Tattoo, or not tattoo…

September 3, 2019

I’ve been quite surprised at the level of interest in my rants to date, positive and negative. I’m flattered that anyone actually reads what I have to say, much less consider a reply (or a riposte)! Thank you to all, both kindred spirits and malcontents.

My son made the decision for me for this month’s topic. Over lunch today he advised my wife and I that he was considering being tattooed. The initial frostiness was slightly thawed, but only slightly, (well…not at all really…) when tempered with his advice that it would constitute a small area of writing on an inner arm, invisible to most, and of significance to him only.

At this point, my life companion advised him of the various negative connotations of tattoos: the negative perceptions of the tattooed; the inevitable regret in years to come; when the permanent nature of the tattoo clashes with the temporary impulse that bore it; or the significance of the image pales or becomes insignificant…how many times we have heard regret mentioned in the same description as the tattoo experience with the passage of time…

I approached the announcement in a similar manner to momentous announcements from my children (now all adults) of similar importance from the past; with a considered silence (read: stony glare) followed by some incisive wit (utterly humorless) and worldly wisdom (born of a lifetime of absolute howlers that I’ve never been brave enough, or are far too embarrassed about, to share with my progeny).

I started with the story about a colleague who shall remain nameless, although a quick Google or Duck Duck Go search will reveal him in good company, who chose to pursue a subspecialty in training for his dermatology specialty in laser therapy, particularly of a cosmetic variety, and particularly relating to tattoo removal. His fees are eye-watering, but rarely complained about by those seeking his skilful removal of unwanted and/or unsightly blemishes. I remember attending a presentation he gave quite some years ago now, when questioned by the audience, our colleagues, he stated candidly that one could take the not inconsiderable cost of the initial artistry, and multiply it by a factor of 10 to 20, depending on the complexity of the procedure, as a ballpark figure for tattoo removal, even without guarantee of complete success.

He explained that different pigments required different frequency of laser light to disrupt them in the skin, and great skill was required to apply only enough energy to disrupt the pigment in the skin, but not cause such tissue insult as to leave visible scarring in place of the original image. As such, he had a range of individual laser devices, much as a painter will have a palette of colours to achieve their pastiche, with which to achieve obliteration of the offending montage. He went on to describe the recent purchase of a new laser device (yttrium or ruby or argon or some such…I can’t remember exactly) at a cost of $50,000…for just one device! And new devices with further target frequencies were becoming available with great rapidity. Impressive tooling up I thought at the time…

But this is not in the mind of he who contemplates the tattoo; consideration of tattoo removal is far from the prefrontal cortex in one so driven. So, I needed the big guns….cancer!

A number of articles in recent times have described lymph node changes^(1,2,3) in fields where tattoo pigments have migrated, that appear scarily-like lymphoma changes. Given the recent emerging tragedy of the rare form of lymphoma associated with insertion of rough textured breast implants⁴,

it strikes me as a fairly short leap to imagine that insertion of a range of chemical substances into your body that have been shown to make their way to your lymph nodes may, with the passage of time, put one at risk of an unforeseen response, perhaps tragically.

It seemed time to lighten the atmosphere a little with a (slightly) more humorous bent.

In a recent medical journal that I was flipping through in my study (actually, on the throne, now I come to think of it), I was intrigued to see reports of burns sustained by tattooed patients undergoing MRI scanning(^5,6). It seems that certain pigments used in tattooing may be susceptible to a “microwave oven” effect when exposed to the intense magnetic fields of MRI scanning, resulting in focal heating of the skin, such that burns have been sustained in some clients. Could it be that your tattoos may render this important diagnostic imaging modality unavailable to you given the risk of significant skin thermal injury?

How convincing were my musings to the young man? Will fashion or common sense emerge victorious?

Dr Alan Underwood

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