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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 7  |  Issue : 1  |  Page : 53-55

A systematized Becker’s nevus without systemic features: a rare case report


Department of Dermatology, Dr Ram Manohar Lohia Hospital and PGIMER, New Delhi, India

Date of Submission14-Jul-2019
Date of Decision06-Dec-2019
Date of Acceptance25-Feb-2020
Date of Web Publication10-Jul-2020

Correspondence Address:
Konchok Dorjay
Department of Dermatology, Dr Ram Manohar Lohia Hospital and PGIMER, New Delhi, 110001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/Pigmentinternational.Pigmentinternational_

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  Abstract 


Becker’s nevus is a cutaneous hamartoma relatively common in peripubertal age. The classical presentation of the Becker’s nevus is characterized by unilateral, hyperpigmented patch with varying degrees of hypertrichosis on upper trunk or proximal upper extremities. The occurrence of multiple Becker’s nevi with extensive involvement is relatively rare. Also, the systematized Becker’s nevus is usually associated with other cutaneous and extra-cutaneous features like breast hypoplasia, leg lipodystrophy, etc. But, we herein report a peculiar case of systematized Becker’s nevus without systemic features.

Keywords: Systematized becker, ’s nevus, without systemic features


How to cite this article:
Bansal P, Sinha S, Dorjay K, Vats G. A systematized Becker’s nevus without systemic features: a rare case report. Pigment Int 2020;7:53-5

How to cite this URL:
Bansal P, Sinha S, Dorjay K, Vats G. A systematized Becker’s nevus without systemic features: a rare case report. Pigment Int [serial online] 2020 [cited 2020 Aug 15];7:53-5. Available from: http://www.pigmentinternational.com/text.asp?2020/7/1/53/289337




  Introduction Top


Becker’s nevus is a benign entity characterized by localized hypermelanosis, usually with hypertrichosis, over the upper trunk and upper limbs in young individuals. Extensive or systematized involvement usually occurs as part of the Becker’s nevus syndrome and has been infrequently reported in literature. Here, we report a case of systematized Becker’s nevus without systemic features.


  Case report Top


A 22-year old male born out of a non-consanguineous marriage presented to the Dermatology Outpatient Department with asymptomatic, hyperpigmented hairy patches, predominantly on the right side of the chest, abdomen, lower back and right lower limb, with some spill over across the midline for the past 7 years. The hyperpigmentation began initially on chest and gradually became conspicuous and involved other areas of body with increased hair growth. It was not associated with any systemic or musculo-skeletal complaints. Cutaneous examination revealed well-defined brownish macules on the right lower abdomen measuring 4cm x 3cm and a similar one on the right side of the chest measuring 10cm x 6 cm [Figure 1]. Thick coarse hairs were seen over the lesions. A similar looking macule covered the entire right lower limb starting from the right lower back relatively sparing the foot, medial aspect of the lower limb, inguinal folds and genitalia [Figure 2]. The margins of the macules were curved along the Blaschkoid lines distribution, more visible on the lesions on the chest and the right lower back. Marked hypertrichosis was apparent on all the macules while acneiform lesions were absent. Induration was not appreciated on palpation. The systemic examination was unremarkable. No neurological or skeletal abnormality was detected. Histopathology revealed basal layer pigmentation and sparse perivascular mononuclear infiltrate with pigment incontinence in the dermis [Figure 3], consistent with the diagnosis of Becker’s nevus.
Figure 1 Hyperpigmented macules with hypertrichosis on upper chest, right shoulder (without hypertrichosis) and side of lower abdomen.

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Figure 2 (A) Hyperpigmented macules with hypertrichosis on the anterior and lateral aspect of right lower limb; (B) hyperpigmented macules with hypertrichosis on right lower back, buttock and posterior aspect of thigh.

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Figure 3 Histopathology showing basal layer pigmentation and sparse perivascular mononuclear infiltrate and pigment incontinence in the dermis.

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  Discussion Top


Becker initially described a concurrent melanosis and hypertrichosis along the nevus unius lateris in 1949 which was subsequently known by the name of Becker’s nevus.[1] It commonly presents in the form of a solitary lesion with patchy tan-brown hyperpigmentation with geographical borders over the chest, shoulder or upper arm unilaterally, occurring more frequently in males (M:F = 5:1).[2],[3] The pathogenesis is yet to be confirmed. The phenomenon of cutaneous mosaicism in which two or more populations of genetically distinct cells arise from a single zygote appears to form the basis of presence of two asymmetrical Becker’s naevi in a single individual.[4] Androgen hyper-responsiveness explains the male predominance, hypertrichosis and pubertal onset and this may be due to increased expression of androgen receptors in dermal fibroblasts of lesional skin.[5]

The reports of Becker’s naevi involving both trunk and lower limbs are scarce. Li et al.[6] and Ramot et al.[2] reported the lesions occurring in a checkerboard pattern. Goel et al. reported a case of unilateral lower limb Becker’s nevus along the Blaschko’s lines.[7] Khetan et al.[8] found five cases of localized Becker’s nevus on the lower limbs.[8] Similarly, Alhausayen et al.[9] reviewed the past literature to conclude that 11 cases of Becker’s nevus over the proximal part of lower limb were reported.Hence we report a rare case of systematized Becker’s nevus involving unilateral lower limb and trunk simultaneously without systemic involvement.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Becker SW. Concurrent melanosis and hypertrichosis in distribution of nevus unius lateris. Arch Derm Syphilol 1949;60:155-60.  Back to cited text no. 1
    
2.
Ramot Y, Maly A, Zlotogorski A. A rare case of multiple Becker’s nevi in a checkerboard mosaic pattern. J Eur Acad Dermatol Venereol 2014;28:1573-4.  Back to cited text no. 2
    
3.
Bansal R, Sen R. Bilateral Becker’s nevi. Indian J Dermatol Venereol Leprol 2008;74:73.  Back to cited text no. 3
    
4.
Acharya R, Shrestha J. Becker’s nevus on face with asymmetric hair growth and acne: a rare case. Egypt J Dermatol Venerol 2018;38:92-4.  Back to cited text no. 4
  [Full text]  
5.
Grande Sarpa H, Harris R, Hansen CD, Callis Duffin KP, Florell SR, Hadley ML. Androgen receptor expression patterns in Becker’s nevi: an immunohistochemical study. J Am Acad Dermatol 2008;59:834-8.  Back to cited text no. 5
    
6.
Li F, Wang T, Wang L. A rare case of multiple Becker’s nevi without systemic involvement. Indian J Dermatol Venereol Leprol 2018;84:194-7.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Goel K, Relhan V, Bansal S, Garg VK. Acquired linear Becker’s nevus on lower limb in blaschkoid pattern. Indian J Dermatol Venereol Leprol 2015;81:328-.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Khaitan BK, Dogra D, Manchanda Y, Rathi S. Becker’s naevus of the lower limb. Acta Derm Venereol 1998;78:238-9.  Back to cited text no. 8
    
9.
Alhusayen R, Kanigsberg N, Jackson R. Becker nevus on the lower limb: case report and review of the literature. J Cutan Med Surg 2008;12:31-4.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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