Squamous neoplasms arising within tattoos: clinical presentation, histopathology and management

Abstract

Tattooing, which involves the placement of ink into the skin, is an ancient decorative technique that has remained popular in modern society. Tattoos have long been known to cause cutaneous reactions, which include the emergence of neoplasms such as keratoacanthoma (KA) and squamous cell carcinoma (SCC) in tattooed areas of the skin. We review the clinical presentations, histology and treatment options for squamous neoplasms, primarily KA and SCC, arising in tattoos.

Updates on the Management of Non-Melanoma Skin Cancer (NMSC)

“…As such, the FDA does not consider NMSCs complications of tattoo application [ 57 ]. Nevertheless, some still suggest that skin cancers should be included in the list of potential complications of tattooing given the actual incidence may be underreported [ 58 ].…”

Tattoo-related squamous proliferations: a spectrum of reactive hyperplasia

“…As noted by Junqueria and colleagues, these reactive squamous proliferations can have varying degrees of atypia and malignant features, including invasion . Therefore, we believe that the level of atypia or malignant features should be reported to the clinician regardless of the nomenclature, to help guide appropriate therapy.…”

“…We read with interest the recent comprehensive review by Junqueira et al . of squamous neoplasms arising in tattoos . Their review included cases of squamous cell carcinomas (SCC), keratoacanthomas (KA), KA‐like SCC and SCC with KA‐like features.…”

“…Fraga and colleagues hypothesized that regardless of the nomenclature, these tattoo‐associated squamous proliferations may represent a single entity . We believe that even if they do not represent a single entity, they at least represent a spectrum of tattoo‐related reactive squamous proliferation, and that these cases of PEH in the literature should be included in a review of this topic (Table ) …”

Eruptive Keratoacanthomas in a Red Tattoo

“…Junqueira et al hypothesised that the skin tries to eliminate the ink like a foreign body by the development of granulomas. 4 Differential diagnosis of KA arising within tattoos may include mycobacterial or fungal infections, foreign body reactions, pseudolymphomatous reactions or sarcoidosis. Histological examination should always be performed, which is considered the gold standard to confirm the diagnosis and rule out squamous cell carcinoma.…”