Can red tattoos harbor keratoacanthoma?

A rapidly growing forearm nodule developed within weeks of tattoo placement, adding to previous reports of tumors arising in red pigment.

By
Andrea Surnit
November 6, 2026
2 min

MDSpire News

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

Measure	Finding	Source context
Patient age and sex	61-year-old woman	Single case report
Time since tattoo placement	2 months	Right forearm tattoo
Lesion history and size	Rapidly growing for 6 weeks; 8 mm	Solitary crateriform nodule with central hyperkeratotic plug
Histopathology	Features consistent with keratoacanthoma; red tattoo pigment was present within tumor epithelium	Excision specimen
Previously published tattoo-associated cases	42 keratoacanthomas and squamous cell carcinomas; 75% arose in red pigment	Both tumor types; not a new analysis in the case report

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.