The correct answer is D: The internet is not always the best place to secure accurate information. Assuming that she still likes the tattoo, it can remain in place harmlessly.
A healthy 20-year-old woman presents for evaluation 6 months after getting a tattoo on her shoulder
Discussion: While statistics are somewhat uncertain, somewhere between 10% and 25% of all Americans have at least one tattoo.[1] There are many potential complications and adverse reactions to tattoos: superficial and deep bacterial and mycobacterial infections, viral infections (most notably hepatitis B and C), a variety of local allergic reactions to the metallic tattoo pigments, the "sick ink" syndrome (a leukocytoclastic vasculitis hypersensitivity), and long-term spontaneous adverse cosmetic alterations are among the most common.[2]
While there are a very small number of cases of all types of skin cancer occurring within a tattoo, this phenomenon is considered quite unusual.[3–5] There is simply no compelling evidence that either temporary epidermal tattooing (eg, with henna) or permanent dermal tattooing (as depicted here) causes any form of visceral or lymphoreticular carcinoma. Therefore, this patient was reassured and admonished to secure critical medical advice from professional providers rather than from the World Wide Web! It is also worth pointing out that tattoo removal is not as easy as many assume; it may require many painful and expensive laser treatment sessions.
Nonetheless, there are indeed several potential pitfalls when it comes to caring for an oncology patient bearing tattoos. The presence of iron oxides in many tattoo pigments may result in variably severe unpleasant sensations (from tingling to intense burning) during magnetic resonance imaging.[6] Remembering that tattoos often are important for self-esteem and identity, surgical interventions should be carefully planned to disrupt tattoo morphology as little as possible; whenever feasible, incisions should be made so as to camouflage the incision lines within the tattoo after closure.[7]
Darkly colored pigment from a tattoo may well be deposited within draining lymph nodes. Thus, great care must be taken in examination of sentinel lymph nodes related to melanomas arising in proximity to tattoos. In this circumstance, tattoo pigment may obscure metastatic disease or, more commonly, may closely mimic metastatic melanoma.[8–10]
References
1. Laumann AE, Derick AJ. Tattoos and body piercings in the United States: a national data set. J Am Acad Dermatol. 2006;55:413-421.
2. Kluger N. Cutaneous complications related to permanent decorative tattooing. Expert Rev Clin Immunol. 2010;6:363-71.
3. Paradisi A, Capizzi R, De Simone C, et al. Malignant melanoma in a tattoo: Case report and review of the literature. Melanoma Res. 2006;16:375-376.
4. Birnie AJ, Kulkarni K, Varma S. Basal cell carcinoma arising in a tattoo. Clin Exp Dermatol 2006;31:820-821.
5. Pitarch G, Martínez-Menchón T, Martínez-Aparicio A, et al. Squamous cell carcinoma over tattoos. J Am Acad Dermatol. 2007;56:1072-1073.
6. Tope WD, Shellock FG. Magnetic resonance imaging and permanent cosmetics (tattoos): survey of complications and adverse events. J Magn Reson Imaging. 2002;15:180-184.
7. Smit JM, Scheele K, Lapid O, et al. Management of tattoos in the operative field. Ann Plast Surg. 2010;64:125-127.
8. Jack CM, Adwani A. Tattoo pigment in an axillary lymph node simulating metastatic malignant melanoma. Int Semin Surg Oncol. 2005;2:28.
9. Chikkamuniyappa S, Sjuve-Scott R, Lancaster-Weiss K, et al. Tattoo pigment in sentinel lymph nodes: a mimicker of metastatic malignant melanoma. Dermatol Online J. 2005;11(1):14.
