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Malignant melanoma developed on nevus within tattoo during laser removal

A malignant melanoma developed on a preexisting nevus within a tattoo during the laser removal process, according to researchers, who found very few similar cases in a literature review.

Researchers in Germany reported on a white patient, aged 29 years, who presented at a laser clinic in 2001 to have multicolored tattoos removed from his arms and chest. The tattoos had been applied 10 years earlier. Before treatment, the patient had a nevus on his right shoulder and had been advised to have it excised, but he declined. Initial dermoscopy findings showed no atypical signs.

In 2002, tattoo removal was initiated using a Q-switched Nd:YAG laser, with only partial treatment applied during each session because of the size of the tattoos. After 43 sessions, there was a loss of response, and treatment was switched to Q-switched alexandrite laser.

After 47 sessions, the patient agreed to have the nevus excised when the clinic made excision conditional for continued treatment. Dermoscopy findings then showed characteristics of an early melanoma, a Clark level II superficial spreading malignant melanoma with a Breslow thickness of 0.45 mm. There were no abnormalities found in chest radiography and lymph node ultrasonograph. The patient refused a second excision with a free margin.

In an English literature review conducted by researchers, 16 cases reported documented episodes of malignant melanoma developing within tattoos, and tattoo placement and malignant melanoma development showed no clear association.

“In the course of Q-switched laser treatment, pigmented cells can lose pigmentation, thus making assessment of melanocytic lesions more difficult,” the researchers reported. “For safety reasons, tattoos should never be placed on pigmented lesions. If they are, the tattoos should not undergo laser treatment.

“We suggest an excision before starting laser tattoo removal. Dermoscopic assessments on a regular basis during the period of tattoo removal are recommended.”

Disclosure: The researchers report no relevant financial disclosures.