Basal Cell Carcinoma Originating in a Tattoo: Case Report and Review of an Uncommon Complication in Tattoo Recipients

Abstract

Background: The placement of a tattoo is a common event. Basal cell carcinoma arising from a tattoo is rare despite this neoplasm being the most common form of skin cancer.

Objective: We describe a 41-year-old man who developed a basal cell carcinoma in his tattoo and review the literature of basal cell carcinomas originating in a tattoo.

Methods: A literature search using PubMed was performed. The following terms were searched: "basal," "carcinoma," "cell," and "tattoo." The characteristics of individuals with a basal cell carcinoma originating in a tattoo were analyzed and summarized.

Results: A total of 13 patients (6 women and 7 men) with a basal cell carcinoma arising in a tattoo have been reported. The majority of the tumors were located on the head (6 cases, 46.2%) followed by either an upper extremity (4 cases, 30.7%) or the trunk (3 cases, 23.1%). Most of the carcinomas were asymptomatic; however, 2 patients reported pruritus associated with their tumor. Nodular basal cell carcinoma was the most common subtype diagnosed (5 tumors), followed by superficial basal cell carcinoma (2 tumors). One patient had either a pagetoid or a mixed (nodular and sclerosing) histology. The pathological variant was not described for 4 patients.

Conclusions: Basal cell carcinoma arising in a tattoo is a rare occurrence. Although this occurrence may be coincidental, emerging evidence of carcinogenesis associated with tattoo pigment may suggest a causal link. Elucidating this important relationship warrants further investigation.

Keywords: basal cell carcinoma; immunocompromised district; pigment; skin cancer; tattoo.

Figure 1

Distant (A) and closer (B) views of a nodular basal cell carcinoma (within the white circle) presenting as a red plaque within the green tattoo on the left forearm of a 41-year-old man. [Copyright: ©2019 Abudu et al.]

Figure 2

Pathological features of a nodular basal cell carcinoma arising in a tattoo from the left forearm of a 41-year-old man. Low (A), medium (B and C), and high (D) magnification views show nodular aggregates of basaloid tumor cells (asterisks) extending from the epidermis into the dermis. Mucin is present in a tumor nodule (M) and there is retraction of the dermal stroma from the palisading cells at the periphery of the tumor nodules (red arrows). Black, amorphous pigment (representing the green tattoo) is also present not only around the tumor but also in the dermis (black arrows). There is solar elastosis in the dermis (black circles) (H&E: A, ×4; B, ×10; C, ×20; D, ×40). [Copyright: ©2019 Abudu et al.]

Figure 3

Appearance of the tattooed left forearm following the Mohs micrographic surgery that removed the basal cell carcinoma. Distant (A) and closer (B) views of the left forearm after a layered closure (between black arrows) was used to close the surgical defect following complete removal of the tumor. [Copyright: ©2019 Abudu et al.]