Nurse Self-Care: Just Say 'No' to Tattoos

I must be getting old. I sound just like my mother. What's with all this "body art"? I don't understand its popularity. In the past, GIs returning home from war sometimes arrived with a singular piece of sentiment on their arms, offering testimony to their military service or a romantic attachment. But what a colossal paradigm shift we have seen in recent years.

Recently in Lancet Oncology, two Finnish physicians published an insightful review article on the relationship between tattoos, inks, and cancer.¹ They identified concerns emanating from the following:

• The precise composition of tattoo ink is not regulated. The introduction of exogenous pigments and dyes to obtain a permanent design (i.e., tattooing) represents a unique in-vivo scenario where a large amount of metallic salts and organic dyes are retained in the skin for a lifetime. The long-term effects of such practices are not known, nor is the relationship of these effects to the quality of the tattooing process.
• The introduction of carcinogenic, pro-carcinogenic, and geno-toxic compounds directly into the dermis is potentially problematic specific to their association with a heightened risk for skin cancers, especially since the capacity of skin to clear toxic products is not well understood.

Critical unknowns should prompt questioning for those considering tattooing. First and foremost, this is a fairly contemporary practice of which the long-term implications are unknown. Even the existence of current negative sequelae may be under-reported. A tattoo may mask underlying skin pathology, and tattooing a nevus could further traumatize it and trigger pathological modifications.

The effects of tattooing on areas with excessive ultraviolet light exposure is unknown, as is the impact of this procedure in individuals with high-risk skin types. Of particular relevance is the potential for pigment assimilation to lymphatic vessels and even distant organ migration. Additionally, the link between the amount of skin surface tattooed, the location of the tattoo, and the colors used in tattoo inks is unknown in regard to its potential pathology.

Tattooing has gained significant popularity in developed countries over the past two decades. Of special note is the prevalence of tattooed Americans. In the United States, approximately one in four individuals between the ages of 18 and 50 has a tattoo, whereas in Europe and Australia, this estimate is closer to 10 percent.²

This contemporary social practice warrants concern despite the lack of definitive outcomes. Could this be the early twenty first century's tobacco exemplar? What is the role of oncology nurses at this juncture?

References:

1. Kluger N & Koljonen V (2012). Tattoos, inks, and cancer. The Lancet Oncology, 13(4): e161-e168.
2. Lauman A & Derick A (2006). Tattoos and body piercings in the United States: A national data set. Journal of the American Academy of Dermatology, 55( ): 413-421.