The patient's hypersensitivity reaction and its spontaneous remission after removal of the implants indicate that Ti, possibly along with some of the other metals detected, could have played a major role in this particular case of tattoo-related allergy.

Given the possible aggressive nature of cellular type of fibrous histiocytoma, we advice complete excision and clinical follow-up. Chest x-rays and ultrasound examination of regional lymph nodes should be performed in atypical lesions.