{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T20:41:08Z","timestamp":1792269668413,"version":"4.4.0"},"reference-count":17,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Cutan Pathol"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Cutaneous adverse reactions associated with tattoos exhibit various histopathologic patterns, ranging from allergic or interface dermatitis to sarcoid\u2010like granulomatous inflammation. Immune checkpoint inhibitors (ICIs) are also well known to induce granulomatous cutaneous eruptions, usually with sarcoid\u2010like features. Interestingly, ICIs can enhance immune responses at previous antigen exposure sites, including tattoos. Herein, we report a case of a non\u2010caseating granulomatous tattoo reaction associated with red pigment in the context of ICI therapy. Histopathologically, the granulomas exhibited a tuberculoid architecture characterized by prominent peripheral lymphoplasmacytic inflammation rather than the relatively \u201cnaked\u201d granulomas more typical of sarcoidal reactions. This case highlights the morphologic heterogeneity of granulomatous reactions arising within tattoos during ICI therapy and underscores the complex interaction between host immunity, tattoo pigment, and immunotherapy. Awareness of this pattern may help prevent misclassification as cutaneous sarcoidosis or infection and guide clinical care for patients on ICIs who develop such granulomatous reactions.<\/jats:p>","DOI":"10.1111\/cup.70213","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T22:51:22Z","timestamp":1789080682000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Non\u2010Caseating Granulomatous Reaction to Red Tattoo Pigment in a Patient Receiving Immune Checkpoint Inhibitor Therapy"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-8538-0023","authenticated-orcid":false,"given":"Ashley","family":"Gochoco","sequence":"first","affiliation":[{"name":"Department of Pathology Beth Israel Deaconess Medical Center  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sushila A.","family":"Toulmin","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Dermatology Beth Israel Deaconess Medical Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Iriarte","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Dermatology Beth Israel Deaconess Medical Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua F.","family":"Goldsmith","sequence":"additional","affiliation":[{"name":"Department of Pathology Beth Israel Deaconess Medical Center  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"issue":"3","key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1586\/eci.10.10","article-title":"Cutaneous Complications Related to Permanent Decorative Tattooing","volume":"6","author":"Kluger N.","year":"2010","journal-title":"Expert Review of Clinical Immunology"},{"key":"e_1_2_10_3_1","first-page":"48","article-title":"Tattoo Complaints and Complications: Diagnosis and Clinical Spectrum","volume":"48","author":"Serup J.","year":"2015","journal-title":"Current Problems in Dermatology"},{"key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1111\/jocd.12149","article-title":"Granulomatous Reaction to Red Tattoo Pigment Treated With Allopurinol","volume":"14","author":"Godinho M. M.","year":"2015","journal-title":"Journal of Cosmetic Dermatology"},{"issue":"2","key":"e_1_2_10_5_1","first-page":"86","article-title":"Sarcoidosis on Tattoos: A Review of the Literature From 1939 to 2011","volume":"30","author":"Kluger N.","year":"2013","journal-title":"Sarcoidosis, Vasculitis, and Diffuse Lung Diseases"},{"key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1159\/000501590","article-title":"Tattoo Reactions Associated With Targeted Therapies and Immune Checkpoint Inhibitors for Advanced Cancers: A Brief Review","volume":"235","author":"Kluger N.","year":"2019","journal-title":"Dermatology"},{"issue":"1","key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1001\/jamaoncol.2021.4318","article-title":"Management of Cutaneous Immune\u2010Related Adverse Events in Patients With Cancer Treated With Immune Checkpoint Inhibitors: A Systematic Review","volume":"8","author":"Nadelmann E. R.","year":"2022","journal-title":"JAMA Oncology"},{"issue":"1","key":"e_1_2_10_8_1","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s40425-018-0323-0","article-title":"Granulomatous\/Sarcoid\u2010Like Lesions Associated With Checkpoint Inhibitors: A Marker of Therapy Response in a Subset of Melanoma Patients","volume":"6","author":"Tetzlaff M. T.","year":"2018","journal-title":"Journal for Immunotherapy of Cancer"},{"key":"e_1_2_10_9_1","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.ejca.2021.07.015","article-title":"Outcomes of Patients With Cancer and Sarcoid\u2010Like Granulomatosis Associated With Immune Checkpoint Inhibitors: A Case\u2010Control Study","volume":"156","author":"Cabanie C.","year":"2021","journal-title":"European Journal of Cancer"},{"issue":"5","key":"e_1_2_10_10_1","doi-asserted-by":"crossref","first-page":"e133","DOI":"10.1016\/j.chest.2015.10.082","article-title":"Nivolumab\u2010Induced Sarcoid\u2010Like Granulomatous Reaction in a Patient With Advanced Melanoma","volume":"149","author":"Danlos F.\u2010X.","year":"2016","journal-title":"Chest"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bcr\u20102016\u2010216217"},{"key":"e_1_2_10_12_1","first-page":"1","article-title":"Granulomatous and Systemic Inflammatory Reactions From Tattoo Ink: Case Report and Concise Review","volume":"8","author":"Bose R.","year":"2020","journal-title":"JCMS Case Reports"},{"key":"e_1_2_10_13_1","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2020.579523","article-title":"Case Report: Immune\u2010Related Toxicity During Adjuvant Treatment With BRAF Plus MEK Inhibitors in a Melanoma Patient","volume":"11","author":"Boutros A.","year":"2020","journal-title":"Frontiers in Immunology"},{"key":"e_1_2_10_14_1","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1111\/j.1473-2165.2009.00469.x","article-title":"Cutaneous Allergic Reactions to Tattoo Ink","volume":"8","author":"Kaur R. R.","year":"2009","journal-title":"Journal of Cosmetic Dermatology"},{"key":"e_1_2_10_15_1","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1111\/srt.12213","article-title":"Histopathology and Immune Histochemistry of Red Tattoo Reactions: Interface Dermatitis Is the Lead Pathology, With Increase in T\u2010Lymphocytes and Langerhans Cells Suggesting an Allergic Pathomechanism","volume":"21","author":"Hogsberg T.","year":"2015","journal-title":"Skin Research and Technology"},{"issue":"2","key":"e_1_2_10_16_1","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/j.jaad.2019.01.078","article-title":"Pigments in American Tattoo Inks and Their Propensity to Elicit Allergic Contact Dermatitis","volume":"81","author":"Liszewski W.","year":"2019","journal-title":"Journal of the American Academy of Dermatology"},{"key":"e_1_2_10_17_1","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1007\/s40257-017-0336-3","article-title":"Dermatologic Reactions to Immune Checkpoint Inhibitors: Skin Toxicities and Immunotherapy","volume":"19","author":"Sibaud V.","year":"2018","journal-title":"American Journal of Clinical Dermatology"},{"key":"e_1_2_10_18_1","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1007\/s10147-019-01490-2","article-title":"Immune Checkpoint Inhibitor\u2010Induced Sarcoidosis\u2010Like Granulomas","volume":"24","author":"Rambhia P. H.","year":"2019","journal-title":"International Journal of Clinical Oncology"}],"container-title":["Journal of Cutaneous Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cup.70213","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/cup.70213","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cup.70213","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T22:51:25Z","timestamp":1789080685000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cup.70213"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,10]]},"references-count":17,"alternative-id":["10.1111\/cup.70213"],"URL":"https:\/\/doi.org\/10.1111\/cup.70213","archive":["Portico"],"relation":{},"ISSN":["0303-6987","1600-0560"],"issn-type":[{"value":"0303-6987","type":"print"},{"value":"1600-0560","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,10]]},"assertion":[{"value":"2025-11-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"cup.70213"}}