A 35 year old patient with skin phototype I according to the Fitzpatrick classification presented to the Plastic Surgery Department of our hospital with a clinical history of fibrocystic mastopathy, intracanalicular papillomatosis and cancerophobia due to a family history of breast neoplasia. Mammography showed well-distributed micronodular tissue that was classified as a BIRADS 3 mammographic pattern. Nevertheless, she was admitted for prophylactic breast cancer surgery. At the time of surgery she had no palpable axillary lymph nodes.

We performed a bilateral skin-sparing mastectomy, with the intraoperative finding of a left axillary lymphadenopathy, close to the subcutaneous tissue, black in colour. Given the possibility of the intraoperative discovery of a melanoma metastasis, we decided to refer the sample for deferred anatomopathological study. No other clinical signs suggestive of tumour pathology were found, so the surgery was completed with bilateral placement of breast prostheses.

An exhaustive examination of the patient during postoperative admission revealed no skin lesions compatible with melanoma, but did reveal the presence of a 10-year-old tattoo in the left pectoral region. The patient was discharged from hospital pending the results of the anatomical pathology study.

The deferred histological study of the surgical specimen described the adenopathy as a purplish-coloured, bilobed fragment measuring 1.6 x 1.3 x 0.5 cm, with a purplish tinge. Microscopy showed reactive lymphoid hyperplasia. The structure of the lymph node was preserved, without the presence of melanocytic cells and with a deposit of a dark granular artificial pigment.

Once again in the consultation room, the clinical examination together with the histological study of the lesion made it possible to attribute the cause of the clinical changes of the lymphadenopathy to the patient's tattooing, with the consequent result of a benign prognosis and without the need for further treatment or follow-up.