With the rising popularity of tattoos, many physicians have seen complications of their application, usually transient and inflammatory in nature, although both benign and malignant neoplasms have been reported as well. We present an unusual case of a hemangioma arising after tattoo application.

Importance:We believe this to be the first documented report of multiple endocrine neoplasia type-1 (MEN-1) in which the diagnosis was suspected based purely on cutaneous findings. The patient was initially referred to the dermatology department for cosmetic concerns and had no overt symptoms, laboratory abnormalities, or known family history of MEN-1. Observations:The patient is a 28-year-old man who was referred to the dermatology department for evaluation and removal of skins lesions, later confirmed by biopsy to be facial angiofibromas and a truncal collagenoma. This combination of cutaneous findings was suspicious for a genodermatosis and genetic testing subsequently confirmed the diagnosis of MEN-1. The patient was referred for appropriate follow up and surveillance. Conclusions and Relevance:This case highlights the importance of vigilance on the part of dermatologists to be aware of subtle skin findings that may be characteristic of rare disorders and may have gone unrecognized by other providers and the patients themselves. In this respect, dermatologists are in a unique position given their specialized training in the recognition of inherited skin disorders. An early diagnosis of an inherited disorder, especially one with increased risk of malignancy, can allow for appropriate surveillance and potentially alter the course of the disease.

We present a 47-year-old man with a sudden eruption of more than 100 reddish-brown papules, which histologically exhibited a dense dermal proliferation of large mononuclear cells with vesicular nuclei and abundant pale cytoplasm. Electron microscopy and immunohistochemistry revealed findings consistent with indeterminate cell histiocytosis and the patient responded well to treatment with narrowband UVB therapy. Case synopsis:A 47-year-old, otherwise healthy man with a history of mild plaque psoriasis presented to his dermatologist for evaluation of two asymptomatic, reddish brown, dome shaped papules on his abdomen. The lesions had been present and asymptomatic for several weeks and further evaluation and treatment was initially deferred given the banal appearance of the lesions. In ensuing weeks however, the number of similar appearing lesions increased and spread centrifugally from his trunk to his extremities and face. When the patient returned for a follow up several weeks later, he had over a hundred lesions involving his entire body, but most prominent on this trunk (Figures 1 and 2). Punch biopsies of representative lesions were obtained at this time. A systemic workup was also performed as even though the patient remained in good health, the sudden increase in the number of skin lesions raised concern for internal disease. A systemic workup including bone marrow biopsy, computed tomography scan of the chest, abdomen and pelvis, complete blood count, and complete metabolic panel was performed. The results of these evaluations were normal except for a mild thrombocytopenia. Given the negative systemic work up and the patient's continued overall good health, concern for systemic involvement was considered minimal.

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