Massimo has always been fascinated by Munch’s painting, The Scream, until in 2009 he decided to have it tattooed on his arm. But when the tattoo artist suggests that he hide a mole between the black lines of the man’s suit in the painting, Massimo says no, and instead asks to leave it visible, that mole there. “What saved me – he remembers – was the instinct not to have my mole covered”. Which in fact, 11 years later, in 2020, the dermatologist is able to evaluate and remove. The histological diagnosis? Melanoma.
“Never tattoo your moles, you have to keep at least an inch away. Only in this way is it possible to identify any transformation of the mole in time. And save your life, because a late diagnosis of melanoma can be fatal,” he says. Ignazio Stanganelli, director of the Skin Cancer Unit IRCCS Istituto Romagnolo for the Study of Tumors, associate professor of the University of Parma and president of IMI, theItalian Melanoma Intergroup who organized an online meeting on body art and melanomas, entitled “The melanoma hidden in the tattoo”.
Sixty million Europeans and 7 million Italians have undergone at least one tattoo: a sea of men and women (more women than men) has succumbed to the call of an ancient art. But that must be done with awareness, knowing that melanoma is an aggressive tumor, which in Italy affects over 14 thousand people every year and is currently the third most frequent cancer under the age of 50.
False positives: the problem of suspected melanomas
Obviously the question is not that tattoos cause cancer, the problem is that they can delay the diagnosis, because the colors, especially black but not only, hide the moles, hide them from the eyes of both patients and dermatologists. “It is exactly so – confirms Stanganelli – today we do not have data on long-term exposure to inks or sufficient evidence to be able to affirm that the pigments used for this form of body art are carcinogenic. We do know, however, and that tattoos can prevent that a melanoma is recognized “. But not only this: since colors do not allow a correct analysis of moles, tattoos can also favor the phenomenon of false positives. “They are the so-called suspected melanomas – explains the IMI president – In these cases the doctor is always forced to remove the lesion because in fact he cannot discern whether it is a benign or malignant lesion. Finally there is the question of the size of the tattoo. : when the diagnosis is very extensive, it is more difficult for the specialist to identify a mole at risk “.
When it is better not to get a tattoo
It is therefore clear that we are not talking about giving up getting tattooed, if you want to do it, but about getting tattooed taking into account the indications of the experts. “Those who tend to have many moles when young – says Giuseppe Scarcella, national head of the Laser & High tech department of ISPLAD, International and Italian Society of Plastic-regenrative and oncologic Dermatology – are more likely to develop as many as an adult, should undergo to periodic check-ups and avoid getting tattooed. Same thing for those with a familiarity with melanoma or a history of skin cancers “. Here, “I am the example of all this” begins to tell Massimo, who in the webinar tells his story as a patient: he has a fair complexion, many in his childhood and a case of melanoma in the family, but he has no tattoo been able to give up. “I have no regrets for doing it – he says – even if today I wouldn’t do it again”.
Tattooed, tattooed and repentant
According to a survey by the Istituto Superiore di Sanità, the average age of the first tattoo is about 25, although the highest percentage of tattooed people (23.9%) is in the 35-44 age group. Almost all of those who get tattooed, 96.5%, do it for aesthetic reasons, 0.5% for medical purposes and 3% as permanent make-up. 12.8% is the percentage of Italians tattooed, which rises to 13.2% if we also consider the ex-tattooed: one in four, in fact, repents and turns to dermatologists to have the tattoo removed. “Even if the tattoos can be removed with the laser – explains Scarcella – the problem of ‘hidden’ moles remains. The treatment in fact cannot be performed on moles, which are therefore either surgically removed first, or a tattooed contour is left behind. about 3 millimeters around the mole. Which in some cases can lead to a ‘surplus’ of tattoo even of a square centimeter “.
Tattoos prohibited under 16
A striking fact is that of minors: today 7.7% of those who have undergone this practice are between 12 and 18 years old. “A fact that worries because tattoos on a minor can only be done from 16 years onwards – is the dermatologist’s comment – and a written parental release is still required. Unfortunately, the legislation is regional as regards sanctions, but in any case under the age of 16 tattooing is prohibited by law “.
Beyond melanoma
Informed consent is signed by just 26.8% of those who undergo this practice – experts say – which also involves health risks in addition to melanomas. 3.3% of tattooed people report complications, more or less important, a percentage that rises to 6.6% if red or yellow inks predominate. “Among the most common – stresses Scarcella – there is pain (39.3% of cases), eczema and itching (26.7%), allergies (17.5%). In addition, granulomatous reactions can also be triggered (27 , 7%) from a foreign body or sarcoid-like, pseudolymphomatous reactions and pseudoepitheliomatous reactions. In any case, more than half of the people who had a reaction did not consult anyone. 20% turned to the tattoo artist, 10% to a dermatologist and another 10% to the general practitioner “.
The law and illegal activity during the pandemic
In Italy, only those in possession of the certificate of attendance of a specific regional training course who operate in compliance with the health and hygiene requirements provided for by the guidelines of the Ministry of Health are authorized to tattoo. According to the latest census of the Istituto Superiore di Sanità in December 2017, there were 4,103 authorized centers in our country, but according to the Tattoo Association, today this figure has doubled. “We have been fighting for years to ensure that our profession is regulated at national level – declares Massimiliano Freguja Crez, Veneto representative of the Tatuatori.it Association – We ask for clear guidelines regarding training and that recognition be national and not regional , as it is today. This is the only way to guarantee high quality hygienic-sanitary safety for the protection of all and able to counter illegal “, a phenomenon that has increased since COVID: with the closure of authorized centers in the red areas – experts assure – there has been a boom in squatters, with a potential increase in risks for those undergoing tattoos. “The tattoo is the first form of polychrome figurative art – concludes Freguja Crez – and it is full-body: which among other things implies a serious preparation of the tattoo artists because when working on large surfaces of skin it is easier for them to be in the to be safeguarded. Our ability lies in positioning the design in such a way as not to prevent correct diagnosis and treatment of skin cancers and melanomas “.
Inform and disclose
“In this context, the role of information provided by patient associations is also fundamental more than ever. An adequate dissemination program – reflects Giovanna Niero, president of the Italian Association of Melanoma Diseases – would promote awareness of the risks and act as a guide for a better lifestyle, enhancing the relationship between doctors and users. Thanks to awareness and education campaigns – he concludes – melanoma is increasingly recognized by the person who is affected by it or by a family member in the initial stages and consequently it is necessary constantly update all information relating to this highly aggressive skin cancer, from prevention, diagnosis and treatment to the sector of assistance and support for the sick “.
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