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We often encounter injuries caused by pencils or colored pencils in toddlers and young children, but subsequent segmental tumor formation is rare. Here we report the case of a 4-year-old boy who had been stabbed under his left eyebrow with a red pencil. Colored pencil-core granuloma, a foreign body granuloma arising from an injury with a colored pencil, was diagnosed on the basis of intraoperative and histopathologic findings. Because of the severe tissue damage that the colorant causes, this type of tumor grows rapidly within a few days and may be accompanied by resorption of the skull if it occurs on the head or face.

Key Clinical Message Although rare, ectopic salivary gland fistula should be considered in the differential diagnosis when treating a fistulous lesion on the neck because its natural history and the level of difficulty of surgery are different from those of the branchial fistula.