Malignant melanoma arising at tattoo sites used for radiotherapy field marking

Various malignant and benign neoplastic lesions have been noted in the past to appear on tattoos (Auger, 1943; Bashir, 1976; McQuarrie, 1966). The development of malignant melanoma in a tattoo has been noted to occur in only a few cases (Kirsch, 1969; Sharlit, 1938; Wolfort et al., 1974). We are reporting hereunder two patients with malignant disease previously treated by surgery and radiotherapy, one developing a primary and the other a metastatic melanoma in tattoo sites used for marking a radiation field. This possible result of radiation and tattooing appears to be, to the best of our knowledge, the first cases in the literature. Case No. 1: A 52-year-old caucasian female with a previous history of tonsillectomy, psoriasis and fibroadenoma of her right breast underwent, in August 1975, left radical mastectomy for intraductal schirrus adenocarcinoma. Three of the eight axillary lymph nodes were invaded by the tumour. Subsequently, the patient received radiotherapy by 60Co γ rays to a total of 3600 cGy (rad) to the suprasternal, axillary, internal mammary and tangential fields. Indian ink was used for marking the radiation fields. The patient was without evidence of disease until June 1977, when a bleeding nevus 0.5 × 1.0 cm was observed on a tattoo at the border of the left tangential chest-wall field. The lesion was excised and on histology a malignant melanoma Clark Level II was found.