Welcome to Straight Talk on Health. I’m your host Dr. Chet Zelasko. Straight Talk on Health is a joint production with WGVU in Grand Rapids MI. With a PhD in exercise physiology and health education I’ve been teaching people how to improve their health through diet, exercise, and supplementation for over 30 years. I look at the science behind all the headlines and social media hype, and let you know whether it’s something to consider or not. You can check out other things that I do on my website Drchet.com and sign up for my free emails.
It’s been years since I’ve talked about tattoos. It was my wife Paula who prompted me to look at them 12-13 years ago. This time, we commented almost simultaneously “Why do so many chefs of all ages have so many tattoos?” I’ve told you I watch too many cooking shows! Wouldn’t you know that within a week of the comment, a new research paper was published and press releases talked about the potential risks of having tattoos. That article led with a photograph of a well-known rapper who had 90% of his upper torso covered with black ink. You can’t help but notice that more people of all ages are getting tattoos than did 10 years ago. I decided it was time to update any links between tattoos and any disease.
Based on a variety of polls, the number of Americans who have tattoos has increased
to 32%. That’s 10% more than last time. The age-group 30 to 49 has the highest percentage of people having at least one tattoo at 46%. That’s a lot of potential problems if the tattoos are connected to any disease or condition.
Let’s review the basics about tattoos. Tattoos place metallic salts and organic dyes under the skin (1). Think about it: someone is injecting your skin thousands of times to get the design completed. What could go wrong? Infections and allergic reactions are commonplace. The rapper I mentioned earlier had severe reactions to getting that much ink too fast and got quite ill. Fortunately, he recovered but can tattoos lead to increased skin issues like skin cancer? Let’s take a look.
In a study published in a major oncology journal, researchers examined the medical literature for case studies on tattoos and skin cancers of various types (1). They found 50 cases; 16 of them were melanoma. That didn’t seem to be an overwhelming number of skin cancer cases when you consider the 60 million or so people who had tattoos 10 years ago. The researchers concluded that at that point, the number of cases of skin cancer is more likely coincidental. That was then. Now there are another 22 million people for about 82 million total. Has the research continued? Yes.
But first, I found a case study—that’s the report of a physician, usually their patient, and what happened to their diagnosis and treatment. Physicians reported on a case of melanoma on a 79- year-old man that occurred in a tattoo he had for 60 years (2). Because of its location on the inner arm that most likely gets less direct sun exposure and is therefore not checked carefully because of that, they suggested that physicians examine tattoos carefully to see if lesions are blending with tattoos. It’s difficult to notice a change in color in tattooed skin; skin cancers are usually pink, red, brown, or black, and those colors appear often in tattoos.
Now to the recent research. There have been two observational studies using questionnaires and medical records for diagnoses of skin and other forms of cancer. In a study done in France, researchers recruited over 111,000 subjects ages18-69 years old. They collected specific data on subjects’ tattoos over 4 years. Researchers examined records from the national insurance health data on the subjects’ skin cancers overall, cutaneous melanoma, and nonmelanoma skin cancer diagnosed during 2007-2021. Out of the 111,000 subjects, only 1789 were diagnosed with any skin cancers with 693 being melanoma skin cancers. There was no relationship found between tattoos and skin cancers.
In another study from researchers in Brazil, they conducted a meta-analyses of 5 studies with over 140,000 subjects. Again, they found no relationship with the number of tattoos and any forms of cancer, skin or otherwise.
In a third recently published study, the results confounded the other studies. In two separately designed studies of twins, researchers from Denmark used the Danish Twin Tattoo Cohort database. In the first study, researchers randomly selected over 2300 participants twins in a cohort study; they also did a case control study of 316 twins born between 1960-1996. The researchers used the cancer diagnoses from the Danish Cancer Registry and tattoo ink exposure from the Danish Twin Tattoo survey from 2021 for their analyses. The analysis addressed effects of time-varying exposure. The larger cohort study showed a close to 4x and 3x the normal risk for skin cancers in those twins with tattoos. The twin case control study yielded a 62% increase risk between twins with versus twins without tattoos.
Where does that leave us? All the types of studies are retrospective; they are looking back at large groups of people and asking new questions about data that had been collected. At some point, all studies used questionnaires to ask people about tattoos and they all use the health care registry to retrieve skin cancer diagnoses. To suggest that one is better than the other would be wrong. But there is one thing that cannot be debated: tattooing involves the breaking of the skin barrier with noxious substances that are concentrated in pools under the skin and have been discovered to have traveled to local lymph nodes. That means that the immune system was stimulated to respond, created a state of inflammation. What we don’t know is how long that response continues its normal process or when it subsides, if ever. There is a lot of research to go.
Over 10 years ago, I said that would officially say that I would “Reserve Judgment.” That means that there’s no statistical significance but there may be a relationship between variables. I’m going to make the same judgement this time. Yes, we have more data than the few case studies I had last time. The data are still equivocal in my opinion.
To tattoo or not to tattoo? It’s up to you; the lack of research is why I’m reserving judgment, but here are my recommendations:
Do your research on where to go now that you know the issues that exist with tattooing. It’s still relatively low for skin cancers but there is still much we don’t know.
Your yearly medical exam just moved up in importance because you need regular skin check-ups with an emphasis on your tattoos. I just had mine about a week before writing this script and I had a couple of pre-cancerous spots frozen.
One more thing; to put it in perspective. After talking with a guy who is next generation after mine about his extensive tattoos. He said “People in my age group who got tattoos would probably never do it again because what was meaningful then most likely means nothing now. That’s why I’m going to have mine removed.”
Paula and I both have three tattoos each. They are the dots they tattoo to make sure the x-rays are lined up in the right location during radiation therapy as we’ve both had cancer. After reading the script, Paula said “I’m glad those are my only tattoos. Until we know more, so am I. Nothing more I can add to that. Your skin. Your choice.
That’s all the time I have for this episode. If you like this podcast, please hit the share button and tell your friends and colleagues about it. Until next time, this is Dr. Chet Zelasko saying health is a choice. Choose wisely today and every day.
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References:
1. Dermatology. 2013;226(2):138-47.
2. Cutis. 2013 Nov;92(5):227-30.
3. J Natl Cancer Inst. 2026 Mar 1;118(3):476-484.
4. Clin Transl Oncol. 2026 Jun 6.doi: 10.1007/s12094-026-04388-4
