Paradoxical Associations Discovered Between Tattoos and Melanoma Incidence

A recent study published in the Journal of the National Cancer Institute has found that greater tattoo exposure is associated with lower incidence of melanoma, a discovery contrary to previously hypothesized associations between tattooing and melanoma risk.^1,2

Modeling the association between tattoo exposure and melanoma incidence yielded an odds ratio (OR) of 0.44 (95% CI, 0.27–0.67), translating to a 44% decreased odds of melanoma incidence among individuals who had received 4 or more tattoos compared with those who were never tattooed.¹ Similarly, an OR of 0.26 (95% CI, 0.10–0.54) was observed comparing individuals who had 3 or more large tattoos with those who were never tattooed.

In examining in situ and invasive melanoma risk, while receiving 1 tattoo session was associated with increased odds of in situ melanoma (OR, 1.85; 95% CI, 1.31–2.63), these odds were reduced with 4 or more tattoo sessions (OR, 0.44; 95% CI, 0.24–0.83). A similar pattern was observed with invasive melanoma odds; invasive melanoma odds were also decreased among individuals who received their first tattoo before age 20 (OR, 0.48; 95% CI, 0.29–0.82) compared with those who were never tattooed.

These findings contrast the investigators’ initial hypothesis that greater tattoo exposure is associated with increased melanoma risk given evidence of carcinogens, such as heavy metals, in tattoo ink, and inflammatory responses associated with tattooing.¹

“The results that tattoos could decrease melanoma risk surprised us. But this isn’t a black and white case of ‘get more tattoos, and you could lower your risk of melanoma,’” said Rachel McCarty, PhD, postdoctoral scientist at the International Agency for Research on Cancer and first author of the study, in a press release.¹ “Instead, we need to do more research to understand what we are seeing and if this decreased risk is simply due to behavioral or physical factors, or if there could be beneficial immune responses associated with tattooing which lower melanoma risk.”

How Was the Study Designed?

The study, which evaluated associations between tattoo exposures and melanoma incidence, was designed as a population-based case-control study of individuals in Utah. The study population consisted of 1167 adult individuals with melanoma (cases) and 5835 individuals without melanoma (controls) who were identified from Utah state databases.

Incident melanoma cases between January 2020 and June 2021, including 566 in situ cases and 601 invasive cases, were selected from the Utah Cancer Registry using rapid case ascertainment. Following identification, investigators conducted outreach and administered telephone interviews, capturing responses in REDCap.

Controls were selected among respondents to the 2020–2021 Utah Behavioral Risk Factor Surveillance System (BRFSS) survey; response data for this group were based on responses to 3 tattoo-specific questions added to the BRFSS.

For statistical analysis, the researchers constructed multivariable logistic regression models to estimate ORs and corresponding 95% CIs associating tattoo exposures with any melanoma diagnosis, and separately by type of melanoma. These models were adjusted for demographic and behavioral factors including sex, age, race and ethnicity, education, smoking status, physical activity, and body mass index.

What Conclusions Can Be Drawn?

With the observational nature of the study’s case-control design, it is important to note that the study has only established a correlative, not causative relationship between tattoos and melanoma incidence.³ Although investigators adjusted for potential demographic and behavioral confounders in the regression models, they noted that they could not control for melanoma risk factors such as indoor tanning, sunscreen use, sunburns prior to diagnosis, tattoo sun exposure, hair and eye color, and personal and family history of melanoma due to lack of data availability. Thus, the investigators caution that tattooing should not be interpreted to be a protective factor against melanoma, and those who have tattoos should continue to make informed decisions about skin protection, such as using sunscreen.¹

The reasons for the associations found in the study remain unclear. Potential explanations proposed by the investigators include differences in sun exposure-related safety behaviors and possible immune responses against precancerous cells from tattooing.^1,2 Further research is warranted to clarify these associations.

Ultimately, while definitive conclusions about causation cannot be drawn, the study adds to a growing body of knowledge regarding melanoma incidence and tattoos that can inform clinical practice and refine risk communication to patients.

REFERENCES:

1. Study Finds Melanoma Less Common in Individuals with Several Tattoos. News release. University of Utah Huntsman Cancer Institute. September 17, 2025. Accessed September 25, 2025. https://tinyurl.com/t54mnve6

2. McCarty RD, Trabert B, Collin LJ, et al. Tattooing and risk of melanoma: a population-based case-control study in Utah. JNCI. Published online August 19, 2025. doi:https://doi.org/10.1093/jnci/djaf235

3. Tenny S, Kerndt CC, Hoffman MR. Case Control Studies. Published March 27, 2023. Accessed October 3, 2025. https://pubmed.ncbi.nlm.nih.gov/28846237/