Abstract

A 29-year-old male presented to the general surgery service for evaluation of suspected cysts that had arisen within areas of tattooed skin. These asymptomatic lesions had been present for over a year and affected areas of red tattoo ink. Histopathologic evaluation of three different lesions each demonstrated a psuedoepitheliomatous reaction with a brisk lichenoid infiltrate in association with red tattoo pigment. Cutaneous reactions to tattoo pigment are well described and can occur at a wide range of time points following placement of dye into the skin, most commonly following use of red tattoo dye. The reported histologic patterns are diverse and can range from lichenoid to granulomatous to sarcoidal, or, as seen in our case, psuedoepitheliomatous. Multiple patterns can be seen simultaneously in one specimen, with a lichenoid component being present in nearly all cases of the psuedoepitheliomatous variant. We report an additional case of psuedoepitheliomatous hyperplasia in response to red tattoo pigment. Dermatopathologists should be aware of this histologic mimicker of squamous cell carcinoma when evaluating biopsies from tattooed skin.

Financial Disclosure:
No current or relevant financial relationships exist.