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Dr. E’s DOs and DON’Ts: Tattoos

It used to be unusual to see a man or woman with a tattoo, but not anymore. In fact, $1.6 billion is spent in the U.S. each year on tattoos, and 45 million Americans have them. Of that amount, a whopping 40 percent are adults age 26-40. Back in July, we posted a blog on how tattoo ink can be mistaken for the spread of cancer to the lymph nodes. However, on the flip side, tattoo ink can also hide potentially problematic moles by making it hard to evaluate them. Further, it isn’t clear whether or not tattoo inks are safe for the body. While state and local authorities oversee the practice of tattooing, ink and coloring (pigments) used in tattoos are not regulated by the Food and Drug Administration (FDA).

Here are some important things to think about if you have or are considering getting a tattoo:


Check the area you intend to have tattooed. Make sure the skin is free of moles or birthmarks, or have your doctor examine any moles in the area to be tattooed. Fifty percent of all melanomas (the deadliest type of skin cancer) develop in pre-existing moles. Having a tattoo over a mole can make it very difficult to detect the development of skin cancer.

If you see any change in an existing mole, have it examined by a doctor immediately. This is particularly true if the mole shows any of the following “ABDCE” features:

Asymmetry—one side of the mole looks different from the other.
Border irregularity—an edge of the mole is ragged or uneven.
Color variations—there is an uneven mixture of brown, black, tan or red.
Diameter—the mole is bigger than a quarter of an inch.
Evolution—the mole evolves or changes over time, either in size or shape.

Consider tattoos permanent. Removal is time-consuming, costly, and doesn’t always work.

Educate yourself about the risks, which include:

  • Infection—dirty needles can pass infections such as hepatitis and HIV.
  • Scarring—unwanted scarring can occur when getting or removing a tattoo.
  • Allergic reactions to tattoo ink—have been reported in both temporary and permanent tattoos.
  • Granulomas—Small knots or bumps can form, as the body may perceive the tattoo pigment as foreign matter.
  • MRI complications—during an MRI, there could be swelling or burning in the tattoo. If you need to have an MRI, make sure to inform the radiologist or technician that you have a tattoo so that appropriate precautions can be taken.


Assume that tattoo inks are safe. The FDA has not approved tattoo pigments for injection into the skin. To date, there have been no systemic studies to look at their safety, so the long-term health effects remain unknown. Henna isn’t an obvious alternative, as it is only FDA approved for use as a hair dye.

Buy or order online do-it-yourself tattoo removal products. The FDA does not regulate these products, and some contain acid-based products can cause adverse skin reactions and permanent injuries.

Undergo laser therapy to remove a tattoo before checking any moles within the tattoo or having a doctor check them for any possible issues. Once laser removal begins, the laser can also remove the pigment that the melanoma cells make (called melanin), making it more difficult to detect irregular pigment (a red flag for melanomas).

Get a tattoo if you are pregnant. It’s unclear whether tattoo ink is safe for a developing baby.

If you choose to get a tattoo, keep in mind it will probably still be there when you’re old. So ink wisely, if at all. In the words of the inimitable Robin Williams, “You know, you get that tattoo of barbed wire when you’re 18, but by the time you’re 80 it’s a picket fence.”

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