Melanoma in a Chinese dragon tattoo

A 42-year-old white man presented to our clinic in October, 2015, with itching in the nasolabial fold and around the eyebrows, with accompaying erythema and desquamation consistent with seborrhoeic dermatitis. We noted multiple naevi on whole body dermatological examination, as well as a multicoloured tattoo of a Chinese dragon covering almost his entire back, arms, and chest. On closer inspection he had one clinically dysplastic pigmented naevus, sited within a scale of the dragon's tail (figure). He reported having the tattoo done 1 year previously, but the naevus had been present at least 5 years earlier, and the tattoo artist had purposefully worked around the existing lesion. The patient had type II skin with blonde hair and blue eyes, and had previously worked in the French Foreign Legion during which time he had had prolonged sun exposure. He reported no medical history apart from multiple painful sunburns in childhood, took no medication, and family history for dermatological disease was negative. We did total surgical excision with 1 cm surgical margins. Histological examination confirmed the diagnosis of superficial spreading melanoma with tumour thickness 0·26 mm, and the tumour was classified as IA according to the American Joint Committee on Cancer (AJCC) staging system. Additional screening tests were within the normal range. We have given sun care education and planned follow-up in line with the AJCC recommendations for melanoma stage IA. The patient remains well with no signs of further disease.