Melanoma
may be hiding in pigmented tattoos, according to a new case
report published in JAMA
Dermatology. Clinicians from Germany recently published a case report
detailing a young white man with a malignant melanoma that developed on a nevus
within a large tattoo.
The
clinicians, led by Laura Pohl, MD, of Laserklinik Karlsruhe, Germany, reported
the case in the hope that other colleagues may help them to gather additional
information on similar cases of melanoma developing within tattoos, in addition
to the 16 cases already reported in English literature.
“Pigmented
lesions in decorative tattoos cause diagnostic difficulties at a clinical and
dermoscopic level. In cases of laser removal of tattoos, hidden suspicious nevi
may be revealed gradually,” the researchers stated.
According
to background information in the case, “the number of decorative tattoos has
been increasing, as has the demand for their removal by laser devices.” In this
case, a man aged 29 years presented to the clinic for removal of large tattoos
that covered most of his chest and arms.
Upon
examination of his skin, the clinicians noticed a nevus on his shoulder and
advised that it be excised. However, the patient refused excision.
With
informed consent, the clinicians began removal of the tattoos in March 2002
with a Q-switched Nd:YAG laser, switching to a Q-switched alexandrite laser
after loss of response after 43 sessions.
By November
2009, the clinicians refused to continue laser removal of the tattoo without
excision of the nevus. The patient consented.
“At that
time, dermoscopy findings showed characteristics of an early melanoma,” the
clinicians wrote. “The excisional biopsy results showed the lesion to be a
Clark level II malignant melanoma with a Breslow thickness of 0.45 mm.”
Based on
their experience with this case, the Dr. Pohl and colleagues made several
recommendations. First, skin examination should take place prior to laser
tattoo removal, and, if suspicious nevi are found, treatment should be withheld
until excision occurs. In addition, clinicians should continue to conduct skin
examinations throughout the process of laser tattoo removal. Finally, the
clinicians recommended that tattoos never be placed on a pigmented lesion in
the skin.
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