Erythematous papule over a tattoo

A 38-year-old man presented with an erythematous papule over a longstanding back tattoo. Dermoscopic examination revealed a polymorphous vascular pattern with serpentine and dotted vessels, and shiny white-blueish lines indicating a fibrous stroma mixed with tattoo pigment. Histopathological analysis confirmed fibroepithelioma of Pinkus (FeP). FeP typically presents as an erythematous or hypopigmented tumor and may mimic benign and malignant lesions. This case highlights the unique presentation of FeP over a tattoo, underscoring the importance of dermoscopy in differential diagnosis. Surgical excision remains the treatment of choice. This is the first documented case of FeP arising over a tattoo.