Got a tattoo? You may be putting yourself at more risk of skin cancer if you spend a lot of time in the sun.

Because skin cancer typically presents as colored moles, spots or growths on the skin’s surface, tattoos can make it more difficult to detect changes.

“The larger the tattooed area and the darker the tattoo pigment, the greater the potential for not noticing a concerning lesion,” said Dr. Andrew Shapiro, a surgeon at Advanced Surgical Physicians in Wellington, Florida, who often removes skin lesions.

Shapiro said if there is a mole or spot in tattooed areas, he advises performing regular skin self-exams, paying close attention to anything that looks different, and “maintaining a low threshold for biopsy.”

Dr. John Berlin, a Boynton Beach, Florida, dermatologist, recently treated a woman who had skin cancer beneath a tattoo on the arm she most often exposed to the sun when driving. Her arm had started bleeding beneath the tattoo, a warning sign, he said.

“If you have a tattoo, be vigilant with sunscreen and checkups,” said Berlin, of Premier Dermatology Partners. “And if you are thinking of getting a tattoo, get a skin check first.”

New moles can appear into your 30s and 40s, notes Dr. Jennifer Tang, dermatologist and cutaneous malignancies group co-leader at University of Miami’s Sylvester Comprehensive Cancer Center.  Tang cautions against tattooing over a mole or a previously removed mole. “Not being able to see a mole’s borders is concerning,” she said.

Often, dermatologists use a magnifying glass with polarized light when examining tattoos; however, it is not always possible to penetrate thick tattoo ink, experts say.

Melanomas in tattooed skin are often diagnosed at a later stage, according to a 2020 study in JAMA Dermatology. Late-stage melanomas are typically more lethal. The study showed tattoo artists rarely consider the risk of tattooing over moles or skin spots, often deferring to the client’s preference of location.  “There has been a significant rise in melanoma incidence among young adults, some of the most frequent tattoo customers, making surveillance by tattoo artists especially important,” the researchers concluded.

Expressions of art and identity, tattoos have become increasingly popular in the last decade: Nearly one-third of adults in the United States have a tattoo, according to a 2023 Pew Research Center survey, including more than half of women ages 18 to 49.

To date, there is no conclusive evidence that tattoos cause skin cancer; however, researchers are investigating whether there could be a link.

A 2022 Duke University study examined published reports of 160 cases of skin cancer in tattooed skin and found that they have become more common over time as tattoos increase in popularity. Although, the author notes, “the findings don’t point to a link between skin cancer and tattoos, but further study is needed.”

Most of the cases in the analysis developed within red tattoo pigment, and those tended to be squamous cell carcinoma and keratoacanthoma lesions, which have an inflammatory component. “There have been some reported allergic, inflammatory reactions to red tattoo ink, so this finding was interesting,” said researcher Jamie Lebhar, now a preliminary intern at the Duke School of Medicine.

Sun exposure, particularly to ultraviolet radiation, is a significant risk factor for skin cancer. In Florida, the UV index is high during the summer months. Many people who spend time outside in Florida are unaware of how tattoo ink interacts with the sun. Darker tattoo inks — blue and black — can absorb more UV radiation, causing those areas to heat up faster and increasing the risk of sunburn.

There isn’t a special sunscreen for tattooed skin. Tang recommends using a broad-spectrum sunscreen with SPF 30 or higher and sun-protective clothing.

Researchers worldwide are only beginning to study the chemicals in tattoo ink and their effects on the body. Some theorize there may be an increased cancer risk because tattoo pigments can be transported from the skin to other body sites, such as lymph nodes.

“Most ink is not regulated, so we don’t know what additional potentially carcinogenic chemicals may be present,” Tang said.

South Florida Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.