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Delayed reaction to tattoo ink can mimic cancer

Doctors originally thought a 30-year-old woman's swollen lymph nodes were a sign of cancer, but they were a symptom of a tattoo reaction.
/ Source: TODAY

When a 30-year-old Australian woman showed up at a medical clinic with swollen lymph nodes under her arms, doctors initially suspected she might have cancer. After a detailed examination, they determined the woman’s enlarged lymph nodes were the result of a reaction to tattoos the woman had acquired years earlier, according to a report published in the Annals of Internal Medicine.

On their initial examination, doctors felt a number of “rubbery” lymph nodes some of which were over half an inch in diameter. The woman’s blood tests were normal as were chest x-rays. Scans of the woman’s enlarged nodes suggested they might be lymphoma related.

But when one of the nodes was removed to be examined, they found it was not only enlarged, but also discolored. Still, the blackened node no cancer cells. Ultimately the woman’s doctors concluded that what they were observing was a reaction to the dye used in the woman’s tattoos.

"This is a reminder that the immune system is designed to remove foreign material and tattoo pigment is no exception," said coauthor Christian Bryant, a hematologist at the Royal Prince Alfred Hospital in Sydney.

Bryant suspects that immune cells were eating away at the ink in the tattoos and carrying it back to the lymph nodes. There "the pigment was 'walled off' in special structures designed to contain irritating substances," Bryant explained.

She had gotten her first tattoo on her back 15 years earlier. She got inked a second time two-and-a-half years before the swollen nodes developed.

After researching the literature on tattoo reactions, the authors learned that reactions to ink can take as long as 30 years to occur. And some doctors had mistaken the swollen lymph nodes as indicative of melanoma.

The new report, however, was the first case in which scans had been done that backed up a diagnosis of cancer — which is why the woman had surgery to have a lymph node removed for examination. When doctors saw the blackened node they realized what had happened.

It's unknown how often this kind of reaction occurs, although it's considered rare.

But Dr. Laura Ferris wasn’t surprised by the new report. “This is something we occasionally see,” said Ferris, an associate professor of dermatology at the University of Pittsburgh. “Sometimes people forget there can be medical consequences to having a tattoo.”

Those potential consequences are why “getting a tattoo may not be a great idea,” Ferris said.

People don’t know in advance if they will be allergic to the ink, Ferris said. “And this is something that’s there forever,” she added. “Getting tattoos is risky.”

While it’s a good idea to do your research to find a reputable tattoo artist, “you can have the most clean professionally done tattoo and still be allergic to the dye,” Ferris said.

Making matters worse, as in this case, the reaction can occur many years after the tattoo is inked into your skin, Ferris said. So doctors might not immediately realize that they're looking at a reaction to the tattoo ink.

"This woman had surgery that she would have never needed," Ferris said.

Other fallout from getting a tattoo can include rashes, infections, sarcoidosis—an inflammatory disease that affects the entire body—and even death. In a report published in June doctors described how a man developed sepsis and died after swimming with a newly inked tattoo.