Several malignant lesions have been reported in association with tattoos, including basal cell carcinomas, squamous cell carcinomas and melanoma. We report a keratoacanthoma arising in a recent tattoo. A 60-year-old woman presented with a tumor on her right leg, over an area of red pigment in a professional tattoo. Histological analysis confirmed the clinical diagnosis of keratoacanthoma. Although the association between malignancy and tattoos is very uncommon dermatologists and dermatologic surgeons should be attentive to this possibility.