Manganoni Ausilia Maria, Sereni Elena, Pata Giacomo, Ungari Marco, Pavoni Laura, Farisoglio Camillo, Calzavara-Pinton Pier Giacomo, Farfaglia Roberto
Department of Dermatology, Brescia Civic Hospital, Brescia, Italy.
Int J Dermatol. 2014 Jun;53(6):773-6. doi: 10.1111/ijd.12417. Epub 2013 Dec 30.
The relationship between the occurrence of skin diseases and skin tattoos remains unclear. Dermatologic disorders have been reported to occur in about 2% of cases. In addition, tattoo pigment can migrate to the regional lymph nodes through the lymphatic vessels and subsequently mimic metastatic disease from melanoma.
A 23-year-old Caucasian man presented with a pigmented lesion on the left scapular region, which had slowly enlarged over time. The patient exhibited an extensive tattoo on the left upper arm, left shoulder, and part of the upper back. His medical history was unremarkable. The pigmented lesion was excised. Histology confirmed malignant melanoma. Ultrasound examination of the abdomen, neck, and inguinal and axillary lymph nodes and a total body computed tomography scan showed no sign of disease. A re-excision with 2-cm margins and sentinel lymph node biopsy (SLNB) were performed. Two grossly enlarged, black sentinel lymph nodes (SLNs) highly suggestive of melanoma metastases were removed.
No evidence of melanoma metastasis was found in any of the sampled tissues. Large amounts of pigment were present within the subcapsular space and sinusoid areas of the two clinically suspicious lymph nodes. Immunohistochemical analysis was negative.
Sentinel lymph node biopsy is widely performed in cutaneous melanoma. Histologic confirmation of any enlarged, pigmented SLN is essential prior to radical surgery, especially when pigmented SLNs are found near a tattoo. Tattoo pigments may deposit in the regional lymph nodes and may clinically mimic metastatic disease. A history of tattooing should be considered in all melanoma patients eligible for SLNB. In a finding of darkly pigmented nodes during SLNB, radical lymphadenectomy should be withheld until immunohistologic confirmation of metastasis in the SLN is obtained.
皮肤疾病的发生与皮肤纹身之间的关系仍不明确。据报道，约2%的病例会出现皮肤疾病。此外，纹身色素可通过淋巴管迁移至区域淋巴结，随后可能酷似黑色素瘤的转移性疾病。
一名23岁的白种男性，左肩胛区出现一个色素沉着病变，该病变随时间缓慢增大。患者左上臂、左肩及上背部部分区域有大面积纹身。其病史无异常。切除该色素沉着病变。组织学检查确诊为恶性黑色素瘤。对腹部、颈部、腹股沟和腋窝淋巴结进行超声检查及全身计算机断层扫描，未发现疾病迹象。进行了切缘为2厘米的再次切除及前哨淋巴结活检（SLNB）。切除了两个明显肿大、呈黑色的高度怀疑为黑色素瘤转移的前哨淋巴结（SLN）。
在任何采样组织中均未发现黑色素瘤转移的证据。在两个临床可疑淋巴结的被膜下间隙和窦状隙区域存在大量色素。免疫组织化学分析为阴性。
前哨淋巴结活检在皮肤黑色素瘤中广泛应用。在根治性手术前，对任何肿大的色素沉着前哨淋巴结进行组织学确诊至关重要，尤其是当在纹身附近发现色素沉着前哨淋巴结时。纹身色素可能沉积在区域淋巴结中，临床上可能酷似转移性疾病。所有符合前哨淋巴结活检条件的黑色素瘤患者都应考虑纹身史。在前哨淋巴结活检中发现色素沉着较深的淋巴结时，在获得前哨淋巴结转移的免疫组织学确诊之前，应暂缓进行根治性淋巴结清扫术。
