1
|
Lebhar J, Jacobs J, Rundle C, Kaplan SJ, Mosca PJ. Skin cancers arising within tattoos: A systematic review. JAAD Int 2024; 16:133-143. [PMID: 38957835 PMCID: PMC11217691 DOI: 10.1016/j.jdin.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 07/04/2024] Open
Abstract
Background Tattooing is a widespread practice and has increased in popularity over time. Many lesions have been described in relation to tattoos, including malignant tumors. Objectives The primary goal of this review is to determine whether the frequency of published cases of skin cancers within tattoos has been increasing over time. Methods Our review is in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and reporting criteria. The databases MEDLINE via PubMed, Embase via Elsevier, and Scopus via Elsevier were searched from inception to February 23, 2023. No data or publication date limits were imposed. Results Our review identified 160 cases of cutaneous tumors arising within tattoos. An increase in published cases over time was observed. Most reported tumors developed within red tattoo pigment (36.9%), with the largest contribution by squamous cell carcinoma and keratoacanthoma lesions. Limitations There was a lack of consistency of information in published case reports which limited the scope of our analysis. Small sample size was also a limitation of this review. Conclusions With the increased popularity of tattoos, it is helpful to continue reporting cases of cutaneous malignancies within tattoos. Awareness of the frequency and severity of tumors within tattoos may be communicated to the public.
Collapse
Affiliation(s)
- Jamie Lebhar
- Duke University School of Medicine, Durham, North Carolina
| | | | - Chandler Rundle
- Department of Dermatology, Duke University Health System, Durham, North Carolina
| | - Samantha J. Kaplan
- Duke University Medical Center Library & Archives, Duke University School of Medicine, Durham, North Carolina
| | - Paul J. Mosca
- Duke University School of Medicine, Durham, North Carolina
- Division of Surgical Oncology, Duke University Health System, Durham, North Carolina
| |
Collapse
|
2
|
Abstract
ABSTRACT Tattoos are characterized by the introduction of exogenous pigments into the dermis. Tattoos usually serve cosmetic purposes, although they may have other causes, such as traumatic pigment implants in accidents or medical-related tattoos in the context of radiotherapy. Dermatologic adverse reactions are relatively uncommon, and they include infections, immune-mediated reactions, cutaneous lesions secondary to the Koebner phenomenon, exacerbation of preexisting dermatosis, benign and malignant neoplasms, and a miscellaneous group of dermatologic conditions that may appear in a preexisting tattoo. The aim of this study is to review the types of histopathologic reactions that may appear in a preexisting permanent tattoo.
Collapse
|
3
|
Cohen PR. Squamous Cell Carcinoma and Tattoo: A Man With a Tattoo-Associated Squamous Cell Carcinoma and Review of Benign Tumors, Lymphoid Conditions, and Malignant Neoplasms Occurring Within a Tattoo. Cureus 2022; 14:e21083. [PMID: 35155032 PMCID: PMC8825690 DOI: 10.7759/cureus.21083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2022] [Indexed: 11/16/2022] Open
Abstract
Tattoos, a common form of body adornment, have been associated with numerous cutaneous complications. These include not only benign neoplasms and malignant tumors but also lymphoid conditions occurring within the tattoo. Tattoo-associated dermatomyofibroma, epidermoid inclusion cyst, hemangioma, lipoma, milia, and pilomatricoma are benign lesions that have each only been described in one individual. However, there are only a few reports of persons with either dermatofibroma or seborrheic keratoses within their tattoo; also, benign nevi within a tattoo may be more common than the number of reported individuals. In contrast, there are multiple patients with tattoo-associated pseudoepitheliomatous hyperplasia. Lymphoid conditions that have been observed in a tattoo include single patients with either lymphomatoid papulosis or B-cell lymphoma; however, several individuals have been described with pseudolymphoma developing within their tattoo. Tattoo-associated cutaneous cancer predominantly includes individuals with squamous neoplasms (such as keratoacanthomas and squamous cell carcinomas) and malignant melanoma; however, basal cell carcinoma originating within a tattoo is not uncommon. A 57-year-old man is described who received a tattoo on his left forearm 35 years earlier; he subsequently developed a squamous cell carcinoma in the black tattoo ink. In contrast to the patient in this report, tattoo-associated squamous neoplasms usually develop within a median of four weeks after tattoo inoculation, touch-up, or laser-assisted removal. Also, in contrast to the reported patient, tattoo-associated squamous neoplasms are more commonly observed in red tattoos. However, malignant melanoma and basal cell carcinoma more frequently occur in black and darker-pigmented tattoos. In addition, dermatofibrosarcoma protuberans, cutaneous leiomyosarcoma, and invasive breast duct carcinoma cutaneous metastases have each been described to appear within a patient’s tattoo. It remains to be determined whether tattoo inoculation or tattoo pigment, or both have an epidemiologic role in the subsequent development of benign, lymphoid, or malignant lesions within the tattoo. Several observations support either a direct or indirect role of tattooing as a contributing factor and tattoo pigment as a carcinogen in the etiology of tattoo-associated malignancies. Investigation into the possible relationship between tattoos and cancer development is in progress.
