Spitz Nevus Arising Within a Black Ink Tattoo: A Case Report of an Extremely Rare Entity

Tattooing has a long history as a form of self-expression and often signifies social status and group belonging. It has become increasingly popular among young people recently and many young adults are choosing to get tattoos, while older generations tend to have fewer. However, data on tattoo-related complications are limited as this demographic group ages. Adverse reactions can occur during the tattooing process as well as in the aftercare phase, including allergic responses, infections, and neoplasms. There has been a surge in the reported cases of skin tumors associated with tattoos in recent years, suggesting a growing concern about potential health risks linked to tattooing. The most common tumors associated with tattoos include malignant melanoma, basal cell carcinoma, keratoacanthoma, and squamous cell carcinoma. The rarer types reported include dermatofibrosarcoma protuberans, non-Hodgkin lymphoma, and Spitz nevi arising in red ink tattoos. Spitz nevi hold particular significance as these melanocytic lesions can be misdiagnosed as malignant melanoma despite their benign biological behavior and favorable prognosis. We present a case of Spitz nevus that developed within a black ink tattoo. To our knowledge, this is the fourth recorded instance of a Spitz nevus developing in a tattoo, and the first case specifically associated with black ink.