From the Research
The absolute percentage risk of developing squamous cell carcinoma (SCC) with chronic pilonidal disease is approximately 0.1% or less, as reported in the most recent and highest quality study 1. This rare malignant transformation typically occurs after decades of chronic, untreated pilonidal disease with persistent inflammation, drainage, and recurrent infections. The risk increases with disease duration, particularly in cases persisting for more than 20 years. Some key points to consider include:
- Patients with long-standing pilonidal sinuses that have been present for decades should be monitored for warning signs such as rapid growth, bleeding, pain, or changes in discharge patterns.
- The malignant transformation is thought to occur through a mechanism similar to other chronic inflammatory conditions, where persistent inflammation leads to cellular damage, dysplasia, and eventually carcinoma.
- While this complication is extremely rare, it represents one of the reasons why definitive treatment of pilonidal disease is recommended rather than allowing it to persist chronically.
- Early surgical intervention for pilonidal disease not only addresses symptoms but may also prevent this uncommon but serious long-term complication, as supported by studies such as 2 and 3.
- A multimodal treatment approach, including neoadjuvant radiotherapy and chemotherapy, as well as surgery with intraoperative radiotherapy, may be effective in managing SCC arising from pilonidal disease, as described in 1.