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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Currently&#44; decorative tattoos are widespread&#44; with a prevalence greater than 25&#37; in the United States in individuals aged between 18 and 50 years&#44; and a slightly lower prevalence in Europe and Australia&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Depending on the series&#44; in the last 40 years&#44; between 18 and 50 cases of malignant melanoma have been reported after tattoos for decorative purposes or for radiotherapy &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and B&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> The first case report dates from 1938&#44; but it was not until 1969 that Kirsch described a melanoma with axillary lymph node metastasis in an arm where the patient had had a tattoo 27 years previously&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Currently&#44; we are seeing an increase in the number of cases of melanoma diagnosed in patients who had been tattooed previously&#46; Although this association may merely be a coincidence&#44; it is important to reflect on a couple of points of importance given their diagnostic and therapeutic ramifications&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">First&#44; from the pathogenic point of view&#44; 4 factors have been suggested that could explain this relationship&#58; A&#44; trauma associated with the tattoo&#59; B&#44; local catabolites produced after introducing the ink&#59; C&#44; photoreaction secondary to introducing the ink in the dermis and hypodermis&#59; and D&#44; the chronic inflammatory process that persists after tattooing&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Second&#44; it is important to reflect on why melanoma appears on tattoos that are predominantly black and blue&#44; whereas nonmelanoma skin cancer appears on reddish pigments&#44; although to date no causal relationship has been established&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> We should remember that pigments based on mercury&#44; cobalt sulfate&#44; and other soluble salts are classed as group 2B agents of possible human carcinogens&#44; whereas cadmium and its derivatives belong to group I of the International Agency for Research on Cancer &#40;carcinogenic for humans&#41;&#44; and that the composition of tattoo inks is not internationally regulated or standardized&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It is important to note that the use of mercury pigments and other heavy metal pigments that were used in the past is now forbidden for any type of pigment production&#44; although they may be present as impurities&#46; Thus&#44; nowadays&#44; metal pigments have been replaced mainly by synthetic azoic and polycyclic pigments&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Klujer and Koljonen&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> who in 2012 published an interesting review on the association between skin cancer and tattoos&#44; remind us that any potential link would be multifactorial&#46; Trauma is not considered a direct pathogenic factor for melanoma&#59; moreover&#44; tattoos are often done on skin with extensive intermittent exposure to sunlight&#44; and this factor clearly is associated with malignant melanoma&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Finally&#44; it is important to note the complications derived from dermatoscopy<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and diagnostic techniques such as selective lymph node biopsy&#46; The presence of pigment in regional lymph nodes may be responsible for diagnostic errors&#44; and these should be recognized by the dermatology surgeon and consultation with the pathologist is essential in all cases&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion&#44; we should be alert to this new reality in our clinics to avoid delays in diagnosis of melanoma on tattoos&#44; as delay is associated with worse prognosis for the patient&#44; even though the cases published to date have not established a causal relationship and the presence of such melanomas may be coincidental&#46;</p></span>"
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Resident's Forum
RF- Melanoma and Tattoos. An Association Under Debate
FR- Melanoma y tatuajes. Una asociación controvertida
T. Ródenas-Herranza,
Autor para correspondencia
teresarodenash@gmail.com

Corresponding author.
, L. Linares-Gonzaleza, J. Aneiros-Fernándezb, R. Ruiz-Villaverdea
a Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Spain
b Servicio de Anatomia Patologica, Hospital Universitario San Cecilio, Granada, Spain
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#44; Pigmented lesion with abnormal ABCD clinical criteria on the right arm over a tattoo&#46; B&#44; Dermatoscopy &#40;DermLite&#174; DL3&#41; &#215;10&#58; Melanoma lesion with areas of regression&#44; broken and atypical pigmented network&#44; asymmetry and manifest polychromasia&#44; confirmed histologically as superficial-spreading melanoma&#44; Breslow depth 0&#46;25&#8239;mm&#46; C&#44; H&#38;E&#44; &#215;2&#58; Low-magnification view of superficial-spreading melanoma with pagetoid distribution&#46; D&#44; Melan A&#58; Detail of melanoma staining and pigment in the superficial dermis&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Currently&#44; decorative tattoos are widespread&#44; with a prevalence greater than 25&#37; in the United States in individuals aged between 18 and 50 years&#44; and a slightly lower prevalence in Europe and Australia&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Depending on the series&#44; in the last 40 years&#44; between 18 and 50 cases of malignant melanoma have been reported after tattoos for decorative purposes or for radiotherapy &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and B&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> The first case report dates from 1938&#44; but it was not until 1969 that Kirsch described a melanoma with axillary lymph node metastasis in an arm where the patient had had a tattoo 27 years previously&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Currently&#44; we are seeing an increase in the number of cases of melanoma diagnosed in patients who had been tattooed previously&#46; Although this association may merely be a coincidence&#44; it is important to reflect on a couple of points of importance given their diagnostic and therapeutic ramifications&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">First&#44; from the pathogenic point of view&#44; 4 factors have been suggested that could explain this relationship&#58; A&#44; trauma associated with the tattoo&#59; B&#44; local catabolites produced after introducing the ink&#59; C&#44; photoreaction secondary to introducing the ink in the dermis and hypodermis&#59; and D&#44; the chronic inflammatory process that persists after tattooing&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Second&#44; it is important to reflect on why melanoma appears on tattoos that are predominantly black and blue&#44; whereas nonmelanoma skin cancer appears on reddish pigments&#44; although to date no causal relationship has been established&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> We should remember that pigments based on mercury&#44; cobalt sulfate&#44; and other soluble salts are classed as group 2B agents of possible human carcinogens&#44; whereas cadmium and its derivatives belong to group I of the International Agency for Research on Cancer &#40;carcinogenic for humans&#41;&#44; and that the composition of tattoo inks is not internationally regulated or standardized&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It is important to note that the use of mercury pigments and other heavy metal pigments that were used in the past is now forbidden for any type of pigment production&#44; although they may be present as impurities&#46; Thus&#44; nowadays&#44; metal pigments have been replaced mainly by synthetic azoic and polycyclic pigments&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Klujer and Koljonen&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> who in 2012 published an interesting review on the association between skin cancer and tattoos&#44; remind us that any potential link would be multifactorial&#46; Trauma is not considered a direct pathogenic factor for melanoma&#59; moreover&#44; tattoos are often done on skin with extensive intermittent exposure to sunlight&#44; and this factor clearly is associated with malignant melanoma&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Finally&#44; it is important to note the complications derived from dermatoscopy<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and diagnostic techniques such as selective lymph node biopsy&#46; The presence of pigment in regional lymph nodes may be responsible for diagnostic errors&#44; and these should be recognized by the dermatology surgeon and consultation with the pathologist is essential in all cases&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion&#44; we should be alert to this new reality in our clinics to avoid delays in diagnosis of melanoma on tattoos&#44; as delay is associated with worse prognosis for the patient&#44; even though the cases published to date have not established a causal relationship and the presence of such melanomas may be coincidental&#46;</p></span>"
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ISSN: 15782190
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