Removal of radiation-related tattoos among breast cancer survivors using a 20-nanosecond Q-switched Ruby laser

Permanent dark ink tattoos for radiotherapy (radiation-related tattoos) play a critical role in breast cancer management by ensuring accurate field localization and consistent patient positioning. While effective, these markings persist permanently and may negatively impact body image and quality of life. Laser tattoo removal using selective photothermolysis is the standard of care for tattoo removal, with the 20-nanosecond Q-switched ruby laser (QSRL) particularly suited for targeting dark dermal pigment. We evaluated the safety and efficacy of QSRL for the removal of radiation-related tattoos in breast cancer survivors. A prospective, single-center interventional study of female breast cancer survivors with radiation-related tattoos. Eligible participants underwent up to 6 QSRL treatment sessions. Outcomes were assessed by 2 independent dermatologists through blinded evaluation of pre- and post-treatment photographs using the Global Aesthetic Improvement Scale (GAIS), patient satisfaction scores, and body-image questionnaires. Adverse effects were documented as well. Seven patients were included with a total of 23 tattoos. Significant improvement or complete resolution (average GAIS ≥ 3) was noted in 91% of treated tattoos, with strong inter-rater agreement (87%). Treatment was well-tolerated, with mild-to-moderate, short-lived pain during the procedure and minimal downtime. Patient satisfaction was high and no adverse events were reported. QSRL is a safe, effective, and well-tolerated modality for removing radiation-related tattoos in breast cancer survivors and may represent a valuable component of comprehensive post-treatment care for eligible patients.