First metatarsal head OATS technique: an approach to cartilage damage.

BACKGROUND Proliferating trichilemmal cysts, also referred to as pilar cysts, are benign adnexal tumors in the scalp diagnosed most commonly in middle-aged women. The cysts can be large and require careful surgical resection, as malignant variants can exist. Although uncommon, it is rare for these tumors to reach large sizes. This report describes a 69-year-old woman with an occipital giant proliferating trichilemmal (pilar) cyst treated with surgical resection and flap reconstruction. CASE REPORT A 69-year-old female patient presented with a slowly growing mass in the occipital region of the head, which had been present for 11 years. The mass exhibited areas of hyperkeratosis and an unpleasant odor. The tumor was first excised with electrocautery to minimize bleeding during removal. We initially attempted to repair the defect using a local rotation skin flap. Although this approach provided some coverage, it quickly became clear that the available tissue would not be enough. As a result, we decided to supplement the repair with a supraclavicular artery island flap to ensure adequate closure. CONCLUSIONS This case highlights how crucial it is to combine thorough clinical evaluation, imaging, and histopathological analysis when dealing with proliferative pilar tumors. In this instance, we successfully removed a large tumor located in the occipital region of a 69-year-old woman. The diagnosis was later confirmed histologically as a benign proliferative pilar tumor. Regular follow-up is essential to ensure the absence of recurrence and to address potential future complications.