Keratoacanthoma occurring within the red dye of a tattoo

Abstract

Keratoacanthoma (KA) is a common keratinizing squamous cell neoplasm of unknown origin characterized by rapid growth and spontaneous involution. Trauma‐induced forms have been observed with various types of skin injury. To our knowledge, reports of KA arising at tattoo sites are scarce in the literature. A 41‐year‐old woman with no medical history presented for a rapidly growing nodule confined to the red part of a tattoo located on the scapula. Histology showed a keratin‐filled cuplike crater with an epithelial proliferation (hyperkeratosis, parakeratosis, no keratinocyte atypia). An inflammatory infiltrate in the dermis composed of lymphocytes and histiocytes intermixed with red ink‐related exogenous pigments was noted. Lack of papillomatosis and viral inclusions ruled out the diagnosis of viral wart, absence of granulomatous reaction ruled out deep fungal or mycobacterial infection and lack of cytological atypia and frank architectural abnormalities did not favour a squamous cell carcinoma. KA should be included in the list of cutaneous complications related to tattooing. Diagnosis can be challenging as differential diagnoses include pseudoepitheliomatous hyperplasia and squamous cell carcinoma. Removal of the entire area, thorough histological examination and careful follow up are mandatory.

CD1A-positive cells and HSP60 (HSPD1) levels in keratoacanthoma and squamous cell carcinoma

“…Epidemiological studies have indicated that risk factors for KA include sun exposure, chemical carcinogens, viruses, cutaneous infection, and trauma. KA has been reported to occur in sites of previous cryotherapy, topical photodynamic and UV therapies, megavoltage radiotherapy, split skin graft donor, excisional surgery scars, and tattoos (Swaw et al 1990 Kluger et al 2008). Many of these procedures are considered to cause local stress that induces Hsp60 overexpression (Jalili et al 2004;Singh et al 2009;Henderson 2010).…”

Skin Cancers Arising in Tattoos: Coincidental or Not?

“…Trauma, scars or cutaneous chronic inflammation have sometimes been found as underlying the development of BCCs [2, 3], SCCs [4] and KAs [21]. In the latter, trauma seems specifically to be a crucial triggering factor as most cases occurred within the first year after tattooing [14, 15, 18, 19]. Only in one case did KA occur 9 years after tattooing [17].…”

“…Tattooing is a traumatizing procedure characterized by the introduction of exogenous pigment in the dermis by puncturing the skin. Even though cases of malignancies such as melanoma [1,5,6,7], basal cell carcinomas (BCCs) [8,9,10,11,12], squamous cell carcinomas (SCCs) [13, 14] and keratoacanthomas (KAs) [14,15,16,17,18,19] have been reported for the past 40 years, it remains unclear what role tattoos play in their pathogenesis. We report here 2 new cases and wish to discuss the arguments and counter-arguments for such a potential relationship.…”

Tattoo-Associated Skin Reaction: The Importance of an Early Diagnosis and Proper Treatment

“…Next to these inflammatory skin reactions we have to consider also the possibility of the development of cutaneous conditions such as pseudolymphomatous reactions [11] and pseudoepitheliomatous hyperplasia [12]. The evolution in neoplastic lymphoma [13, 14], squamous cell carcinoma, and Keratoacanthoma [15] is a rare outcome, since this neoplastic condition usually appears when they are fully evolved and not with “premalignant” condition. Despite that, it is mandatory to perform histological examination when we are in front of suspected papulonodular lesions arising from a tattoo.…”