Tattooing and risk of melanoma: a population-based case-control study in Utah

Rachel D McCarty^{1

2

3}, Britton Trabert^{1

2

4}, Lindsay J Collin^{1

2

5}, Morgan M Millar^{1

6

7}, David Kriebel⁸, Laurie Grieshober^{1

2}, Mollie E Barnard^{1

2

9}, Jenna Sawatzki¹, Marjorie Carter⁷, Valerie Yoder⁷, Jeffrey A Gilreath¹, Douglas Grossman^{1

10}, John Hyngstrom^{1

11}, Paul J Shami^{1

12}, Jennifer A Doherty^{1

2

7}

Affiliations

¹ Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, 84112, UT, USA.
² University of Utah Intermountain Healthcare Department of Population Health Sciences Spencer Fox Eccles School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, 84108, UT, USA.
³ Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, 25 ave Tony Garnier, Lyon Cedex, 90627 69366, FR, CS.
⁴ Department of Obstetrics and Gynecology, Spencer Fox Eccles School of Medicine, University of Utah, 30 North Mario Capecchi Dr, Level 5 South, Salt Lake City, 84112, UT, USA.
⁵ Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, 30322, GA, USA.
⁶ Department of Internal Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, 84132, UT, USA.
⁷ Utah Cancer Registry, University of Utah, 250 East 200 South, Suite 1375, Salt Lake City, 84111, UT, USA.
⁸ Lowell Center for Sustainable Production, University of Massachusetts Lowell, 883 Broadway St, Lowell, 01854, MA, USA.
⁹ Slone Epidemiology Center, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord St, Boston, 02118, MA, USA.
¹⁰ Department of Dermatology, University of Utah Health Sciences Center, 30 N. Mario Capecchi Dr, Salt Lake City, 84112, UT.
¹¹ Department of Surgery, Rush University, 1520 W. Harrison St, Chicago, 60607, IL, USA.
¹² Department of Internal Medicine, Division of Hematology and Hematologic Malignancies, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, 84112, UT, USA.

PMID: 40839395
PMCID: PMC12404683
DOI: 10.1093/jnci/djaf235

Tattooing and risk of melanoma: a population-based case-control study in Utah

Rachel D McCarty et al. J Natl Cancer Inst. 2025.

. 2025 Aug 21:djaf235.

doi: 10.1093/jnci/djaf235. Online ahead of print.

Authors

Affiliations

¹ Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, 84112, UT, USA.
² University of Utah Intermountain Healthcare Department of Population Health Sciences Spencer Fox Eccles School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, 84108, UT, USA.
³ Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, 25 ave Tony Garnier, Lyon Cedex, 90627 69366, FR, CS.
⁴ Department of Obstetrics and Gynecology, Spencer Fox Eccles School of Medicine, University of Utah, 30 North Mario Capecchi Dr, Level 5 South, Salt Lake City, 84112, UT, USA.
⁵ Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, 30322, GA, USA.
⁶ Department of Internal Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, 84132, UT, USA.
⁷ Utah Cancer Registry, University of Utah, 250 East 200 South, Suite 1375, Salt Lake City, 84111, UT, USA.
⁸ Lowell Center for Sustainable Production, University of Massachusetts Lowell, 883 Broadway St, Lowell, 01854, MA, USA.
⁹ Slone Epidemiology Center, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord St, Boston, 02118, MA, USA.
¹⁰ Department of Dermatology, University of Utah Health Sciences Center, 30 N. Mario Capecchi Dr, Salt Lake City, 84112, UT.
¹¹ Department of Surgery, Rush University, 1520 W. Harrison St, Chicago, 60607, IL, USA.
¹² Department of Internal Medicine, Division of Hematology and Hematologic Malignancies, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, 84112, UT, USA.

PMID: 40839395
PMCID: PMC12404683
DOI: 10.1093/jnci/djaf235

Abstract

Background: Tattooing can deliver carcinogens directly into the skin and cause immunologic responses, yet the relationship between tattooing and melanoma risk is unknown.

Methods: In a population-based case-control study with 1,167 melanoma cases (566 in situ; 601 invasive) and 5,835 frequency-matched controls, we examined tattooing and melanoma risk using multivariable logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs).

Results: While ever receiving a tattoo was not strongly associated with melanoma risk, heavier tattooing exposure was associated with decreased risk. Overall melanoma risk was decreased among individuals who had received four or more tattoo sessions (OR 0.44 [95% CI 0.27-0.67]) and individuals who had three or more large tattoos (OR 0.26 [95% CI 0.10-0.54]) compared with those who were never tattooed. Invasive melanoma risk was also decreased among individuals who received their first tattoo before age 20 (OR 0.48 [95% CI 0.29-0.82]) compared with never tattooed individuals.

Conclusions: Our findings suggest more tattoo exposure is associated with reduced melanoma risk, which does not support previously hypothesized associations between tattooing and increased melanoma risk. Unmeasured confounding is likely to contribute to our findings as we were not able to control for important melanoma risk factors. Potential causes of these associations could include sun exposure-related behaviors or immune responses to tattooing. Further investigation is warranted to clarify these relationships.

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Conflict of interest statement

Institutional pilot funding from the Huntsman Cancer Institute supported this work. Lindsay J. Collin was supported by R00CA277580 from the National Cancer Institute of the National Institutes of Health. Lindsay J. Collin reports personal fees from Epidemiologic Research & Methods, LLC outside of the submitted work.

Figures

**Figure 1.**
Flow chart of included melanoma cases and frequency-matched controls in Utah Abbreviation: Behavioral Risk Factor Surveillance System (BRFSS)

See this image and copyright information in PMC

References

1. Schaeffer K, Dinesh S. 32% of Americans have a tattoo, including 22% who have more than one. Pew Res. Cent https://www.pewresearch.org/short-reads/2023/08/15/32-of-americans-have-... (accessed Aug 16, 2023).
1. Foerster M, Schreiver I, Luch A, Schüz J. Tattoo inks and cancer. Cancer Epidemiol 2020; 65: 101655–101655. - PubMed
1. Regensburger J, Lehner K, Maisch T, et al. Tattoo inks contain polycyclic aromatic hydrocarbons that additionally generate deleterious singlet oxygen: PAHs in tattoo inks. Exp Dermatol 2009; 19: e275–81. - PubMed
1. Engel E, Spannberger A, Vasold R, König B, Landthaler M, Bäumler W. Photochemical cleavage of a tattoo pigment by UVB radiation or natural sunlight. JDDG; 2007; 5: 583–9. - PubMed
1. Hauri U, Hohl C. Photostability and breakdown products of pigments currently used in tattoo inks. Curr Probl Dermatol 2015; 48: 164–9. - PubMed

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Tattooing and risk of melanoma: a population-based case-control study in Utah

Affiliations

Tattooing and risk of melanoma: a population-based case-control study in Utah

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources