Tattoo Risks Can Include Masking Skin Cancer

TORONTO - The popularity of tattoos has exploded in recent decades, turning body art from a badge worn mainly by sailors and tough guys to a much more mainstream form of personal expression.

Tats can be safely acquired, as long as the shop you visit follows proper procedures. But they can actually pose a bit of an increased risk when it comes to skin cancer, experts in the field say.

To be clear, there is no evidence linking tattoo ink to an increased likelihood of developing a skin cancer. But tattoos can mask a burgeoning melanoma, making it difficult to track changes in an existing mole or spot a new one as it forms.

"The key point is that it's harder to do the surveillance on moles that are covered by tattoos," says Dr. Hooman Khorasani, director of the skin cancer institute at New York's Mount Sinai Hospital.

"The ink will camouflage the mole, and sometimes interferes with some of the tools that we use for detection."

Dr. Nicolas Kluger, who has seven tattoos of his own, has published a number of scientific studies on tattoos, including a review which looked at whether skin cancers are more common in people with body art. (They are not.)

But Kluger, a dermatologist who is working on a PhD at the University of Helsinki, agrees that tattoos can make it hard to spot what dermatologists call "the ugly ducklings" — the misshapen, mottled moles that are melanoma.

"If you have a huge tattoo on the back, it doesn't pop out as easily as before," says Kluger, who has seen a few melanomas on old tattoos.

Melanoma is cancer of the melanocyte cells of the skin. These are the cells that produce melanin, which gives skin its pigment. It is the deadliest form of skin cancer, and is in fact one of the worst forms of the disease period.

"Melanoma, gram for gram, is one of the most deadly kinds of cancer," says Dr. Mark Faries, director of the melanoma research program at the John Wayne Cancer Institute in Santa Monica, Calif.

There has been an explosion of melanoma diagnoses in recent years. Khorasani says in the United States it is the fastest growing cancer among men, and the second fastest among women after lung cancer. Roughly one American dies of melanoma every hour, he says. Late last week it reportedly claimed the life of "Homeland" actor James Rebhorn.

The Canadian Cancer Society estimated that last year 6,000 Canadians were diagnosed with melanoma, 3,300 men and 2,700 women. In 2013 melanoma was estimated to have made up 1.6 per cent of the 39,400 male deaths to cancer, and 1.1 per cent of the 36,100 female cancer deaths in this country.

Most melanomas are found early, when a cure is highly likely. But any delay in diagnosis and excision of the cancer increases the risk treatment won't succeed.

"If caught at a Stage 1 tumour it's almost always cured. Whereas if it's left in place and even grows to be just a millimetre or two thicker, the chance of it being life threatening goes up substantially," Faries says.

A millimetre is less than the thickness of a dime.

"So a relatively small change in thickness, allowing the melanoma to grow in place if it happened to be missed for whatever reason could have serious implications," he says.

Experts suggest people should routinely check their skin for new moles or existing moles that have changed colour and shape. That is especially important to do if a person has a tattoo.

These experts say people who are getting tattoos should never have one situated on a mole. In fact, Khorasani goes a step further, suggesting people who have a lot of moles should probably avoid getting tattoos.

"I would say: If you are light skinned, if you have lots of moles, I think it would be very silly to get a tattoo," he says.

Kluger discourages people who have already had a melanoma from getting tattoos. And he suggests people who have relatives who have had melanoma — which means their risk is a bit higher than the average person's — should have a dermatologist check their skin first.

He also suggests those people choose a design that isn't dark and large. Go for something lighter, Kluger says.

Another important piece of advice relates to the removal of tattoos. People who decide to undergo laser treatments to get rid of a tattoo must make sure the technician does not apply the laser to moles. That's because the treatment will take the pigment out of the mole as well.

"Not only does the laser remove the ink on the tattoo, but is also removing the ink on the birth mark," says Khorasani. "So it makes it harder for the changes of that mole to be seen."

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