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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The prevalence of tattoos in the population has increased and dermatologists must be familiar with its complications&#46; The survey carried out by Kluger et al&#46; showed a prevalence of tattooed individuals in Brazil of 22&#46;3&#37;&#59; the most prevalent age group being 25&#8210;34 years old &#40;30&#46;3&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Bicca et al&#46; analyzed the prevalence of tattoos in recruits in Pelotas&#44; Rio Grande do Sul&#44; and the result was 10&#46;82&#37; of 1&#44;968 recruits&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Nevi traumatized by tattooing may undergo changes that increase the suspicion of malignancy&#44; such as cytological atypia&#44; pagetoid spreading and dermal mitosis&#59; therefore&#44; nevi&#44; pigmented lesions&#44; or melanoma scars should not be tattooed&#46; Tattooing pigment in nevi can either delay the diagnosis of malignant transformation or simulate findings of malignancy&#44; resulting in unnecessary surgery&#46; It is recommended to avoid tattooing areas of the body with an abundance of nevi&#44; keeping a margin of 0&#46;5 to 1&#8239;cm from these lesions&#46; Patients with atypical nevi syndrome or a personal or family history of melanoma should consult a dermatologist prior to tattooing&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;6</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A cross-sectional study was carried out&#44; using convenience sampling between December 2021 and July 2022&#44; at the Dermatology Outpatient Clinic of Hospital de Cl&#237;nicas de Porto Alegre&#44; in Porto Alegre&#44; Rio Grande do Sul&#44; Brazil&#46; The inclusion criterion was having a tattoo&#46; Exclusion criteria were being under 18 years of age or having some physical or psychiatric disability that made it impossible to understand the study and&#47;or sign the Informed Consent Form&#46; The tattoos were inspected and when they were over a nevus&#44; the lesion was photographed and stored using a FotoFinder equipment&#46; The dermoscopic characteristics were analyzed jointly by the researchers&#46; This study was approved by the Ethics Committee under protocol number 52210121&#46;2&#46;0000&#46;5327&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A total of 112 individuals participated in the research&#44; who had 485 tattoos&#46; Of these&#44; 82 &#40;16&#46;9&#37;&#41; were located over melanocytic nevi&#44; with a total of 194 nevi being tattooed&#46; The study by Kluger retrospectively analyzed complications in 31 patients with tattoos and observed 10&#37; tattooed nevi&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> This value is lower than that was found in the present study&#44; which can be justified because this was a cross-sectional study in which all tattoos were inspected actively looking for nevi&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The following dermoscopic changes were observed in tattooed nevi&#58; dots&#44; globules&#44; erythema&#44; tattoo obliteration&#44; amorphous blurring&#44; blue veil&#44; densification of the nevus pigment&#44; partial obliteration of the nevus pigment&#44; total obliteration of the nevus pigment&#44; pseudonetwork and perifollicular pigment&#46; <a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1&#8211;4</a> demonstrate some aspects observed in the study&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Blurring was seen as amorphous dark areas in the nevus&#44; and was the most observed change&#44; present in 108 nevi &#40;55&#46;7&#37;&#41;&#46; Tattooing pigment present in small dots was present in 93 nevi &#40;47&#46;9&#37;&#41;&#59; while larger round clusters with the appearance of globules were present in 70 nevi &#40;36&#46;1&#37;&#41;&#46; Tattooing pigment present in small quantities in the nevus caused densification of the melanocytic network in 26 nevi &#40;13&#46;4&#37;&#41;&#46; An important observation is the blue veil &#8210; a pattern attributed to malignant melanocytic lesions &#8210; observed in 16&#46;5&#37; of the nevi in this study &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The pseudonetwork pattern was seen as a lacy tattoo pigmentation in 30 nevi &#40;15&#46;5&#37;&#41;&#46; Erythema was observed in eight nevi &#40;4&#46;1&#37;&#41;&#44; and was present only in red pigment tattoos &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Heavier tattooing caused obliteration of the nevus&#44; attributed in this study as partial if it was still possible to observe the melanocytic pattern interspersed with the tattooing pigment&#44; or total when it was only possible to observe the tattooing pigment &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; These