The application of decorative tattoos to the skin is an ancient practice, which continues to be popular in the present day. Increasingly, a number of complications of tattoo application are recognized, including a diverse variety of cutaneous hypersensitivity reactions to tattoo pigments. Herein we describe an unusual case of a necrobiotic granulomatous tattoo reaction showing combined features of necrobiosis lipoidica and early granuloma annulare. The relevant literature is reviewed, and the practical significance of such unusual histological features as a part of the tattoo reaction is discussed.