Pigmentation of axillary sentinel nodes from extensive skin tattoo mimics metastatic melanoma: case report

Abstract

Sentinel lymph node biopsy is widely performed in cutaneous melanoma. Histologic confirmation of any enlarged, pigmented SLN is essential prior to radical surgery, especially when pigmented SLNs are found near a tattoo. Tattoo pigments may deposit in the regional lymph nodes and may clinically mimic metastatic disease. A history of tattooing should be considered in all melanoma patients eligible for SLNB. In a finding of darkly pigmented nodes during SLNB, radical lymphadenectomy should be withheld until immunohistologic confirmation of metastasis in the SLN is obtained.

Pigmented lymph nodes in a patient with melanoma: tattoos

“…The benefits of sentinel lymph node biopsy (SLNB) in the treatment of melanoma remain controversial; however, it may be beneficial in some patients. 1 We report a case of a patient with melanoma who showed black pigmented lymph nodes in SLNB due to decorative tattoos. A 26-year-old man presented with a congenital nevus that had changed in the last 3 months.…”

“…5 Eventually, if a tattoo is present or has been present in any body area, the pigment can migrate to the regional lymph nodes through the lymphatic vessels and subsequently mimic metastatic disease from melanoma. 1,5 The methods used to remove tattoos, such as the Q-Switch laser, do not eradicate the presence of the pigment in the lymph nodes. 4,6 Other possible causes of pigmented lymph nodes are anthracitic pigment, dental amalgam, aluminium, titanium, dermatopathic lymphadenitis and hemosiderin-laden macrophages after local trauma or surgery.…”

“…6 But, histological confirmation of an enlarged pigmented node is essential before a radical surgery is performed to avoid morbidity, especially in patients with tattoos. 1,3,4,7 Hence, pigmented lymph nodes needs to be included into the differential diagnosis and the documentation of decorative tattoos is important during the skin cancer screening as well as during the follow-up of melanoma patients. 3,[8][9][10] G. Blasco-Morente, 1, * I. P erez-L opez, 1 A.…”

“…3,[8][9][10] G. Blasco-Morente, 1, * I. P erez-L opez, 1 A. Mart ınez-L opez, 1 J. Aneiros-Fern andez, 2 J. Tercedor-S anchez, 1 S. Arias-Santiago, 1 Successful use of infliximab as first line treatment for severe childhood generalized pustular psoriasis Editor Generalized pustular psoriasis (GPP) is a severe form of psoriasis characterized by an acute onset of widespread sterile pustules on an erythematous background accompanied by a significant systemic inflammatory reaction with pyrexia, arthralgia and malaise. GPP is extremely rare in childhood with the pustular variant occurring in only 1-5.4% of children with psoriasis.…”

Nodal pigmentation due to tattoo pigment does not influence survival of melanoma patients

“…In mouse models, about 32 % of the pigments dissolve out of the tattoo within a time span of 42 days. On histopathological examination, pigment deposits in lymphatic basins may either mimic or mask small amounts of melanoma tumor cells [ 5 ] . Intriguingly, it seems that it is not the amount of pigment that causes a cutaneous reaction, but the ingredients of the pigment [ 3 ] .…”