J Clin Aesthet Dermatol. 2020;13(6):22–23
by Cristian D. Gonzalez, MD; Barbara J. Walkosz, PhD; and Robert P. Dellavalle, MD, PhD, MSPH
Dr. Gonzalez is with the Department of Dermatology at University of Colorado School of Medicine in Aurora, Colorado. Dr. Walkosz is with Klein Buendel, Inc. in Golden, Colorado. Dr. Dellavalle is with the Department of Dermatology at University of Colorado School of Medicine in Aurora, Colorado and the United States Department of Veterans Affairs Rocky Mountain Regional VA Medical Center Dermatology Service in Aurora, Colorado.
FUNDING: Funding for this project was provided by the National Cancer Institute (Diversity Training Branch and NIH/NCI Center to Reduce Cancer Health Disparities) (R01CA206569-03S1)
DISCLOSURES: The authors have no conflicts of interest relevant to the content of this article.
ABSTRACT: Tattoo studios provide a unique venue for primary and secondary skin cancer prevention. Most tattoo artists promote sun protection for new tattoos in the form of aftercare instructions. Unfortunately, most tattoo artists are not well-informed on comprehensive sun safety recommendations, such as applying sunscreen prior to sun exposure with a sun protective factor (SPF) of 30 or higher, reapplying sunscreen when outdoors for more than two hours, using clothing that physically blocks ultraviolet rays, wearing wide-brimmed hats that shade the head, or seeking shade when available. However, recent evidence suggests that tattoo artists are open to learning about comprehensive sun safety recommendations and secondary skin cancer prevention methods. Tattoo studios also offer an opportunity to reach younger adults who may not be exposed to public health information or have access to health care. In addition to providing aftercare instructions to their clients, tattoo artists can disseminate sun safety information through social media and tattoo studio websites. Tattoo studios might serve as a an effective intervention environment to provide comprehensive full-body skin cancer prevention recommendations. Current recommendations to protect new tattoos from the sun should be compatible with the current sun safety guidelines from the American Academy of Dermatology.
Keywords: Tattoo, sun protection, skin cancer awareness, primary skin cancer prevention, secondary skin cancer prevention
Tattoos have gained tremendous popularity worldwide. In the United States, 23 percent of adults (aged 18 years and older) have at least one tattoo, with younger adults (aged 18–39 years old) being more likely to have tattoos.1 Tattoos are also common among members of the military and various ethnic groups, particularly Hispanic people.2 Concurrently, increasing evidence points to the need for prevention programs to be targeted toward young adults, as invasive melanoma of the skin is now one of the most common cancers among young adults in the United States.3 Risk factors for skin cancer, such as sunburn prevalence and low rates of sun protection, are also elevated in this population.4,5 As a result, tattoo artists can potentially serve as a powerful vehicle to disseminate important information to a large and diverse audience.
Nonmedical professionals, such as tattoo artists, hairdressers, and massage therapists can play an essential role in providing sun protection and skin cancer education to their clients.6,7 Sun protection is crucial for individuals with tattoos. The exposure of tattoos to sun can cause premature fading and cracking and ultraviolet (UV) radiation can prompt a healing tattoo to scar or scab over. Following proper aftercare instructions given by tattoo artists can help to prevent these complications. Most tattoo artists (84%) provide aftercare instructions to their clients.8 However, in a recent study, most tattoo artists (6/10, 60%) that were surveyed reported providing aftercare instructions on protecting only the tattooed skin rather than recommending full-body sun protection.9 In an in-depth interview of 10 Hispanic tattoo artists, none provided full-body sun protection in their aftercare instructions.10 As the incidence of skin cancer continues to rise in the United States, new public health campaigns are warranted to promote full-body sun protection; specifically, ones that target younger populations.
Along with aftercare instructions, a number of opportunities exist to disseminate sun protection information to the tattoo community, including through social media accounts and websites for tattoo studios and artists. Over the last decade, the rise of the Internet and social media has enabled tattoo artists to showcase their artwork to a greater audience. Most tattoo artists post their artwork on websites and via their Facebook, Pinterest, Twitter, Tumblr, and Instagram accounts. Further, tattoo artists turn to social media to enhance their training or to gather ideas and diversify their work.11 Some tattoo studios also use their websites as an opportunity to post aftercare instructions for their clients. However, only 50 percent of tattoo studio websites provide information on sun protection and even less provide long-term UV protection advice (19/50 examined; 38%).12 For the medical community, this represents an opportunity to implement sun safety training for tattoo artists and provide skin cancer prevention information to be posted on websites and social media pages.
