Tattoos and Melanoma Risk

Tattoos and Melanoma: A Surprising Signal from a Large Population Study by Alexander Stratigos, MD

INTRODUCTION Tattoos are increasingly common worldwide, yet their long-term health implications—particularly in relation to skin cancer—remain incompletely understood. While tattoo inks may contain potentially carcinogenic substances and induce chronic inflammatory responses in the skin, epidemiological evidence linking tattooing to melanoma has been scarce and conflicting. A new large populationbased case–control study offers timely and provocative data, challenging prevailing assumptions and opening new avenues for research. MAIN POINTS Study design:  Population-based case–control study including 1,167 melanoma cases (in situ and invasive) and 5,835 matched controls from Utah, the US state with the highest melanoma incidence Results: Overall tattoo exposure: Ever having a ta#oo was not associated with melanoma risk overall (OR 0.92, 95% CI 0.74–1.13), nor with invasive melanoma (OR 0.81, 95% CI 0.60–1.09). Dose-related findings: Individuals with ≥4 tattoo sessions had a 56% lower risk of melanoma (OR 0.44, 95% CI 0.27–0.67) and a similar reduc7on for invasive melanoma (OR 0.43,95% CI 0.24–0.80). Those with ≥3 large tattoos showed an even stronger inverse association (overall melanoma OR 0.26, 95% CI 0.10–0.54; invasive melanoma OR 0.23, 95% CI 0.07–0.75). Receiving the first tattoo before age 20 was associated with a reduced risk of invasive melanoma (OR 0.48, 95% CI 0.29–0.82). Sex-specific differences: Among men, ≥4 tattoo sessions were associated with a marked reduction in melanoma risk (overall OR 0.25, 95% CI 0.09–0.53; invasive OR 0.15, 95% CI 0.04–0.62). Among women, associations were weaker and mostly non-significant (≥4sessions: overall OR 0.64, 95% CI 0.36–1.07). Low-level exposure signal: A single tattoo session was associated with an increased risk of in situ melanoma, particularly in women (overall OR 1.53, 95% CI 1.16–2.00; women OR 1.90, 95% CI 1.30–2.74), suggesting possible detection or behavioral bias. No evidence of colocalization: Fewer than 7% of tattooed melanoma cases reported a melanoma arising within 6 inches of a tattoo, arguing against a direct local carcinogenic effect.

Comment In this large population-based case–control study, tattooing was not associated with an increased risk of melanoma. Unexpectedly, higher levels of tattoo exposure (multiple tttoo sessions or several large tattoos) were associated with a lower risk of melanoma, particularly invasive disease and more prominently among men. While these findings challenge long-standing concerns about tattoo inks and carcinogenicity, the authors emphasize that unmeasured confounding and behavioral factors may partly explain the results, and further research is needed.

McCarty RD, Trabert B, Collin LJ, et al. Ta7ooing and risk of melanoma: a populaAon-based case-control study in Utah. J Natl Cancer Inst. 2025 Dec 1;117(12):2495-2504. doi: 10.1093/jnci/djaf235. PMID: 40839395

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

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