disease has been present for over 20 years, or the physical findings are unusual. A patient should always be evaluated by a physician for a diagnosis, and to make sure that there are no visible abnormalities that could be cancer.