A case of unexpected facial tattooing following intra-oral injection of Indian ink

Abstract

Conflict of interest: none declared. An 88‐year‐old woman, who was an ex‐smoker, presented with a 2‐month history of bluish pigmentation on the left upper lip and cheek (Fig. 1). Six years previously, she had been seen by the maxillofacial surgeons because of an 18‐month history of an enlarging lesion on the left buccal mucosa. Examination at the time revealed a 25 × 40 mm irregular papillomatous plaque extending from the anterior commissure to the alveolar ridge posteriorly. A biopsy had confirmed this as a verrucous carcinoma. This was excised, after which local reconstruction using a buccal fat pad had been performed, and the patient was given a postoperative course of radiotherapy. Two years later, a biopsy from abnormal mucosa at the treated site showed proliferative verrucous leucoplakia. A year after this, a new nodule on the left buccal mucosa was treated with wide local excision. At her latest presentation, histopathology revealed verrucous hyperplasia and moderate dysplasia extending to all excision margins. The margins of the buccal mucosa had been marked during the operation with Indian ink, to tattoo the limits of the excision and thus aid postoperative monitoring. Unfortunately, the permanent dye diffused through the skin, leaving a blue pigmented patch on the left side of the upper lip, extending onto the cheek. The patient remains under follow‐up by the maxillofacial surgeons.