Extraspinal ependymomas are rare. The majority occur in the sacrococcygeal region. The subcutaneous variety accounts for approximately two thirds of cases, which are commonly misdiagnosed as a pilonidal cyst or sinus. Treatment is complete surgical resection. The role of coccygectomy is controversial. Adjuvant radiotherapy is of benefit to those with an incompletely excised tumour. Up to 20% metastasise, chiefly to the inguinal lymph glands, but pulmonary metastases are also reported. Palliative chemotherapy has not been shown to be of any benefit. Long term follow-up is important as metastases can occur up to 20 years after initial presentation. We report a 37-year-old woman with a subcutaneous sacrococcygeal ependymoma with iliac lymph nodal metastasis at presentation.