Pilomatrixoma is a benign skin tumor arising from the matrix of a hair follicle that is typically small and slow growing. Giant variants larger than 5 cm, especially in the cervical region, can mimic malignant masses clinically and radiologically. A 29-year-old man developed a solitary, firm subcutaneous mass approximately 6 cm in the left anterior cervical region that rapidly enlarged over 6 months without pain or systemic symptoms. Contrast-enhanced CT showed a well-defined heterogeneous subcutaneous lesion without muscle or vascular invasion. Core needle biopsy supported the diagnosis of pilomatrixoma, and the mass was completely excised under intravenous sedation and local anesthesia. Histopathology confirmed basaloid cells, shadow cells, and foreign body giant cell reaction. At one-year follow-up, the patient was disease-free with an excellent scar result. Complete surgical excision results in minimal morbidity and avoids overtreatment.