Tattoo pigment lymphadenopathy mimicking metastasis in vulvar cancer.

Approximately 24% of American adults have tattoos. Studies of humans and mice demonstrate that tattoo pigment migrates to lymph nodes and can cause lymphadenopathy. A 32-year-old woman presented with a 6-cm vulvar mass and extensive bilateral inguinofemoral lymphadenopathy. Bilateral small tattoos were noted in the groins. Vulvar biopsy confirmed squamous cell carcinoma, and fine needle aspiration of the lymph nodes showed no evidence of malignancy. The patient underwent a radical hemivulvectomy and bilateral inguinofemoral lymphadenectomy. Both inguinal and femoral nodes were enlarged because of extracellular tattoo pigment and reactive follicular hyperplasia without any evidence of metastasis. This case emphasizes the need to consider tattoo pigment as a cause of lymphadenopathy in any patient with a regional tattoo.