A sarcoidal reaction in a tattoo may be an isolated finding or it may represent a cutaneous sign of systemic disease. Two cases of systemic sarcoidosis with granulomatous reactions in tattoos are reported. In each the presenting complaint was the development of a nodule within a tattoo of many years duration. The diagnosis was suspected when histological examination of an intracutaneous nodule revealed a granulomatous reaction of the sarcoidal type. Further studies such as biopsy of lymph nodes, chest x-ray films, and culture studies established the diagnosis. The need for complete evaluation of patients with sarcoidal reactions in tattoos is stressed.