Fig. 1. (A) Plaque lesions restricted to red tattoo areas. (B) Granulomatous reaction with Swiss-cheese appearance and granule containing black pigmented material on the superficial dermis (H&E, ×100; arrowhead: granule). (C) Multiple ovoid cavities with scattered black pigmented materials, suspicion of tattoo pigment (H&E, ×400; arrowheads: tattoo pigment). (D) Scanning electron microscopy image. (E) In the scanning electron microscopy and energy-dispersive X-ray spectroscopy findings, zirconium was detected. The mean zirconium content (weight, %) of biopsy specimen was 30.28.
