Dermatologists have called for tattoo parlours to provide more information on the health risks of tattoos, particularly in relation to how they may impede the diagnosis and management of skin cancers.

In a case series published in the Australasian Journal of Dermatology, UK clinicians describe patients in whom tattoo ink pigmentation has obscured changes in moles and hindered dermatologic assessment.

In one case cited by the doctors from the Nottingham University’s Department of Dermatology, a 76‐year‐old male only became aware of a superficial spreading melanoma on his forearm when the lesion spread beyond the edge of the tattoo pigmentation, by which time it had a Breslow thickness 4.9 mm.

“The patient expressed concern that the tattoo had resulted in a delayed detection of his melanoma despite regular monitoring. This demonstrates the challenge of detecting sinister changes to pigmented lesions situated within a tattoo,” they wrote.

Extensive tattooing also has implications for reconstructive skin grafting, they warned. One of their patients underwent Mohs micrographic surgery for a 10 mm morphoeic basal cell carcinoma of the right medial canthus, but all optimal donor sites for a full‐thickness skin graft  were covered by tattoos.

“The patient expressed if he had known this potential challenge could occur he may not have proceeded with such extensive tattoo art,” they said.

A renal transplant patient also expressed regret about his tattooing across his trunk and limbs because it made his skin cancer monitoring checks difficult, they noted.

“These cases highlight the potential delay to diagnosis of cutaneous malignancy when tattoo ink masks a pre‐existing pigmented lesion and when de novo non‐melanoma malignancy arises within extensive tattooing,” they said.

“We suggest the need for additional education in tattoo parlours, the media and in the public forum to ensure those having tattoos fully understand the potential implications of tattooing.