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Malignant degeneration of pilonidal cysts
K A Davis1, C N Mock, A Versaci
1Department of Surgery, Rhode Island Hospital, Brown University School of Medicine, Providence.
The American Surgeon
|March 1, 1994
Summary
Malignant degeneration is rare in pilonidal disease, with squamous cell carcinoma being most common. Adjuvant chemotherapy and radiation may reduce local recurrence rates in these long-standing cases.
Area of Science:
- Oncology
- Dermatology
- Surgical Pathology
Background:
- Pilonidal disease, a chronic condition affecting the sacrococcygeal region, rarely undergoes malignant transformation.
- Malignant degeneration in pilonidal disease is an uncommon but serious complication.
Observation:
- The study reviewed 44 cases of malignant degeneration in pilonidal disease, including 3 new cases and 41 previously published.
- Squamous cell carcinoma was the predominant histology, accounting for 36 of 44 cases.
- Malignant changes were associated with long-standing pilonidal disease, averaging 23 years of antecedent disease duration.
Findings:
- Inguinal metastases were observed in six patients, with five dying within 16 months.
- Treatment modalities included adjuvant radiation therapy, chemotherapy, or both.
- Six patients with recurrence underwent curative resection, with three achieving long-term disease-free survival (>10 years).
Implications:
- The findings suggest that adjuvant chemotherapy and radiation therapy warrant consideration as a novel approach to decrease local recurrence rates.
- Early recognition and aggressive management are crucial for improving outcomes in malignant degeneration of pilonidal disease.