A 26-year-old African American female presents with a painless lesion on her left ear lobe. You notice multiple ear and nose piercings and a tattoo covering the ear and left shoulder. The lesional growth measures 1cm in diameter and seems to be beyond the boundaries of the original piercing area. She also recalls trying some over-the-counter steroid creams but the growth has not regressed. Which of the following best explains the pathogenesis of this lesion?