Giant condyloma acuminatum or Buschke-Lowenstein tumor has been reported to involve many areas about the perineum. The majority of previous documentations have implicated the coronal sulcus, prepuce, and fossa navicularis of the penis as the most likely foci to support growth. Authors have contributed multiple cases of perianal and rectal involvement as well as rare reports of inguinal, bladder, and endocervix-low uterine segment tumors. A case of giant condyloma acuminatum involving a chronic pilonidal sinus overlying the sacrum is described. Wide surgical extirpation was found to be a curative means of management.