Tattoo pigment in an axillary lymph node simulating metastatic malignant melanoma.

Breast Unit and Pathology Department Mayday University Hospital, London Road, Croydon, CR7 7YE, Surrey UK.
International Seminars in Surgical Oncology 02/2005; 2:28. DOI: 10.1186/1477-7800-2-28
Source: PubMed

ABSTRACT We report a case of axillary lymphadenopathy thirty years after a decorative tattoo clinically mimicking metastatic melanoma. The importance of relying on histological confirmation of metastatic disease before altering extent of surgery is discussed. The importance of recording presence of decorative tattoos is stressed.

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    ABSTRACT: Background: Previously described methods for removal of tattoos are chemical, mechanical, surgical, termal and laser assited methods. Invention of the Q-switch mode, advanced the laser method, to be one of the most effective methods of tattoo removal. Objective: Comparing the tattoo removal and rate of lymphatic elimina-tion of 3 different wavelengths of Q-switched Nd-YAG laser (532nm, 1064nm, combination 532 + 1064). Methods: In this study we examined lymphatic elimination and the effect of 532 nm, 1064 nm, and the com-bination (532 + 1064 nm) wavelength of laser pulse for the possible lymphatic cleansing mechanism of black pigmented tattoos. This study was performed on 18 New-Zealand rabbits, black pigmented tattoos were en-graved on the back and the four extremities of the animals. 532 nm wavelength of Q switched Nd: YAG la-ser beam was applied on the left upper and bilateral lower extremities of the rabbits. During this period, ex-cisional skin biopsies and lymph node biopsies were performed on days 7, 14 and 21. Results: Day 21 lymph node biopsies revealed mixed type of reactive hyperplasia and intracellular pigments were markedly seen in the laser treatment group and no intracellular tattoo pigment was seen in the control group. Conclusion: The findingd of this study indicate that lymphatic elimination may be one of the significant mechanisms of tattoo removal and the application of different wavelengths of Q-switched Nd-YAG laser do not show statistically significant differences in tattoo removal.
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    ABSTRACT: The case of a 37-year-old man with a Clarkes level III, Breslow thickness 1.2 mm superficial spreading melanoma of his forearm is described. Intraoperatively, a black-pigmented ipsilateral axillary sentinel lymph node, highly suspicious for metastatic disease, was harvested. The patient had a faded tattoo in the vicinity of the malignant melanoma. Histological examination of the lymph node demonstrated normal lymphoid tissue and the presence of pigmented macrophages due to tattoo ink. Metastatic malignant melanoma was ruled out.The importance of histological confirmation of an enlarged pigmented node before complete dissection of the regional lymph nodes is discussed. The importance of recording the presence of decorative tattoos is stressed as the tattoo pigment may clinically mimic metastatic disease in those with malignant melanoma undergoing sentinel lymph node biopsy.
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