Background: There has been a longstanding debate regarding whether keratoacanthomas\n(KAs) are neoplastic or reactive/inflammatory lesions. Aim:\nThe aim of this case report is to, within the aforementioned debate, offer\nsupport in favor of the potential reactive nature of keratoacanthomas. Case\nPresentation: A 64-year-old male presented with an eruption of 25 keratoacanthomas\nwithin a red ink tattoo. Eruptions were partially resolved over a\nmatter of months, and completely resolved with treatment using oral Acitretin\ntherapy. We believe this to be the third such reported case of eruptive\nKAs within only the red ink portions of a tattoo. Prior cases involved 2 and 8\nKAs each. Discussion: Multiple studies suggest that KAs are neoplastic in\nnature and very distinct from cutaneous squamous cell carcinoma. Especially\ninteresting is the finding that KAs have increased expression of apoptotic\ngenes; this is particularly notable because of the tendency for these lesions to\nspontaneously involute. Skin tumorigenesis can occur in predisposed individuals\nafter carcinogen exposure, thus red ink possesses theoretical potential\nas a carcinogen. KAs could be seen in this case as in fact a reactive neoplasm.
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