Collapse
|
4
|
Cutaneous Malignancies in Tattoos, a Case Series of Six Patients. Curr Oncol 2021; 28:4721-4737. [PMID: 34898571 PMCID: PMC8628776 DOI: 10.3390/curroncol28060398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 02/05/2023] Open
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.
Collapse
|
5
|
Portilla Maya N, Kempf W, Perez Muñoz N, Rodríguez-Martínez P, Posada R, Fernández-Figueras MT. Histopathologic Spectrum of Findings Associated With Tattoos: Multicenter Study Series of 230 Cases. Am J Dermatopathol 2021; 43:543-553. [PMID: 34276026 DOI: 10.1097/dad.0000000000001695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IMPORTANCE Reactions to tattoo may simulate common dermatosis or skin neoplasms. Histopathology allows diagnosis and helps determining the level and degree of inflammation associated, consequently orientating treatment. OBJECTIVE To describe the histological features found in biopsies of cutaneous reactions to tattoo. DESIGN This study was designed as a multicenter case series. SETTING All consecutive histopathological samples of tattoos referred from 1992 to 2019 to the Hospital General de Catalunya, Hospital Germans Trias i Pujol, and a private practice, all in Barcelona, Spain, and from the Kempf und Pfaltz Histologische Diagnostik in Zurich, Switzerland were retrieved from the files. PARTICIPANTS AND EXPOSURE The inclusion criteria were all cosmetic/permanent makeup, artistic/professional, and traumatic tattoos associated with either inflammatory reactions alone and/or with tumors and/or infections. Exclusion criteria were cases without any associated pathologic finding in the place of the ink, amalgam tattoos, and medical or temporary tattoos. MAIN OUTCOMES AND MEASURES In all patients, clinical features (age, sex, location, tattoo color, and presentation) were recorded. Histological features evaluated included ink color, associated tumors or infections, and inflammatory reaction pattern. Inflammation was graded in low to moderate or severe. RESULTS From 477 biopsies diagnosed as tattoos, 230 cases from 226 patients met the inclusion criteria. Samples corresponded to 107 male and 120 female subjects and 3 of unknown gender. Median age was 39 years (ranging from 9 to 84 years). Fifty-three samples were referred from centers in Spain and 177 from the center in Switzerland. The series was analyzed in 2 parts: tattoos associated only with inflammatory reactions (117/230) and tattoos associated with tumors or infections (113/230). The most common form of inflammatory pattern associated with tattoo was the fibrosing reaction (79/117, 68%), followed by granulomatous reaction (56/117, 48%), lichenoid reaction (33/117, 28%), epithelial hyperplasia (28/117, 24%), pseudolymphoma (27/117, 23%) and spongiotic reaction (27/117, 23%). Combined features of 2 or more types of inflammatory patterns were seen in 64% cases. CONCLUSIONS AND RELEVANCE Our series confirms that cutaneous reactions to tattoos are polymorphous. Inflammation tends to present with combined patterns. Infections are tending to decline, and pathologic findings are not specific to ink color or clinical features.
Collapse
Affiliation(s)
- Nataly Portilla Maya
- Dermatologist, Dermatology Department, Clínica Erasmo LTDA. Valledupar, Colombia
| | - Werner Kempf
- Dermatopathologist, Pathology Department, Kempf und Pfaltz Histologische Diagnostik, Zurich, Switzerland
| | - Noelia Perez Muñoz
- Pathologist, Pathology Department, Hospital Universitari General de Catalunya (HUGC), Sant- Cugat del Vallès, Spain; and
- Pulmonologist, Pathology Department, Hospital University German Trias I Pujol, Barcelona, Spain
| | | | - Rodolfo Posada
- Pathologist, Pathology Department, Hospital Universitari General de Catalunya (HUGC), Sant- Cugat del Vallès, Spain; and
| | | |
Collapse
|
6
|
Kazlouskaya V, Lai YC, Khachemoune A. Leiomyosarcoma of the skin: review of the literature with an emphasis on prognosis and management. Int J Dermatol 2019; 59:165-172. [PMID: 31729020 DOI: 10.1111/ijd.14705] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/15/2019] [Accepted: 10/19/2019] [Indexed: 12/30/2022]
Abstract
Leiomyosarcoma (LMS) of the skin is rare, and no management guideline currently exists. Although LMS is historically classified as either dermal (cutaneous) or subcutaneous, definition for its classfication is inconsistent in the literature. Studies on the managenent of LMS are scarce, and there is no consensus on the appropriate surgical margin for the treatment of LMS. While a 1 cm margin may be sufficient in cutaneous LMS, wider margins may be required for subcutaneous tumors. Mohs micrographic surgery is a promising surgical modality for the treatment of cutaneous LMS. In this review, current knowledge on LMS is summarized and a practical approach to the management of this rare neoplasm is proposed.