Unfortunately, the obligation to provide aftercare tattoo instructions varies from state to state. Only seven states in the United States require the provision of tattoo aftercare instructions with content that has been approved by their state health departments.13 However, 30 states do require tattoo artists to provide some verbal or written form of aftercare instructions. This implies that aftercare instructions on sun protection vary significantly among tattoo studios. The medical community can advocate for the creation of standardized sun safety information with aftercare instructions. We recommend a number of sun safety recommendations to be included with aftercare instructions (Table 1).
A recent survey of tattoo artists in New York City revealed that more than 90 percent of tattoo artists were open to receiving education on skin conditions related to tattoos.8 Many of them had questions they would like to ask a dermatologist regarding proper aftercare instructions. In a series of in-depth interviews with 10 tattoo artists, all artists indicated they would benefit from additional skin cancer prevention information and would be willing to provide full-body, comprehensive sun protection advice to their clients.9
New public health campaigns should focus on educating tattoo artists on sun safety and secondary skin cancer prevention. Standardizing the content and provision of sun protection aftercare instructions would facilitate a unique opportunity to educate a group composed of young, ethnically diverse individuals on sun protection and skin cancer surveillance, many of whom might not have access to healthcare.
- Taylor P, Keeter S. Millennials: Confident. Connected. Open to change. 24 Feb 2010. http://www.pewsocialtrends.org/2010/02/24/millennials-confident-connected-open-to-change/. Accessed 27 May 2020.
- Laumann AE, Derick AJ. Tattoos and body piercings in the United States: a national data set. J Am Acad Dermatol. 2006;55(3):413–421.
- American Cancer Society. About melanoma skin cancer. 2016. https://www.cancer.org/content/dam/CRC/PDF/Public/8823.00.pdf. Accessed 27 May 2020.
- Holman DM, Ding H, Guy GP, et al. Prevalence of sun protection use and sunburn and association of demographic and behavioral characteristics with sunburn among US adults. JAMA Dermatol. 2018;154(5):561–568.
- Center for Disease and Control. Sunburn and sun protective behaviors among adults aged 18-29 years—United States, 2000–2010. MMWR Morb Mortal Wkly Rep. 2012;61(18):317–322.
- Bailey EE, Marghoob AA, Orengo IF, et al. Skin cancer knowledge, attitudes, and behaviors in the salon: a survey of working hair professionals in Houston, Texas. Arch Dermatol. 2011;147(10):1159–1165.
- Campbell SM, Louie-gao Q, Hession ML, et al. Skin cancer education among massage therapists: a survey at the 2010 meeting of the American Massage Therapy Association. J Cancer Educ. 2013;28(1):158–164.
- Rosenbaum BE, Milam EC, Seo L, Leger MC. Skin care in the tattoo parlor: a survey of tattoo artists in New York City. Dermatology (Basel). 2016;232(4): 484–489.
- Walkosz BJ, Dellavalle RP (2017). Pilot test of a sun safety program for the tattoo community. Poster presented to the annual conference of the Society for Behavioral Medicine; March 29–April 1, 2017; San Diego, CA.
- Gonzalez CD, Pona A, Walkosz BJ, Dellavalle RP. Hispanic tattoo artists could provide skin cancer prevention via aftercare instructions and social media. J Drugs Dermatol. 2019;18(12):1237–1243.
- Walzer A, Sanjurjo P, Media and contemporary tattoo. Communication & Society. 2016;29(1):69–81.
- Sansmark EK, Salazar M, Jones J, et al. Online tattoo skin care UV protection recommendations. Letter re: cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ. 2012;345:e4757.
- Liszewski W, Jagdeo J, Laumann AE. The need for greater regulation, guidelines, and a consensus statement for tattoo aftercare. JAMA Dermatol. 2016;152(2):141–142.