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Background: Venous malformations (VMs) are slow-flow vascular anomalies present at birth that enlarge during adolescence, subsequently causing thrombosis, hemorrhage, and pain. Case presentation: We describe a case of an adolescent male presenting with a large scalp venous malformation. Given the size and location of the lesion, a hybrid approach employing both sclerotherapy and surgical resection was utilized. The VM was successfully removed without complication. Conclusion: A hybrid approach is a safe and effective treatment consideration for immediate management of large venous malformation in higher-risk locations. [ABSTRACT FROM AUTHOR]