Collapse
Affiliation(s)
| | - Yi C Lai
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Amor Khachemoune
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, NY, USA.,Department of Dermatology, Brooklyn Veterans Hospital, Brooklyn, NY, USA
| |
Collapse
|
7
|
Abstract
Introduction: Decorative tattooing involves the introduction of exogenous pigments and/or dyes into the dermis to produce a permanent design.Areas covered: This review provides an overview of the current aspects of cutaneous complications associated with permanent tattooing and permanent make-up based on the previous reviews of interest, case series, and case reports of interest. References for this review were found through a search of PubMed by use of the terms 'tattoo', 'tattoos', or 'tattooing'.Expert opinion: Complications include primarily infections, allergy to tattoo pigments, benign, and sometimes malignant tumors arising on tattoos and the localization of various dermatoses to tattoos. Immunocompromised patients and individuals with chronic conditions should be able to discuss with their physician and ask advice before getting tattooed. Tattoo color allergy still remains an unsolved issue. The identification of current culprit failed. It is most likely a byproduct that appears in situ in the skin during the life of the tattooed bearer. Studies involving expert centers are warranted to establish the best treatments for tattoo allergy. The risk of tattoo associated cancers appears to this author as largely overstated. However, case controls studies on large on cohorts of individuals with or without tattoos could help to evaluate whether tattoos have a possible in role in cancers.
Collapse
Affiliation(s)
- Nicolas Kluger
- Department of dermatology, allergology and venereology, Helsinki University Central Hospital, Helsinki, Finland.,"Tattoo" Consultation, Department of Dermatology, Bichat-Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| |
Collapse
|
8
|
Boulart L, Mimoun M, Noel W, Malca N, Chaouat M, Boccara D. Dealing with tattoos in plastic surgery. Complications and medical use. ANN CHIR PLAST ESTH 2017; 62:e23-e29. [DOI: 10.1016/j.anplas.2016.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 09/08/2016] [Indexed: 10/20/2022]
|
9
|
|
10
|
Ayanlowo OO, Gold-Olufadi SA, Akinkugbe AO, Otrofanowei E, Nga CN, Olumide YM. Growing trend of tattooing and its complications in Nigeria. Int J Dermatol 2017; 56:709-714. [PMID: 28138959 DOI: 10.1111/ijd.13521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 08/21/2016] [Accepted: 10/30/2016] [Indexed: 11/26/2022]
Abstract
Tattoo, a Polynesian word meaning 'to mark', is a form of body modification done by inserting indelible ink into the dermis to change its pigmentation. Tattoos are done for social, cultural, and religious purposes. It has been in existence since the 18th century and was associated with sailors, lower class individuals, and criminals. However, since the late 20th century, tattooing has undergone a redefinition and shifted to an acceptable form of expression all over the world, including Nigeria, cutting across almost all age groups and socioeconomic class. This review is aimed at highlighting the indication, complications arising from the procedure as well as removal, and how to manage them. The dermatological complications associated with tattoos can occur either during inking or attempts at removal. Most times, tattoos are obtained through unsafe means by unauthorized personnel, and this is associated with numerous health risks. Of particular importance to the dermatologists are the hypersensitivity reactions, granulomatous skin disease, and formation of both keloid and hypertrophic scars. Treatment options vary and include use of silicone gel and intralesional steroids for hypertrophic and keloid scars, topical medication for hyperpigmentation, and use of LASER for tattoo removal. In conclusion, the trend of tattooing has become a widely accepted form of social expression all over the world and is gradually gaining ground in Nigeria. Patients frequently present to the dermatologists and physicians for solutions to the complications. It is important to proffer solutions and educate patients on the various health risks associated with tattooing.
