“…[90] • The average age of presentation is 49 with an average duration of pilonidal disease of 23 years (philipshen et al, 1981). [91] The process of malignant degeneration is similar in pilonidal squamous-cell carcinomas and other chronically inflamed wounds, such as burns, osteomyelitis, scars, skin ulcers and fistulas [92,83,84] Similar to other chronic ulcerative and scarifying cutaneous disorders, it is believed that the development of tumours due to pilonidal sinus is caused by the release of free oxygen radicals by activated inflammatory cells, inducing genetic damage and neoplastic transformation. [90] .Additionally, the normal repair DNA mechanism is impaired in chronic inflammation and predisposes patients to malignancy.…”