Dermatology Online Journal

Artwork: to be studied
Mr Zakir Shariff MS MRCSEd, Mr Hamid Tehrani MRCSEd, Mr Jagajeevan Jagadeesan MRCS, Mr Joseph Hardwicke MRCS
Dermatology Online Journal 12 (4): 21

Plastic Surgery Department, Lancashire Teaching Hospital, Preston. zakirshariff@hotmail.com

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Tattoos are forms of art and identity and are a permanent mark or design made on the skin by a process of pricking and ingraining an indelible pigment or by raising scars. Reactions to tattoo pigments have been described and include acute inflammatory allergic hypersensitivity, and granulomatous, lichenoid, or pseudolymphomatous types of histopathologic reactions. There is no proven evidence linking tattoos with skin cancer although dark tattoos can make early diagnosis of skin cancer difficult.

Figure 1
Figure 1. Melanoma ( white arrow ) arising within a forearm tattoo.

We report a case of 48-year-old gentleman who was referred to our plastic surgery outpatient department with a history of change in color and mild inflammation within the tattoo on his right forearm, which was tattooed approximately 30 years previously (Fig. 1). He noticed the change 3 months previous to presentation and initially thought it could be an infection. When it did not show signs of abating, he consulted his general practitioner who immediately referred him to our department on suspicion of malignancy. An excision biopsy revealed melanoma with a Breslow thickness of 0.3 mm.

Although there is no proven causative link between tattoos and melanoma development, theories have been postulated to implicate carcinogenic effects of the tattoo ink or the trauma associated with tattooing [1, 2, 3]. Owing to dark tattoo colors, the development of skin cancer may be overlooked by patient or physician until significant tumor growth has occurred.

We use this case to highlight the importance of vigilance and of a high index of suspicion for any skin changes within a tattoo, which may otherwise be easily overlooked.

References

1. Stinco G, De Francesco V, Frattasio A, Quinkenstein E, Patrone P. Malignant melanoma in a tattoo. Dermatology. 2003;206(4):345-6. PubMed

2. Khan IU, Moiemen NS, Firth J, Frame JD. Malignant melanoma disguised by a tattoo. Br J Plast Surg. 1999 Oct;52(7):598. PubMed

3. Kircik L, Armus S, van den Broek H. Malignant melanoma in a tattoo. Int J Dermatol. 1993 Apr;32(4):297-8. PubMed

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