Tattooing in cancer surgery

Area of Science:

• Oncology
• Surgical Oncology
• Radiation Oncology

Background:

• Combined therapy (radiation, chemotherapy, surgery) offers improved survival for advanced head and neck cancer.
• Preoperative adjuvant therapy often causes tumor regression, obscuring original tumor boundaries.
• Viable tumor cells can persist at the periphery after regression, necessitating complete excision with margins.

Purpose of the Study:

• To highlight the importance of accurate tumor demarcation before neoadjuvant therapy.
• To present permanent tattooing with India ink as a method for precise lesion localization.
• To discuss the indications, materials, and methods for tattooing in head and neck cancer management.

Main Methods:

• Review of cases undergoing combined modality treatment for advanced head and neck cancer.
• Histopathological examination of excised specimens to assess tumor margins.
• Application of permanent India ink tattooing to mark the skin and mucous membrane boundaries of the primary tumor before neoadjuvant therapy.

Main Results:

• Tumor regression after neoadjuvant therapy can significantly obscure original tumor dimensions.
• Histologic evaluation confirms the presence of viable tumor cells beyond the visibly apparent limits post-therapy.
• India ink tattooing provided a reliable and permanent method for marking the initial tumor extent.

Conclusions:

• Accurate pre-treatment tumor delineation is essential for achieving complete surgical resection.
• Permanent tattooing with India ink is a safe and effective technique for marking tumor margins.
• This method aids surgeons in ensuring adequate margins, potentially improving oncologic outcomes in head and neck cancer.