Collapse
Affiliation(s)
- Olusola O Ayanlowo
- Department of Medicine, Faculty of Clinical Sciences, University of Lagos, Lagos University Teaching Hospital (LUTH), Lagos, Nigeria
| | | | - Ayesha O Akinkugbe
- Department of Medicine, Faculty of Clinical Sciences, University of Lagos, Lagos University Teaching Hospital (LUTH), Lagos, Nigeria
| | - Erere Otrofanowei
- Department of Internal Medicine, Lagos University Teaching Hospital (LUTH), Lagos, Nigeria
| | - Charles N Nga
- Department of Medicine, University of Uyo Teaching Hospital, Akwa-Ibom, Nigeria
| | - Yetunde M Olumide
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| |
Collapse
|
11
|
Kluger N. Skin tumors arising in tattoos: coincidental or upcoming public health issue? ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.09.28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
12
|
Kluger N. Cutaneous complications related to permanent decorative tattooing. Expert Rev Clin Immunol 2014; 6:363-71. [DOI: 10.1586/eci.10.10] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
13
|
Wenzel SM, Rittmann I, Landthaler M, Bäumler W. Adverse reactions after tattooing: review of the literature and comparison to results of a survey. Dermatology 2013; 226:138-47. [PMID: 23689478 DOI: 10.1159/000346943] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 12/24/2012] [Indexed: 11/19/2022] Open
Abstract
The number of tattooed people has substantially increased in the past years. Surveys in different countries reveal this to be up to 24% of the population. The number of reported adverse reactions after tattooing has also increased including infections, granulomatous and allergic reactions and tumors. However, the case reports do not reflect the frequency of adverse reactions. This review compares the medically documented adverse reactions published in 1991-2011 with the findings of a nation-wide survey that recently revealed the features and health problems associated with tattoos. To compare the data with the survey, the sex of patients was reported and the location and color of tattoos were evaluated. The results show clearly that colored tattoo inks are mainly responsible for adverse skin reactions and that tattoos on the extremities are involved most.
Collapse
Affiliation(s)
- Sabrina M Wenzel
- Department of Dermatology, University of Regensburg Medical Center, Regensburg, Germany
| | | | | | | |
Collapse
|
14
|
Juhas E, English JC. Tattoo-associated complications. J Pediatr Adolesc Gynecol 2013; 26:125-9. [PMID: 23287600 DOI: 10.1016/j.jpag.2012.08.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 07/25/2012] [Accepted: 08/07/2012] [Indexed: 01/07/2023]
Abstract
Tattoo rates in the United States have been rising in recent years, with an expected concomitant rise in tattoo-associated complications. Tattoo complications range from cutaneous localized and generalized inflammatory eruptions, to local bacterial or viral infections, and finally to infectious endocarditis and hepatitis. Many complications may be avoided with proper counseling prior to tattoo placement, especially in high risk individuals. It is important for physicians to be able to recognize and diagnose complications from tattoos to avoid morbidity and possible mortality.
Collapse
Affiliation(s)
- Elizabeth Juhas
- Department of Dermatology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | | |
Collapse
|
15
|
Shinohara MM, Nguyen J, Gardner J, Rosenbach M, Elenitsas R. The histopathologic spectrum of decorative tattoo complications. J Cutan Pathol 2012; 39:1110-8. [DOI: 10.1111/cup.12023] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 02/12/2012] [Accepted: 05/18/2012] [Indexed: 12/19/2022]
Affiliation(s)
- Michi M. Shinohara
- Department of Medicine, Division of Dermatology; University of Washington; Seattle; WA; USA
| | - Jennifer Nguyen
- Department of Dermatology; University of Pennsylvania; Philadelphia; PA; USA
| | - Jennifer Gardner
- Department of Dermatology; University of Pennsylvania; Philadelphia; PA; USA
| | - Misha Rosenbach
- Department of Dermatology; University of Pennsylvania; Philadelphia; PA; USA
| | - Rosalie Elenitsas
- Department of Dermatology; University of Pennsylvania; Philadelphia; PA; USA
| |
Collapse
|
16
|
Høgsberg T, Hutton Carlsen K, Serup J. High prevalence of minor symptoms in tattoos among a young population tattooed with carbon black and organic pigments. J Eur Acad Dermatol Venereol 2012; 27:846-52. [DOI: 10.1111/j.1468-3083.2012.04590.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
17
|
|
18
|
Les tatouages : histoire naturelle et histopathologie des réactions cutanées. Ann Dermatol Venereol 2011; 138:146-54; quiz 144-5, 155. [DOI: 10.1016/j.annder.2010.08.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 08/05/2010] [Accepted: 08/26/2010] [Indexed: 11/20/2022]
|