title: Tattoo granuloma of the eyelid mimicking carcinoma.
abstract: A 68-year-old woman was referred to the Oculofacial Plastic and Reconstructive Surgery service for evaluation of a left upper eyelid lesion that was worrisome for carcinoma. The mass measured 8 × 8 mm; it was well-circumscribed, pink, and firm with distortion of the eyelid margin, central ulceration, and loss of the lashes. The patient denied previous surgery or trauma in this area, but she had a history of blepharopigmentation (tattoo eyeliner) of all 4 eyelids approximately 7 years prior. Incisional biopsy revealed inflammatory changes consistent with a localized reaction to the tattoo pigment granules. Local kenalog injection was attempted with improvement of the overall appearance but with persistent deformity including irregularity of the margin and loss of lashes. The persistent abnormal appearance was worrisome for an underlying carcinoma missed on the initial incisional biopsy and prompted a full-thickness wedge resection and reconstruction of the abnormal area. The results of biopsy of the excised tissue confirmed absence of malignant neoplasm and showed changes consistent with tattoo granuloma. Tattoo granuloma of the eyelid should be considered in the differential diagnosis of eyelid lesions worrisome for carcinoma in patients with a history of blepharopigmentation.
authors.affiliation: *Casey Eye Institute, Oregon Health & Science University; †Veteran's Affairs Medical Center; and ‡Departments of Dermatology, and §Pathology, Oregon Health & Science University, Portland, Oregon, U.S.A.
authors.forename: Carson R
authors.initials: CR
authors.lastname: Bee
authors.forename: Eric A
authors.initials: EA
authors.lastname: Steele
authors.forename: Kevin P
authors.initials: KP
authors.lastname: White
authors.forename: David J
authors.initials: DJ
authors.lastname: Wilson
mesh_terms: D000368:Aged; D004396:Coloring Agents / Q000009:adverse effects*; D003937:Diagnosis, Differential; D005141:Eyelid Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D005142:Eyelid Neoplasms / Q000175:diagnosis*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D015745:Granuloma, Foreign-Body / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D015552:Injections, Intralesional; D012878:Skin Neoplasms / Q000175:diagnosis*; D013653:Tattooing / Q000009:adverse effects*; D014222:Triamcinolone Acetonide / Q000627:therapeutic use
chemical_list: D004396:Coloring Agents; D005938:Glucocorticoids; D014222:Triamcinolone Acetonide