Cutaneous Malignancies in Tattoos, a Case Series of Six Patients

Abstract

Background: A variety of side effects following the tattooing of the skin were reported over the years. Analytical studies showed that some tattoo inks contain harmful compounds.

Methods: We presented six patient cases with cutaneous malignancies in tattooed skin and performed an extensive literature research.

Results: Two patients with black ink tattoos that were diagnosed with malignant melanoma raises the number of described cases to 36 patients. One of the patients developed an immunologic reaction limited to the tattoo area after treatment with a targeted immune therapy. In the other patient, the malignancy (malignant melanoma) was fatal. Basal cell carcinoma was seen in four patients with tattoos containing varying ink colors (black, green, red). This increased the number of described patient cases to 18. Although some ink components and their cleavage products have carcinogenic properties, epidemiological evidence for a causative correlation fails. Further epidemiologic studies on tattoos and malignancies, as well as on the appearance of naevi in tattoos, are necessary. Determining the type of mutation might be helpful to separate sun-induced tumors from skin cancers due to other pathogenic mechanisms.

Keywords: basal cell carcinoma; endocrine disruptors; melanoma; polyaromatic hydrocarbons; squamous cell carcinoma; tattoo; tattoo ink; tumor promotion.

Figure 1

A recurrent skin lesion on the back which was previously removed 18 years ago.

Figure 2

(Hematoxylin and Eosin 10×): Patient No. 2: the histology shows malignant melanocytes with atypia in the epidermis and in the dermis. Note the difference of color between melanin pigment (brown) and the black tattoo pigment (right/bottom).

Figure 3

(Hematoxylin and Eosin 10×): A benign melanocytic nevus within the tattoo of patient No. 2: The slide shows benign small melanocytes without atypia in the in the dermis in association with the fine-granular black tattoo pigment.

Figure 4

(Hematoxylin and Eosin 5×): Patient No 2: The slide demonstrates melanoma cells in the lymph node with brown melanin pigment and black ink in the same lymph node (arrows).

Figure 5

Patient with a basal cell carcinoma in tattooed skin [13].

Figure 6

A nodular and superficial basal-cell carcinoma arising from red, black and green tattoo ink on the right shoulder. Reprinted from Ref. [19].

Figure 7

A patient with five shiny plaques on the back.

Figure 8

Patient 6: A patient with BCC on his back, paravertebral left side.