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This patient presented with a tender scalp bump that had been there for 20 years slowly growing. Today was its last day on earth. Surprisingly large sac removed and dissected on tray. Pilar cysts are a common thing we see and are derived from the outer root sheath of the hair follicle. Commonly, as they grow they put pressure on the hairs above them causing the hairs to stop growing and as you can see a bald spot appears. Hair will start growing again once the pressure is relieved. Thanks to my patient for sharing his procedure. Large scalp bump. Excision and closure. Horizontal mattress stitch. Tissue eversion. Large sac under skin. Dermatology procedure. Dermatology Physician Assistant. MrPopZit.