Epidermal inclusion cysts are the most common cutaneous cysts. Numerous synonyms for epidermal inclusion cysts exist, including epidermoid cyst, epidermal cyst, infundibular cyst, inclusion cyst, and keratin cyst. These cysts typically present as nodules directly underneath the patient's skin, and often have a visible central punctum. They are usually freely moveable. The size of these cysts can range from a few millimeters to several centimeters in diameter. Though can occur anywhere in the body, cysts in retrorectal or coccygeal region is quite rare, particularly in adults. Here we present a case of large coccygeal epidermoid inclusion cyst in an elderly lady.