Clinical Report: Can red tattoos harbor keratoacanthoma?

Overview

A case report described a keratoacanthoma arising within red pigment in a recently placed forearm tattoo in a 61-year-old woman. The authors also cited 42 previously reported tattoo-associated keratoacanthomas and squamous cell carcinomas, 75% of which arose in red pigment; these reports do not establish incidence or causation.

Background

Keratoacanthoma is a squamous lesion that can be difficult to distinguish from cutaneous squamous cell carcinoma. Tattoo-associated cases have been reported, with a predominance in red pigment in the cited case literature. The reason for this pattern is incompletely understood; degradation of red azo pigments has been proposed as a possible contributor, but the mechanism has not been established. The current report concerns one patient and provides no comparative data or longitudinal follow-up.

Data Highlights

Key Findings

• A 61-year-old woman presented with a rapidly growing, solitary 8-mm crateriform nodule within the red pigment of a forearm tattoo placed 2 months earlier.
• The lesion had a central hyperkeratotic plug, and excision showed histopathologic features consistent with keratoacanthoma.
• Histopathologic examination demonstrated red tattoo pigment deposits within the tumor epithelium.
• The authors identified 42 previously published tattoo-associated keratoacanthomas and squamous cell carcinomas; 75% arose within red pigment.
• The reported red-pigment proportion combines keratoacanthomas and squamous cell carcinomas and does not establish a keratoacanthoma-specific association or causal relationship.
• The authors described surgical excision as first-line treatment for solitary keratoacanthomas; the case report did not include longitudinal follow-up.

Conclusion

This case adds to reports of keratoacanthoma and squamous cell carcinoma arising in tattoos, often in red pigment. The available case-based evidence does not establish incidence, causation, or a mechanism.

Related Resources & Content

1. Jackson EK et al., Skin Health and Disease, 2026 -- Keratoacanthoma in a red tattoo
2. European consensus-based interdisciplinary guideline, 2026 -- European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma. Part 1: Diagnostics and prevention - Update 2026
3. ASCO Publications — Actinic keratosis as a premalignant lesion: Systematic review and meta-analysis of topical field–directed therapy versus vehicle/placebo.
4. Ophthalmology Management — PEARLS FOR ACANTHAMOEBA KERATITIS
5. the new optometrist — Warning Coloration
6. ASCO Publications — Presence of frequent underlying RAS mutations in cutaneous squamous cell carcinomas and keratoacanthomas (cuSCC/KA) that develop in patients during vemurafenib therapy.
7. Keratoacanthoma in a red tattoo
8. European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma. Part 1: Diagnostics and prevention - Update 2026
9. European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma. Part 1: Diagnostics and prevention - Update 2026
10. Keratoacanthoma in a red tattoo
11. Adjuvant Cemiplimab or Placebo in High-Risk Cutaneous Squamous-Cell Carcinoma