Pigments used to create tattoos can cause inflammatory reactions in both epidermis and dermis which can penetrate more deeply into the body, affecting lymph and other areas. Giant cells were extracted from lymph nodes adjacent to ink, on this subject. Other studies repeat this finding, causing providers to mistake lymphadenopathy for cancer, melanoma, or other more serious disease states. Patients may experience symptoms similar to malignant conditions such as swollen nodes, severe cluster headaches, and worsening autoimmune conditions. In some cases, patients with tattoos showed migrating ink in adjacent lymph nodes that formed granulomatous reactions leading to sarcoidal, necrobiotic sardoidal granulomas, which can be the first sign of systemic sarcoidosis. In one patient, treatment required biopsy of over 15 lymph nodes to rule out cancer.
Providers who find lymphadenopathy in tattooed patients should be aware of potential differential diagnosis confusion, and must consider referral to rule out potential serious diagnoses. It is currently unknown if the chronic lymphadenopathy seen in patients with tattoos can be a cause of cancer.