Risk Factors for Squamous Cell Carcinoma: A Case for Red Pigment in Tattoos

Abstract

Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online under ''Instructions for Authors''.) They should be no more than 4 double-spaced pages with no Abstract or sub-headings, with a maximum of four (4) references. If figures are included, they should be limited to two (2). The cost of printing color figures is the responsibility of the author.

Pathogenesis, Diagnosis and Management of Squamous Cell Carcinoma and Pseudoepithelial Hyperplasia Secondary to Red Ink Tattoo: A Case Series and Review

“…However, rapidly evolving lesions localised to the red part of tattoo, most arising within 1 week to 1 year, with 2 years being the longest reported onset for PEH, contradict fortuitous aetiology [ 2 ]. This argument does not prove a non-fortuitous aetiology for SCCs as there are reports of SCCs arising in very old tattoos (McQuarrie et al reports incidence in a 21-year-old red ink tattoo; Sarma et al in a 50-year-old black tattoo) [ 6 , 7 ]. McQuarrie et al fails to demonstrate delay in onset as the time interval from first occurrence of a lesion to cancer diagnosis is not reported [ 6 ].…”

“…McQuarrie et al fails to demonstrate delay in onset as the time interval from first occurrence of a lesion to cancer diagnosis is not reported [ 6 ]. The first occurrence of skin irritation in Sarma et al is reported to be recent to diagnosis; however, this provides no information on the onset of the SCC itself [ 7 ]. PEH’s low incidence, presentation among the young and healthy, coupled with incidence secondary to infections, neoplasia, inflammation and trauma suggest that incidence cannot be purely casual [ 3 , 7 , 8 , 9 ].…”

“…Tattooing is a traumatising process characterised by puncturing of the dermis and the introduction of exogenous materials. Trauma may be a specific triggering factor as most cases of SCC and PEH arise within the first year after tattooing [ 7 ]. PEH has also reported post Mohs micrographic surgery, reaffirming a potential role for trauma [ 10 ].…”

“…The chronic inflammation post-tattoo placement is thought to be more strongly associated with development of SCC due to later onset of development compared to PEH [ 14 ]. However, trauma alone cannot explain the rise of SCC or other cutaneous manifestations within an individual pigment colour [ 7 ]. If the trauma, scarring process or chronic inflammation play such an important role, we would expect a much higher incidence of SCC and PEH in all traumatic processes and not only tattoos.…”

“…Between the cases reviewed, the longest reported interval between onset of PEH and tattoo procedure was 2 years [ 2 ]. In contrast, SCC can present 50 years post-tattoo [ 7 ]. Attention to clinical details coupled with histological evaluation can minimise the chance of diagnostic errors and optimise treatment and follow-up.…”