# Case report: Iatrogenic tattoos caused by skin marking pen in a postoperative patient

## TL;DR

A patient developed a tattoo-like mark from a surgical pen used during eyelid surgery, leading to pigment retention.

## Contribution

This case highlights pigment retention as a new potential risk of surgical marking pens.

## Key findings

- The patient had blue-black marks from a surgical pen that persisted after blepharoplasty.
- Pigment was found in the epidermis under dermoscopy.
- Surgical excision was used to remove the pigmented skin.

## Abstract

In this report, a female patient suffering from pigment retention caused by a skin marking pen was elucidated. The patient underwent blepharoplasty 6 months ago and presented with blue-black linear marks at the upper eyelid incision 2 weeks after surgery. Under dermoscopy, scattered pigments were observed to accumulate in the epidermis of the upper eyelid. The patient was diagnosed with iatrogenic tattoo by a surgical marking pen. We chose surgical excision of the skin with the pigmentation. Previous studies have established that the risk of bacterial contamination, contact dermatitis, and allergies may increase with the surgical marking pens, while pigment retention has not yet been mentioned yet. Here, we present a case with a pigment retention in the incision. The selection of the surgical labelling methods and the management of the pigmentation were also addressed. According to our clinical findings, the risk of pigment retention by marking pens needs to be mentioned in the patient’s informed consent. Therefore, the practitioner should ensure that the ink is cleaned by the end of each invasive procedure.