patterns were present in 44&#46;3&#37; and 21&#46;1&#37; of nevi respectively&#44; and can hide asymmetries and other suspicious findings in nevi&#44; which is a matter of concern&#44; as together they were present in almost two-thirds of the nevi&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Perifollicular pigmentation was observed in only two nevi &#40;1&#46;0&#37;&#41;&#46; An interesting presentation&#44; observed in 4&#46;1&#37; of nevi&#44; was tattoo obliteration&#44; in which the nevus stood out and there was an abrupt interruption of the tattooing pigmentation &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; The authors believe this pattern may be associated with the appearance or growth of the nevus after the tattoo&#44; and that histopathological evaluation could be informative&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">On most occasions&#44; the examiner can differentiate between changes caused by tattooing and changes due to the nevus&#46; However&#44; tattooing pigment can cause obliteration of the nevus&#44; impairing the observation of the melanocytic network and consequently the screening for melanoma&#46; To the best of the authors knowledge&#44; this is the first study analyzing the dermoscopic patterns of nevi that have undergone tattooing&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#39; contributions</span><p id="par0060" class="elsevierStylePara elsevierViewall">Felipe Miguel Farion Watanabe&#58; Design and planning of the study&#59; collection&#44; analysis and interpretation of data&#59; drafting and editing of the manuscript&#59; critical review of the literature&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Lia Dias Pinheiro Dantas&#58; Design and planning of the study&#59; effective participation in research orientation&#59; approval of the final version of the manuscript&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Renan Rangel Bonamigo&#58; Design and planning of the study&#59; analysis and interpretation of data&#59; effective participation in research orientation&#59; approval of the final version of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Letter - Research
Dermoscopic changes of tattoos over melanocytic nevi
Felipe Miguel Farion Watanabea,
Corresponding author
Felipem.farion@gmail.com

Corresponding author.
, Lia Dias Pinheiro Dantasb, Renan Rangel Bonamigoa,c
a Department of Dermatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
b Postgraduate program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
c Department of Internal Medicine, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The prevalence of tattoos in the population has increased and dermatologists must be familiar with its complications&#46; The survey carried out by Kluger et al&#46; showed a prevalence of tattooed individuals in Brazil of 22&#46;3&#37;&#59; the most prevalent age group being 25&#8210;34 years old &#40;30&#46;3&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Bicca et al&#46; analyzed the prevalence of tattoos in recruits in Pelotas&#44; Rio Grande do Sul&#44; and the result was 10&#46;82&#37; of 1&#44;968 recruits&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Nevi traumatized by tattooing may undergo changes that increase the suspicion of malignancy&#44; such as cytological atypia&#44; pagetoid spreading and dermal mitosis&#59; therefore&#44; nevi&#44; pigmented lesions&#44; or melanoma scars should not be tattooed&#46; Tattooing pigment in nevi can either delay the diagnosis of malignant transformation or simulate findings of malignancy&#44; resulting in unnecessary surgery&#46; It is recommended to avoid tattooing areas of the body with an abundance of nevi&#44; keeping a margin of 0&#46;5 to 1&#8239;cm from these lesions&#46; Patients with atypical nevi syndrome or a personal or family history of melanoma should consult a dermatologist prior to tattooing&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;6</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A cross-sectional study was carried out&#44; using convenience sampling between December 2021 and July 2022&#44; at the Dermatology Outpatient Clinic of Hospital de Cl&#237;nicas de Porto Alegre&#44; in Porto Alegre&#44; Rio Grande do Sul&#44; Brazil&#46; The inclusion criterion was having a tattoo&#46; Exclusion criteria were being under 18 years of age or having some physical or psychiatric disability that made it impossible to understand the study and&#47;or sign the Informed Consent Form&#46; The tattoos were inspected and when they were over a nevus&#44; the lesion was photographed and stored using a FotoFinder equipment&#46; The dermoscopic characteristics were analyzed jointly by the researchers&#46; This study was approved by the Ethics Committee under protocol number 