Mohs Micrographic Surgery for a Red Tattoo Reaction

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Tattooing can result in an array of cutaneous reactions. Previous reports include allergic, photosensitive, infectious, granulomatous, lichenoid, pseudolymphomatous reactions and the development of neoplasms in areas of tattoos. In decorative tattooing, insoluble pigment is placed in the dermis using needles to create different designs. In cosmetic tattooing, pigment is placed to define and delineate the lips, eyes, and other areas to enhance the appearance of a patient. Herein, the authors focus on the development of pseudoepitheliomatous hyperplasia (PEH) and squamous cell carcinoma (SCC) in tattoos. Interestingly, the majority of previously reported cases of PEH or SCC arising in tattoos have been associated with red ink. It is also important to note that PEH and SCC may be difficult to histologically differentiate. The authors report a case of PEH and SCC arising within the red ink of a multicolored tattoo, successfully managed with Mohs micrographic surgery (MMS).
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