TATTOO PIGMENT MIMICKING METASTATIC MALIGNANT-MELANOMA

BACKGROUND. The benefits of elective lymph node dissection (ELND) in t he treatment of melanoma remain controversial, however, it may be bene ficial in some patients. Tattoo pigment from decorative tattoos may mi grate to the regional lymph nodes. In patients who develop malignant m elanoma and who have been tattooed, this pigment may clinically mimic metastatic disease. OBJECTIVE. We wish to alert clinicians that pigmen t from tattoos may migrate to the regional lymph nodes. In the unusual instance of a tattooed patient who develops malignant melanoma, when undergoing ELND, surgeons should rely on histologic confirmation of me tastatic disease before altering operative plans. METHODS. ELND for ma lignant melanoma, in a patient with a history of decorative tattoos th at had been removed by dermabrasion, was performed. Black lymph nodes that clinically resembled metastatic disease were identified. Subseque nt histologic examination revealed normal lymph node architecture with a heavy collection of black pigment. Mass spectrophotometry showed th is pigment to be consistent with tattoo dye. RESULTS. A patient who ha d undergone dermabrasion for removal of decorative tattoos developed m alignant melanoma in the same extremity. Clinically suspicious black l ymph nodes were identified during ELND. Histologic examination did not reveal metastatic disease. Additional therapy was not considered intr a- or postoperatively even though the clinical suspicion of metastatic disease was high. The patient was not subjected to any unnecessary em otional or physical distress pending histologic confirmation. CONCLUSI ONS. Tattoo pigment in the lymph nodes may clinically mimic metastatic melanoma. Histologic confirmation of metastatic disease should always be obtained before additional therapy is considered.