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

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 57year-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, tattooassociated 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.

Tattoo ink exposure is associated with lymphoma and skin cancers – a Danish study of twins

“…Consequently, the preventive effects of the recent European restrictions (27) intended to limit exposure to a long list of known or suspected carcinogenic compounds may be lower than first anticipated. Our findings are consistent with the conjecture and with reported findings such as squamous cell carcinoma, benign tumors, lymphoid conditions, and rare cases of malignant neoplasms occurring within the area of a tattoo (28)(29)(30)(31)(32)(33).…”

Skin cancers arising within tattoos: A systematic review

“…A total of 20 cases of squamous cell carcinoma arising in a tattoo are described in the literature. 7 , 39 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 The cases were reported most frequently in males (50%) followed by females (40%) ( Table I ). Most of the lesions were located on the extremities (71.4%) ( Table I ).…”

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

“…It has been reported that tattoo inks can contain toxic, carcinogenic or pro-carcinogenic products24 such as metals, polycyclic aromatic hydrocarbons and primary aromatic amines25–28 that may induce DNA damage and cellular mutations 29. It is hypothesised that the presence of these substances could be at the origin of some cases of squamous cell carcinoma,30 31 keratoacanthoma,31 melanoma32 33 and basal cell carcinoma on the skin 13. These hazardous substances are thought to be particularly dangerous when tattoos are extensive.…”

“…These hazardous substances are thought to be particularly dangerous when tattoos are extensive. Given these concerns, there is a renewed interest in further studying the possible toxic effects25 27 28 34–36 or malignancies30–33 37 38 associated with tattoos.…”