In 2022, when Jamie Lebhar, MD, was a medical student at Duke University, her third-year research advisor, Paul Mosca, MD, PhD, MBA, associate professor of surgery, told her about a patient who had a squamous cell carcinoma within their tattoo.
With tattoos increasingly common, Lebhar wondered if reports of skin cancer cases in tattooed skin had increased as well.
Every medical student at Duke devotes their third year of school to a research project, and Lebhar decided to use hers to explore this question. Working with medical librarian Samantha Kaplan, MLIS, PhD, and other colleagues, Lebhar conducted a systematic review — an organized search of the scientific literature — and analyzed published cases.
She found that published reports of cases of skin cancers in tattooed skin have indeed become more common over time, though the number of reported cases remains small. The findings don’t point to a link between skin cancer and tattoos, but further study is needed, said Lebhar, now a resident at Duke Health who plans to specialize in dermatology.
“You cannot make an association between tattoos and skin cancer from this study, but there were interesting findings in which skin cancers within tattoos had notably differing characteristics than skin cancer arising in non-tattooed skin,” Lebhar said.
The study was published in the journal JAAD International.
One of the study’s limitations was the small sample size, Lebhar said. Since 1938, there have been just 160 cases of skin cancer in tattooed skin reported in the scientific literature. To put that into perspective, more than 5 million new cases of skin cancer are diagnosed every year, according to the American Cancer Society.
Most of the cases in the analysis developed within red tattoo pigment, and those tended to be squamous cell carcinoma and keratoacanthoma lesions, which have an inflammatory component. “There have been some reported allergic, inflammatory reactions to red tattoo ink, so this finding was interesting,” Lebhar said.
It all points to the need for physicians to consider publishing case reports when cancers occur in tattooed skin, she said.
And, as Lebhar makes the transition from student to doctor, it has become more apparent to her that dark tattoo ink makes screening for skin cancer more difficult.
“Dark ink does impact my ability to pick out the darker moles or to see the borders of a lesion,” she said. “And I do think that the tattoo artist community should be advising against putting tattoos on pre-existing nevi [moles].”