Cutaneous Malignancies in Tattoos, a Case Series of Six Patients

Skin cancers arising within tattoos: A systematic review

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.

Tattoos: risks and complications, clinical and histopathological approach

BACKGROUND

Skin modification through tattoos is as old as humanity itself. However, this trend is on the rise, and with the use of different types of pigments and application practices, both cutaneous and systemic complications can arise. Adverse reactions can be grouped into five classes: inflammatory, infectious, neoplastic, aesthetic, and miscellaneous. On histopathology, inflammatory reactions can exhibit a lichenoid pattern or present as spongiotic dermatitis, granulomatous reactions, pseudolymphoma, pseudoepitheliomatous hyperplasia, or scleroderma/morphea-like changes. This article reviews tattoo complications, including their clinical and histopathological characteristics.

METHODS

An open search was conducted on PubMed using the terms "tattoo", "complications", and "skin". No limits were set for period, language, or publication type of the articles.

RESULTS

Reactions to tattoos are reported in up to 67% of people who get tattooed, with papulonodular and granulomatous reactions being the most common. Some neoplastic complications have been described, but their causality is still debated. Any pigment can cause adverse reactions, although red ink is more frequently associated with them. Patients with pre-existing dermatoses may experience exacerbation or complications of their diseases when getting tattoos; therefore, this procedure is not recommended for this patient group.

CONCLUSIONS

Dermatological consultation is recommended before getting a tattoo, as well as a histopathological examination in case of complications. In patients who develop cutaneous inflammatory reactions following tattooing, additional studies are recommended to investigate systemic diseases such as sarcoidosis, pyoderma gangrenosum, atopic dermatitis, and neoplasms. It is important for physicians to be trained in providing appropriate care in case of complications.

Pink and Orange Tattoo Pigments: Two Occurrences of Squamous Cell Neoplasms

This case report covers the case of a 56-year-old woman with two separate occurrences of squamous cell neoplasms, one arising in pink tattoo pigment and another arising in orange tattoo pigment. A review of the literature was conducted to evaluate the prevalence of malignancy occurring in tattoos. This is rare and there are a limited number of case reports and no large studies done on this condition. Most malignancies in tattoos occur in red, black, or blue tattoo inks and no cases have been reported thus far of malignancy in pink or orange tattoo pigments. Due to the limited number of cases, more case studies are needed to determine the prevalence, risk, and epidemiology of malignancy arising within tattoos.

Epidural analgesia and tattoos: a modified technique to minimise risks and improve safety

A healthy young woman with a sizeable lumbar tattoo was admitted to the delivery room in active labour at full-term gestation. She was experiencing strong, painful contractions and anxiety, concerned about the possible risks of receiving an epidural through a tattoo. Although there is little published evidence to suggest complications of performing an epidural through a tattoo, some studies report 'tissue coring phenomenon'. The anaesthesiology team informed the patient of the risks inherent in a traditional epidural and the potential long-term risks of receiving an epidural through the tattoo. Upon signing the informed consent form, the modified epidural technique was performed, and its administration proceeded without complications. A healthy boy was born 3.5 hours later in a vacuum-assisted delivery. This article describes the modified epidural technique designed to minimise tissue coring, and the results of 18 months of uneventful patient follow-up.

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

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.