PMC7704616_01
Fifteen year-old tattoo made of black pigment with erythematous and painful infiltrative reaction with papules and plaques.
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f1
After 3 months from the start of dabrafenib plus trametinib, the patient complained an inflammatory reaction of her tattoos (Figure 1), which was clinically swollen, erythematous and painful, in a scar sarcoidosis-like reaction.
(A) The skin biopsy shows a sarcoidal granulomatous dermatitis within the dermis. The epidermis is normal. (Ematoxylin and Eosin staining; 10x). (B, C) The sarcoidal granulomas are discrete nodular aggregates of epithelioid histiocytes with very few lymphoid cells at the periphery ("naked granulomas"). Tattoo pigment is seen within the cytoplasm of histiocytes. Necrosis is not present. (Ematoxylin and Eosin staining; 40x).
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f2
Therefore, a skin biopsy was taken with the pathology report showing non necrotizing granulomatous lesions in the dermal layer, consisting of epithelioid histiocytes incorporating blackish pigment (attributable to tattoo) and giant pluri-nucleated cells, defined as "Langhans cells" (Figure 2).
Contrast CT-scans performed during targeted therapy (A, B) showing enlarged mediastinal lymph nodes; and (C, D) after the definitive suspension of treatment showing reduction in the diameter of the previously reported lymph nodes.
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f3
The CT-scan assessment showed enlarged mediastinal lymph nodes with inflammatory characteristics with no signs of disease relapse (Figure 3). At the last CT scan reassessment, the patient remained disease-free, and the mediastinal lymph nodes were no longer enlarged (Figure 3).