Background <p>Thoracoscopic minimally invasive techniques have been applied in rib resection. Although they significantly reduce trauma compared with traditional thoracotomy, they still leave noticeable surgical scars on the lateral chest wall. The periareolar incision offers superior cosmetic outcomes compared with conventional incisions; however, its application in rib tumor resection has not yet been reported.</p> Case presentation <p>We report a case of thoracoscopic resection of the second rib via a periareolar approach. A 34-year-old male presented with a mass in the right second rib detected during a routine physical examination. PET-CT revealed osteolysis with increased FDG uptake (SUVmax 11.7), suggestive of a primary bone tumor. The patient underwent thoracoscopic rib resection using a Gigli saw through a 2-cm periareolar incision combined with a 1-cm thoracoscopic port. The operative time was 110&#xa0;min, with an estimated blood loss of 30 mL. The chest tube was removed on postoperative day 3, and the patient was discharged uneventfully. Postoperative pathology confirmed Langerhans cell histiocytosis with negative margins. At the 4-week and 6-month follow-ups, the patient recovered well, was satisfied with the cosmetic appearance of the incision, and experienced no complications.</p> Conclusions <p>Thoracoscopic rib resection via the periareolar approach is safe and feasible. This technique significantly improves cosmetic outcomes, reduces surgical trauma, and may serve as a new option for rib resection.</p>