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| LETTER TO THE EDITOR |
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| Year : 2017 | Volume
: 4
| Issue : 2 | Page : 126-128 |
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Three cases of Becker’s nevus on lower extremity
Anup K Tiwary
Department of Dermatology, Venereology and Leprosy, Government Medical College, Nainital, Haldwani, Uttarakhand, India
| Date of Web Publication | 1-Dec-2017 |
Correspondence Address:
Anup K Tiwary
Department of Dermatology, Venereology and Leprosy, Government Medical College campus, Bareilly Road, House No. 12, Nainital, Haldwani, Uttarakhand
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2349-5847.219671
How to cite this article:
Tiwary AK. Three cases of Becker’s nevus on lower extremity. Pigment Int 2017;4:126-8 |
Sir,
The term “Becker’s nevus” is synonymous to Becker’s melanosis and pigmented hairy epidermal nevus.[1] It is an example of acquired sporadic cutaneous mosaic disorder classically presenting as asymptomatic solitary, brownish hyperpigmented hairy patch with irregular geographical border, and occasionally with acneiform eruptions.[1] It usually affects the shoulder, anterior chest, and scapular region. This is quite unusual to find lower limb involvement in Becker’s nevus. Herein, we report three cases of Becker’s nevus, all the three presenting over the lower limb.
Case 1: A 21-year-old male presented with an asymptomatic hyperpigmented hairy patch on the left lower leg since the age of 10 years. Six years before, few papules and coarse hairs started to appear within the patch. Local cutaneous examination demonstrated a single large brownish-black patch with irregular border of size approximately 25 × 10 cm covering the lateral aspect of left lower leg [Figure 1]. Hypertrichosis with coarse hairs and follicular hyperkeratotic acneiform papules were also evident. There were no other cutaneous or systemic abnormalities. Family history was also absent. These characteristic clinical features were consistent with the diagnosis of Becker’s nevus; however, biopsy was done to confirm the diagnosis histopathologically. Histopathologic examination (HPE) revealed hyperkeratosis, acanthosis, increased melanocytes number in basal layer, and few melanophages in papillary dermis with no junctional or intradermal nevus cells. No smooth muscle hyperplasia was seen. With all such clinical and histopathological findings, it was diagnosed to be a case of Becker’s nevus. | Figure 1: Single hyperpigmented hairy patch with acneiform lesions over the lateral aspect of left lower leg
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Case 2: A 19-year-old male presented with hyperpigmented hypertrichotic slowly growing patch over left thigh for past 7 years. Cutaneous examination revealed multiple hyperpigmented patches with irregular geographic border with breaking off blotchy hyperpigmented macular lesions at the periphery of the patches, over the anterolateral aspect of left thigh. There was increased hair density over the patch [Figure 2]. No other cutaneous or extracutaneous abnormalities were noted. There was no such family history. On the basis of peculiar clinical presentation, it was diagnosed as Becker’s nevus. | Figure 2: Hyperpigmented patch with irregular geographic border over the anterolateral aspect of left thigh along with increased hair density over the patch
Click here to view |
Case 3: A 18-year-old male came to the out-patient door of our department presenting with asymptomatic slowly growing tan hairy patch over right thigh since the age of 12 years. On cutaneous examination, multiple hyperpigmented macules were seen at the periphery along with the inner large solitary tan patch over the anteromedial aspect of right thigh [Figure 3]. Increased hair growth and density was observed within this patch. No other deformities were noted and family history was also negative. All these clinical features were consistent with the diagnosis of Becker’s nevus. | Figure 3: Solitary hairy tan patch over the anteromedial aspect of right thigh
Click here to view |
HPE could not be done in cases 2 and 3 due to denial of the patients for biopsy.
William Becker, in 1949, first described this nevus as “Concurrent melanosis and hypertrichosis in distribution of nevus unius lateris.”[2] Although its etiopathogenesis is yet to be fully elucidated, however certain features such as male preponderance (M:F is 5:1), peripubertal development, hypertrichosis, overlying acneiform eruptions, increased number of androgen receptors, and its messenger RNA in lesional skin and rare association with accessory scrotum supports the pathogenic role of androgens.[3],[4] In the view of the usual sporadic occurrence and asymmetrical distribution, it has been considered as an outcome of cutaneous mosaicism characteristically predisposed to pigmentation and androgen sensitivity.[5] Familial occurrence in some cases have been explained by paradominant inheritance and inheritance of an unstable premutation.[5] Due to clonal defects in morphogenesis, it has occasionally been seen to be associated with some ipsilateral cutaneous and extracutaneous abnormalities (called as Becker’s nevus syndrome) such as breast, limb and pectoralis major hypoplasia, lipoatrophy, supernumerary nipples, segmental odontomaxillary hypoplasia, spina bifida, scoliosis, pectus carinatum, and an accessory scrotum.[1],[6]
Becker’s nevus characteristically presents as asymptomatic unilateral brownish hyperpigmented hairy patch with irregular geographic contour, most commonly over shoulder, and upper trunk predominantly in peripubertal male.[1] Rarely, this nevus may present with some atypical features such as late onset, multiple nevi, affection of other sites such as face, neck, lower trunk and lower limbs, bilateral involvement, and absence of hypertrichosis.[7],[8],[9],[10],[11],[12] Our three cases of Becker’s nevus showed involvement of lower limb (thighs and leg) which is rarely seen.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Kumar GR, Karthikeyan K, Sengottian KL, Tejaswi C. A typical Becker’s nevus at an atypical site in a female child. Indian J Paediatr Dermatol 2014;15:125-6.  [Full text] |
| 2. | Becker SW. Concurrent melanosis and hypertrichosis in distribution of nevus unius lateris. Arch Dermatol 1949;60:155. |
| 3. | Manoj J, Kaliyadan F, Hiran KR. Atypical presentation of Becker’s melanosis. Indian Dermatol Online J 2011;2:42-3. [ PUBMED] [Full text] |
| 4. | 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. [ PUBMED] |
| 5. | Happle R. Paradominant inheritance: a possible explanation for Becker’s pigmented hairy nevus. Eur J Dermatol 1992;2:39-40. |
| 6. | Glinick SE, Alper JC, Bogaars H, Brown JA. Becker’s melanosis: associated abnormalities. J Am Acad Dermatol 1983;9:509-14. [ PUBMED] |
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| 8. | Alfadley A, Hainau B, Al Robaee A, Banka N. Becker’s melanosis: a report of 12 cases with atypical presentation. Int J Dermatol 2005;44:20-4. [ PUBMED] |
| 9. | Tymen R, Forestier JF, Boutet B, Colomb D. Late Becker’s nevus. One hundred cases (author’s transl). Ann Dermatol Venereol 1981;108:41-6. [ PUBMED] |
| 10. | Khaitan BK, Manchanda Y, Mittal R, Singh MK. Multiple Becker’s naevi: a rare presentation. Acta Derm Venereol 2001;81:374-5. [ PUBMED] |
| 11. | Rathi SK. Becker’s nevus on lower extremity. Indian J Paediatr Dermatol 2015;16:190-1. [Full text] |
| 12. | Bansal R, Sen R. Bilateral Becker’s nevi. Indian J Dermatol Venereol Leprol 2008;74:73. [ PUBMED] |
[Figure 1], [Figure 2], [Figure 3]
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