Atypical Intraepidermal Melanocytic Proliferation Masked by a Tattoo: Implications for Tattoo Artist

by Science Editor

This article looks at how tattoos can mask carcinomas and melanomas in the skin and how the careful examination of skin prior to and after tattooing is needed to detect any changes in the skin

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Atypical Intraepidermal Melanocytic Proliferation Masked by a Tattoo: Implications for Tattoo Artists and Public Health Campaigns.

Abstract: The Authors; present a case of an atypical intraepidermal melanocytic proliferation masked by a large tattoo in a 39-year-old Caucasian male. Tattooed skin can be difficult to examine, particularly when the tattoos are dark, pigmented, and extensive. We demonstrate that a careful examination of tattooed skin leads to the early detection of atypical melanocytic proliferations.

We present an extensive review of literature related to the relationship between tattoos and skin cancer, as well as public health recommendations for tattoo artists and individuals seeking to obtain tattoos. We urge a vigilant examination of tattooed skin and encourage collaboration between dermatologists and tattoo artists in promoting the detection of suspicious lesions prior and following tattooing
Industry Significance Rating:

Medium - Industry wide monitoring is recommended.


Cureus. 2018 Jul 13;10(7):e2975. doi: 10.7759/cureus.2975.

Authors: Kristina Navrazhina, Barry Goldman, Marie C. Leger.
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The authors present a case of atypical intraepidermal melanocytic proliferation masked by a large tattoo coupled with high resolution cytology images of excised tissue. The authors make the observation that based on their review there are a relatively small number of cases of melanoma in tattoos reported in the medical literature (17) and those cases of melanoma and basal cell carcinoma tended to appear more often on black tattoos in contrast to squamous cell carcinoma, keratoacanthomas, and benign pseudo-epitheliomatous hyperplasia cases in tattoos which seem to have occurred more often in association with red tattoos.

The authors make the compelling argument that although a causal link between tattoos and melanoma has not been established, early detection of melanocytic changes may be masked by tattoos, therefore those people who are in higher risk groups "
Individuals with numerous nevi, atypical mole syndrome, or a family history of melanoma" should consider having a dermatological exam prior to undergoing tattooing and those who do have tattoos would should consider "close monitoring of tattoos and regular skin examinations to facilitate the early diagnosis and treatment of developing skin malignancies".

In an article published here on in our Educational Articles section;
"Carcinomas in Tattoos a Statistical Anomaly"

We mention that currently there is not a standardised mandatory reporting system for cancers in tattoos which may go some way towards explaining the unexpectedly low incidence of cancers in tattoos relative to the incident rates of cancers in un-tattooed skin.

The authors mention that a large proportion of tattooist (90%) have expressed an interest in undergoing further education in skin conditions, no doubt that this would a positive impact on early detection and referral however it would also require a standardised approach to the provision of education and clearly identified boundaries for the degree of advice to be provided by tattooist to their client base.


Any client who has one of the following;

  • Numerous nevi (numerous moles/pigmented skin lesions)

  • Atypical mole syndrome (also referred to as dysplastic nevi) - Unusual looking moles (large and irregular), multiple moles on their skin (e.g. 50 or more) and the condition may also run in their family.

  • Family history of melanoma

  • Unusual skin lesions or active skin condition

Should be advised to seek advice from a dermatologist prior to undergoing tattooing
All clients with tattoos should consider undergoing regular skin checks (particularly those with body art that obscures the underlying skin) to aid in early detection of skin changes.


Scientific Report,  moles, nevi, nevus, atypical melanocytic proliferation, early detection, melanoma, public health, tattoo


The Education Team here at keeps a close eye on the scientific and medical literature for new publications relating to cosmetic and medical tattooing that may be of interest to our customers. The intent is to alert industry members to important publications within the literature to expand the knowledge base particularly in relation to high impact reports.

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