On July 9, the Journal of the American Academy of Dermatology released an important article highlighting a crucial but often overlooked fact: that tattoo pigment can hide signs of skin cancer. Whether you’re contemplating your first tattoo in time for National Tattoo Day on July 17, already have a body canvas full of ink, or are simply ink-curious, understanding how tattoos can conceal signs of skin cancer might just save your life—or a loved one’s.
To provide more insight on the subject, NewBeauty spoke with Deborah S. Sarnoff, M.D., president of The Skin Cancer Foundation and clinical professor of dermatology at NYU.
How might tattoo pigments interfere with the detection of skin cancer?
“Tattoo pigments interfere with the detection of skin cancer because they can mask the warning signs. When diagnosing melanoma, there are often warning signs that are referred to as the ‘ABCDEs.’ A stands for asymmetry, B for irregular border, C for variation in color, D for diameter (larger than approximately 6 mm), and E for evolving. Very often, tattoo pigments are dark blue or black and they can mask the early detection of changes in pigmented lesions. One can also develop a melanoma de novo [melanoma that develops on the skin rather than a pre-existing mole], and the early warning signs will be completely obscured by the tattoo pigments.
Early melanoma detection can result in a 100 percent cure, but delay in diagnosis can be lethal. It is very important for people who have tattoos to closely examine those areas at least once a month. These self-examinations are helpful. If any new lesion is seen on close inspection or if there is any change in a previously noted pigmented lesion within the tattoo, it is very important to bring it to the attention of a board-certified dermatologist. A simple biopsy can determine if in fact there is skin cancer, evolving at the site.”
Are certain colors or types of tattoo pigments more problematic for skin cancer detection than others?
“Certain colors in the tattoo pigment are more problematic. If a tattoo is dark green or navy blue or black, these colors can definitely obscure detection of the brown or black or blue pigments seen within an evolving melanoma. Sometimes, if there is red pigment, this could obscure development of a non-melanoma skin cancer known as a squamous cell carcinoma or a basal cell carcinoma. These non-melanoma skin cancers often present as pink nodules or red areas of the skin, which would be obscured by the red pigment.”
Are there specific areas of the body where tattoos are more likely to obscure skin cancer symptoms?
“There are no specific areas of the body where tattoos can obscure skin cancer signs. Anytime you have a darkly colored tattoo or a red tattoo, these colors can obscure the development of a skin cancer. Symptoms of a skin cancer might include bleeding or itching and if there are any areas of a tattoo that are persistently irritated, bleeding, or itching, it could be a sign of a skin cancer developing within the tattoo.”
What are the common signs of skin cancer that might be hidden by tattoos?
“Common signs of a skin cancer developing with an a tattoo would be developing an elevated bump that previously was not there, persistent, itching, intermittent itching or bleeding, crusting or chronic irritation in an area of the tattoo. Of course, these signs could be due to an allergy to one of the tattoo inks, but it would be important to seek out the attention of a board-certified dermatologist to examine the area.”
How often should people with tattoos have their skin checked by a dermatologist?
“In general, people should have their skin checked by a dermatologist once a year. For people that have tattoos, close inspection should be given at that exam in the area of the tattoos. For people with a previous history of skin cancer, the interval might be increased to twice a year. That would be determined by a conversation with one’s dermatologist. At any rate, it would be very important to cover the area of tattoo with a broad-spectrum sunscreen— at least SPF 30 is recommended. Frequent application of the sunscreen approximately every two hours would be needed if the tattooed area is exposed to the sun.”
Are there any new technologies or techniques being developed to help detect skin cancer in tattooed areas?
“There are new methods which involve artificial intelligence [see: the DermaSensor] and various forms of spectrometry in the early detection of skin cancers. The problem is that tattoo pigment, which primarily is located in the dermis can completely obscure recognition of the atypical pigment cells in a melanoma. This interference is not only a problem in detecting the melanoma with the naked eye, but can be a problem in detecting the melanoma histologically, when a pathologist looks under the microscope.”
Is it safe to get tattoos if you have a history of skin cancer?
For people that have had a history of malignant melanoma in the past, very often a dermatologist will recommend not having further tattooing of the skin. This can often be problematic in patients that want to have sleeves or elaborate artwork on extensive areas of the body. Since the person who has had previous skin cancer is at a higher risk of developing further skin cancers, tattooing large areas elevates their risk of late detection.”