52210121&#46;2&#46;0000&#46;5327&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A total of 112 individuals participated in the research&#44; who had 485 tattoos&#46; Of these&#44; 82 &#40;16&#46;9&#37;&#41; were located over melanocytic nevi&#44; with a total of 194 nevi being tattooed&#46; The study by Kluger retrospectively analyzed complications in 31 patients with tattoos and observed 10&#37; tattooed nevi&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> This value is lower than that was found in the present study&#44; which can be justified because this was a cross-sectional study in which all tattoos were inspected actively looking for nevi&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The following dermoscopic changes were observed in tattooed nevi&#58; dots&#44; globules&#44; erythema&#44; tattoo obliteration&#44; amorphous blurring&#44; blue veil&#44; densification of the nevus pigment&#44; partial obliteration of the nevus pigment&#44; total obliteration of the nevus pigment&#44; pseudonetwork and perifollicular pigment&#46; <a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1&#8211;4</a> demonstrate some aspects observed in the study&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Blurring was seen as amorphous dark areas in the nevus&#44; and was the most observed change&#44; present in 108 nevi &#40;55&#46;7&#37;&#41;&#46; Tattooing pigment present in small dots was present in 93 nevi &#40;47&#46;9&#37;&#41;&#59; while larger round clusters with the appearance of globules were present in 70 nevi &#40;36&#46;1&#37;&#41;&#46; Tattooing pigment present in small quantities in the nevus caused densification of the melanocytic network in 26 nevi &#40;13&#46;4&#37;&#41;&#46; An important observation is the blue veil &#8210; a pattern attributed to malignant melanocytic lesions &#8210; observed in 16&#46;5&#37; of the nevi in this study &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The pseudonetwork pattern was seen as a lacy tattoo pigmentation in 30 nevi &#40;15&#46;5&#37;&#41;&#46; Erythema was observed in eight nevi &#40;4&#46;1&#37;&#41;&#44; and was present only in red pigment tattoos &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Heavier tattooing caused obliteration of the nevus&#44; attributed in this study as partial if it was still possible to observe the melanocytic pattern interspersed with the tattooing pigment&#44; or total when it was only possible to observe the tattooing pigment &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; These patterns were present in 44&#46;3&#37; and 21&#46;1&#37; of nevi respectively&#44; and can hide asymmetries and other suspicious findings in nevi&#44; which is a matter of concern&#44; as together they were present in almost two-thirds of the nevi&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Perifollicular pigmentation was observed in only two nevi &#40;1&#46;0&#37;&#41;&#46; An interesting presentation&#44; observed in 4&#46;1&#37; of nevi&#44; was tattoo obliteration&#44; in which the nevus stood out and there was an abrupt interruption of the tattooing pigmentation &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; The authors believe this pattern may be associated with the appearance or growth of the nevus after the tattoo&#44; and that histopathological evaluation could be informative&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">On most occasions&#44; the examiner can differentiate between changes caused by tattooing and changes due to the nevus&#46; However&#44; tattooing pigment can cause obliteration of the nevus&#44; impairing the observation of the melanocytic network and consequently the screening for melanoma&#46; To the best of the authors knowledge&#44; this is the first study analyzing the dermoscopic patterns of nevi that have undergone tattooing&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#39; contributions</span><p id="par0060" class="elsevierStylePara elsevierViewall">Felipe Miguel Farion Watanabe&#58; Design and planning of the study&#59; collection&#44; analysis and interpretation of data&#59; drafting and editing of the manuscript&#59; critical review of the literature&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Lia Dias Pinheiro Dantas&#58; Design and planning of the study&#59; effective participation in research orientation&#59; approval of the final version of the manuscript&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Renan Rangel Bonamigo&#58; Design and planning of the study&#59; analysis and interpretation of data&#59; effective participation in research orientation&#59; approval of the final version of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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ISSN: 03650596
Original language: English
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