Cranial fasciitis is a rare variant of nodular fasciitis of childhood, a benign condition cured by surgical excision. Recently, spontaneous involution has been reported and a ''watch and wait'' approach was recommended. We report an instance of a congenital cranial fasciitis that grew rapidly during a 10-month follow-up after fine needle aspiration and incisional biopsy. Conservative surgical excision was curative with no recurrence over a follow-up period of 4 years. Therefore, we recommend that early excision may be necessary in lieu of a ''watch and wait'' approach for large, rapidly growing cranial fasciitis.