SARCOIDOSIS REMAINS an enigmatic condition that is diagnosed by exclusion of other causes of granulomatous inflammation.1,2 Is the presence of foreign body material in the granulomas compatible with a diagnosis of sarcoidosis? Is foreign material a nidus for expression of granulomatous inflammation in a predisposed patient? These are questions addressed by Marcoval et al3 in this issue of the ARCHIVES. Their findings suggest that all patients who manifest cutaneous granulomatous inflammation of the sarcoidal type should be evaluated for the presence of systemic sarcoidosis regardless of whether they have a history of injury or have polarizable material in their skin biopsy findings.