Page 62 - JSOM Fall 2024

in identifying malignancies within tattoos, even upon close milestones in an individual’s identity development or life story.
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examination. Thus, tattoos may delay the treatment of skin Studies show that people get tattoos to celebrate accomplish-
cancers, thereby increasing the likelihood of metastases and ments, honor losses, recall memories, or encourage persever-
death. 38 ance. Tattoos can also represent personal challenges or serve
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as reminders to motivate behavioral changes. Thus, skin art
The debate over whether tattoo ink can cause malignancies allows SOF medics to learn more about their patients. Accord-
has been ongoing for more than a decade. The relationship ing to Dougherty and Koch, tattoos “often are used to convey
between skin cancers and tattoos has been deemed coinciden- information about what the wearer would like others to know
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tal. However, a study published earlier this year appears to about them as they move about in public, simply being ob-
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be the first to establish an association between tattoo ink and served or inviting conversation and questions.” This is par-
an increased risk of malignant lymphoma. After adjusting ticularly true for tattoos on generally uncovered or minimally
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for smoking status and other factors, individuals with tattoos covered body parts such as hands, arms, and the neck. By in-
had a 21% increased risk of lymphoma compared with those quiring about or commenting on tattoos during examination
without. Interestingly, the study did not identify the size of the and treatment, medics can establish rapport, distract patients
tattoo as a significant factor but rather the time span since from discomfort, and foster a sense of connection.
tattoo acquisition: the risk seemed more pronounced for indi-
viduals with tattoos less than 2 years old and those older than Acknowledgments
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a decade. The research team hypothesizes about time-related The author would like to thank the anonymous reviewers for
changes in the toxicokinetics of ink pigments to explain the commenting on the earlier version of this paper.
observed time effect. Ultimately, additional studies are needed
to understand the complex relationship between time, tattoo, Disclosures
and lymphoma. The author has no conflict of interest to declare.

Some servicemembers may opt for so-called inkless tattoos. Funding
Similar to ink-based tattoos, the tattooing needle pierces the The author has not received any funding or financial support
skin but does not contain any colorants. The tattoo design is for this article.
achieved through skin scarring. It is worth noting that med-
ical literature discusses not only the carcinogenicity of ink References
pigments but also the tattooing procedure itself as a potential 1. Messahel A, Musgrove B. Infective complications of tattooing
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factor contributing to carcinogenesis. More specifically, tat- and skin piercing. J Infect Public Health. 2009;2(1):7–13. doi:
10.1016/j.jiph.2009.01.006
too needle trauma, especially in tattoos that have been altered 2. Isaacs T, Ngwanya RM, Lehloenya RJ. Tattoos: A summary knowl-
repeatedly (“overworked tattoos”), has been hypothesized as edge for the practising clinician. S Afr Med J. 2018;108(9):714–
a relevant factor. 41 720. doi:10.7196/SAMJ.2018.v108i9.13231
3. Krutak L. The cultural heritage of tattooing: a brief history. Curr
Tattoos are currently being studied for potential new roles in Probl Dermatol. 2015;48:1–5. doi:10.1159/000369174
medicine. Because interstitial fluid is considered equivalent to 4. Winn AE, Rivard SC, Green B. Lesions arising in a tattoo of an
active duty US Marine Corps woman. J Spec Oper Med. 2016;
blood in terms of biomarker composition, scientists are devel- 16(2):96–100.
oping ways to replace ink pigments with biosensors to moni- 5. United States Food and Drug Administration. FDA issues draft
tor biomarker concentrations in interstitial fluid. Such tattoo guidance on tattoo inks. Published June 12, 2023. Accessed June
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functionalization could provide a reversible, biocompatible, 5, 2024. https://www.fda.gov/cosmetics/cosmetics-news-events/fda
real-time, and minimally invasive means of biosensing, which -issues-draft-guidance-tattoo-inks
would be useful for monitoring biochemical processes in SOF 6. Weiß KT, Schreiver I, Siewert K, et al. Tattoos – more than just
colored skin? Searching for tattoo allergens. J Dtsch Dermatol
personnel during both training and deployment. 42,43 However, Ges. 2021;19(5):657–669. doi:10.1111/ddg.14436
certain tattoo inks may still pose obstacles to health moni- 7. Serup J, Hutton Carlsen K, Sepehri M. Tattoo complaints and
toring and diagnosis. For instance, colorants containing heavy complications: diagnosis and clinical spectrum. Curr Probl Der-
metals such as lead, cadmium, and chromium may interfere matol. 2015;48:48–60. doi:10.1159/000369645
with medical equipment and imaging techniques, most notably 8. Giulbudagian M, Battisini B, Bäumler W. Lessons learned in a
magnetic resonance imaging. 44 decade: Medical-toxicological view of tattooing. J Eur Acad
Dermatol Venereol. Published online May 6, 2024. doi:10.1111/
jdv.20072
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Tattooing turns normal skin into abnormal skin. Fortunately, 9. Dieckmann R, Boone I, Brockmann SO, et al. The risk of bacterial
this often causes neither bodily discomfort nor disease. How- infection after tattooing. Dtsch Arztebl Int. 2016;113(40):665–
ever, an increasing number of case reports suggest notable ex- 671. doi:10.3238/arztebl.2016.0665
ceptions and fatal outcomes. According to one such report, an 10. Islam PS, Chang C, Selmi C, et al. Medical complications of tat-
otherwise healthy 34-year-old male with a recent tattoo on toos: a comprehensive review. Clin Rev Allergy Immunol. 2016;
50(2):273–286. doi:10.1007/s12016-016-8532-0
his right forearm suffered infective endocarditis. Consider- 11. Bonadonna L. Survey of studies on microbial contamination of
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ing both the rarity and substantial morbidity associated with marketed tattoo inks. Curr Probl Dermatol. 2015;48:190–195.
endocardial infection, this case report serves as an illustrative doi:10.1159/000369226
warning of the complex reactions secondary to the application 12. Silvestre JF, Villanueva González I. Diagnostic approach for sus-
of tattoos. pected allergic cutaneous reaction to a permanent tattoo. J Inves-
tig Allergol Clin Immunol. 2019;29(6):405–413. doi:10.18176/
jiaci.0383
Additional Note 13. Chalarca-Cañas D, Caviedes-Cleves MA, Correa-Londoño LA,
Ospina-Gómez JP, Velásquez-Lopera MM. Tattoos: risks and
In the absence of adverse health reactions, tattoos can be a valu- complications, clinical and histopathological approach. An Bras
able resource for SOF medics. Tattoos often mark significant Dermatol. 2024;99(4):491–502. doi:10.1016/j.abd.2023.07.004

60 | JSOM Volume 24, Edition 3 / Fall 2024