Q-switched YAG laser vs. punch biopsy excision for iatrogenic radiation tattoo markers - a randomized controlled trial

Background Ink markers are tattooed as landmarks before radiotherapy of breast cancer with the purpose of obtaining a precise radiation field. The black tattoo spots may cause potential psychological distress for the affected women. Objective The objective of this study was to evaluate the efficacy and adverse effects in a side-by-side comparison of Q-switched (Q-sw) YAG laser vs. punch biopsy excision of iatrogenic radiation tattoo markers. Methods Ten female volunteers with black tattoo markers after previous radiotherapy for breast cancer were included. Subjects received one punch biopsy excision and a series of three treatments at 6-week intervals with Q-sw YAG laser (Q-YAG 5 system, 1064 nm, Palomar Inc., Burlington, VT, USA); the interventions was randomly assigned to two closely located tattoos (n = 20). Treatment measures were evaluated 12 weeks after final treatment and included clinical efficacy, patient satisfaction, preferred treatment and adverse effects. A blinded observer evaluated the efficacy and adverse effects from photographs. Results Ten patients completed the study. Blinded photographic evaluations showed an overall excellent clearance (75-100% reduction in tattoo appearance) from both excision and laser treatments (P = 0.317). Patients were equally satisfied with Q-sw YAG laser treatment [median 9 (5.75-10, 25-75 percentiles)] and excision therapy [median 10 (5.75-10)] (P = 0.672). However, the majority of the patients preferred YAG laser (n = 8) to excision (n = 2) (P = 0.022) because adverse effects in terms of hypopigmentation (0/10 vs. 8/10 patients) and scarring (1/10 vs. 8/10 patients) occurred more frequently and appeared more pronounced in excision biopsy (hypopigmentation P = 0.014, scarring P = 0.021). Conclusion Q-sw YAG laser and punch biopsy excision are effective to clear iatrogenic radiation tattoo markers, but patients preferred the laser treatment because of less pronounced adverse effects.