|Year : 2016 | Volume
| Issue : 1 | Page : 37-39
Giant bilateral Becker's nevus: Uncommon presentation of a common disease
Karan Sancheti1, Indrashis Podder1, Anupam Das2, Nidhi Gupta1, Ramesh Chandra Gharami1
1 Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India
2 Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
|Date of Web Publication||17-Jun-2016|
Dr. Anupam Das
“Prerana” 19, Phoolbagan, Kolkata - 700 086, West Bengal
Source of Support: None, Conflict of Interest: None
Becker's nevus or melanosis is an acquired pigmented hairy nevus with both epidermal and dermal components, commonly seen in males. Herein, we report a case of giant bilateral Becker's nevus involving shoulder, scapular region, anterior chest and both the arms. Bilaterally, symmetrical presentation and large area of involvement make it a rare case.
Keywords: Becker's nevus, bilateral, giant
|How to cite this article:|
Sancheti K, Podder I, Das A, Gupta N, Gharami RC. Giant bilateral Becker's nevus: Uncommon presentation of a common disease. Pigment Int 2016;3:37-9
| Introduction|| |
Becker's nevus is a benign cutaneous hamartoma of ectomesodermal tissue, more common in males. It is rarely congenital, may present in childhood, but usually first noticed in adolescence; characterized by one or more irregular hyperpigmented patches that are arranged in a checkerboard pattern with geographic configuration. It is mostly located over the shoulder, anterior chest, scapular area; although a few cases with face, neck, and distal limb involvement have been reported. It occurs sporadically and is distributed asymmetrically suggesting cutaneous mosaicism. A few cases with distribution in blaschkoid pattern have been reported. It is prone to acne and hypertrichosis due to increased androgen sensitivity.
Becker's nevus syndrome is referred to an association of Becker's nevus with unilateral breast hypoplasia and muscle, skin, and/or skeletal abnormalities. We report a sporadic case of a young male who presented with hyperpigmented lesions overlying anterior chest, scapular region, and both arms.
| Case Report|| |
A 24-year-old otherwise healthy male presented with asymptomatic gradually increasing hyperpigmentation. The lesion started at the age of 18 as a small hyperpigmented macule on the left side of the chest and later, similar lesion appeared on the right side. The pigmentation gradually darkened and progressively involved both sides of the chest, back, shoulder, and both arms. There was increased growth of hair over the left side. Medical, surgical, and family history were noncontributory. Laboratory parameters such as complete blood count, renal profile, and hepatic profile were within normal limits.
General examination was unremarkable. Cutaneous examination showed bilaterally symmetrical hyperpigmentation with irregular margins; involving the anterior chest, shoulder, scapular region, and both arms. Hypertrichosis was seen on the left side of chest [Figure 1] and [Figure 2]. There was no similar lesion elsewhere in the body. Hairs, nails, and mucosae were normal. There was no atrophy or hypertrophy of the involved skin, muscles, or bones. Histopathological examination showed hyperpigmentation of the basal layer, and melanophages were present in the upper dermis [Figure 3]. Based on clinical appearance and histopathological findings, a diagnosis of Becker's nevus was made. The patient was counseled about the disease, was referred for laser therapy, and has been advised regular follow-up at our center. The response to laser therapy has not been satisfactory.
|Figure 1: Bilaterally symmetrical hyperpigmentation with irregular margins; involving the anterior chest and the proximal arms. Note the hypertrichosis on the left side|
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|Figure 2: Hyperpigmented macules coalescing to form giant patches over the back|
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|Figure 3: Photomicrograph showing normal epidermis and dermis, with increased basal layer melanization (H and E, ×100)|
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| Discussion|| |
Becker's nevus is also known as Becker's melanosis or pigmented hairy epidermal nevus. It is a variety of epidermal nevus with dominant clinical features of pigmentation, hypertrichosis, and lack of warty changes, sometimes showing evidence of increased androgen sensitivity, and co-localizing with other developmental anomalies such as smooth muscle hamartoma, pectus excavatum, spina bifida, scoliosis, aplasia of pectoralis major muscle, ipsilateral limb shortening, localized lipoatrophy, congenital adrenal hyperplasia, and accessory scrotum. The lesions most often appear in the second and third decades of life and are 6 times more common in males than in females. Familial occurrence has been reported. The lesions commonly have a unilateral distribution, involving the upper quadrant of the anterior or posterior chest and the shoulder, but they also have been described on the forehead, face, neck, lower trunk, extremities, and buttocks. Normally, Becker's melanosis is asymptomatic, but some patients report pruritus. After development, the lesion may enlarge slowly for a year or two, but then remains stable in size. Besides, the color can fade with time, but hypertrichosis is persistent.
The epidermis shows slight acanthosis and regular elongation of the rete ridges. There is hyperpigmentation of the basal layer, and melanophages are seen in the upper dermis. The number of melanocytes is increased; evident when stained for dopa-oxidase activity in both involved and uninvolved skin nearby. The hair structures appear normal or increased in number.
The differential diagnosis primarily includes café au lait macules, congenital melanocytic nevus, plexiform neurofibroma, and congenital smooth muscle hamartoma. Patients with Becker's melanosis should be examined for soft tissue and bony abnormalities. Electrolysis, waxing, camouflage, and laser therapy may be recommended. The hyperpigmented component has been reported to be successfully treated with Q-switched ruby and frequency-doubled Nd: YAG laser.
Bansal and Sen, reported a case of bilateral Becker's nevus which presented as palm-shaped brown-colored patch on each side of the back having coarse dark hairs; in our case also, the upper torso was involved in a symmetrical fashion. Asymmetric presentation has also been reported viz., two asymptomatic hyperpigmented lesions confined to the right half of torso. Khatami et al., reported giant confluent brown patches, bilaterally distributed over the back, chest, and upper arms, and partially covered by dark coarse hairs. In our case also, partial hair growth is seen only over the left side. A giant Becker's nevus with epidermal nevus has been reported in the form of hyperpigmented scaly plaque extending along the left lateral thigh, knee, and leg and hyperpigmented patch with irregular borders and satellite macules extending bilaterally to the medial arms across the left shoulder and lower neck. Becker's nevus involving the oral mucosa  and knee  has also been reported. The mucosa was spared in our case, neither was there any involvement of the lower extremities nor presence of satellite macules. There is no evidence of any developmental abnormalities, thus ruling out Becker's nevus syndrome; a part of epidermal nevus syndrome, a disease complex of epidermal nevi, and developmental abnormalities of different organ systems. This case has been reported for its uncommon presentation. Our case adds to the diversity of the presentations of a common dermatological condition.
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[Figure 1], [Figure 2], [Figure 3]