Malignant Melanoma Arising in Red Tattoo Ink

Abstract

We report the case of a 33-year-old male who presented with a malignant melanoma on his anterior chest wall. The lesion was only found in the red ink pigment of the tattoo, as were several in-transit dermal metastases. Possible explanations include a pre-existing lesion which was seeded with red ink or the possibility of the red ink causing an inflammatory reaction leading to malignant transformation. This is the first reported case of a melanoma developing in the red ink pigment of a multi-colored tattoo.

Women and Tattoos: Fashion, Meaning, and Implications for Health

“…The inks used to create tattoos are constantly changing, untested for human use, and largely unregulated . The US Food and Drug Administration (FDA) has regulatory authority and considers tattoo inks to be cosmetics.…”

“…Commercial tattoo inks are complicated chemical mixtures consisting of pigments suspended in one or more diluents. Additional ingredients such as binders, surfactants, preservatives, and fragrance are used to alter the viscosity and other physical properties of the ink as aids to the tattooist's craft (Table ) . Traditionally, black pigments were composed of carbon or iron salts, and colors were based on metals, including heavy metals.…”

“…The physiologic response to tattooing, as detailed in Table , is complex, dynamic, and continuous throughout the lifetime of the tattoo . An initial acute inflammatory response, caused by skin cleansers, ink ingredients, and the local trauma of thousands of needlesticks, begins the phagocytic capture and aggregation of pigment particles .…”

“…An initial acute inflammatory response, caused by skin cleansers, ink ingredients, and the local trauma of thousands of needlesticks, begins the phagocytic capture and aggregation of pigment particles . Although the absorption, distribution, metabolism, and excretion of tattoo ink have not been well explored, it is known that absorption of soluble ink ingredients and pigment particles through dermal blood and lymph vessels begins immediately, with pigment particles soon evident in local and regional lymph nodes, as well as the liver . With time, ongoing pigment absorption causes fading and blurring of tattoos, speeded by exposure to ultraviolet light …”

“…Known mutagens and carcinogens present in tattoo ink include polycyclic aromatic hydrocarbons (PAHs) and nitrosamines . Photocleavage of azo pigments can also create toxic primary aromatic amines .…”