Various benign and malignant lesions have been described in relation to tattoos including melanoma. Few cases of malignant melanoma (MM) arising in tattoos have been reported in the literature. We report a 79-year-old man with an MM that arose in a tattoo he had for 60 years on the inferior aspect of the left arm. This case underscores the need for careful examination of tattoos to insure that dysplastic or malignant pigmented lesions are not overlooked. We also discuss the possibility of pathogenic relationship between MM and tattoos.