A 76-year-old woman consulted because of tumor and pain in the buttock. US showed a 3.5 cm diameter cystic tumor in subcutaneous tissue, seemed to be atheroma. We tried to remove the tumor through percutaneous procedure, but it continued from retroperitoneal space to beside the sacrum. The operation was done as a partial excision. Histopathological findings showed an epidermal cyst. CT suggested a congenital cystic tumor in presacral space. We diagnosed this cystic tumor as a presacral epidermoid cyst. Presacral epidermoid cyst is a rare tumor occurs in the presacral space. It rarely becomes malignant or infected. Presacral epidermoid cyst should be treated by operation with general anesthesia. Most of cases were reported by gastroenterological surgeon. We report this case to inform dermatologists about this tumor as a differential diagnosis of cystic tumor in the buttock.

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