Becker Melanosis Clinical Presentation

  • Author: Jason K Rivers, MD, FRCP(C); Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 3, 2012
 

History

  • The earliest finding of Becker nevus is an asymptomatic irregular tan-to-brown patch, most commonly located over the shoulder, upper chest, or back, as shown in the image below. Becker nevus of chest wall with associated hypertrBecker nevus of chest wall with associated hypertrichosis. Courtesy of Jason K. Rivers, MD.
  • Pigmentation may be subtle, and onset most commonly occurs in the peripubertal period. The patch expands during the first several years as new irregular pigmented macules and patches develop at the periphery and coalesce with the larger patch. This expansion results in a geographic configuration that may cover a large area.
  • Several months to years after the appearance of pigmentation, thick brown-to-black hairs develop both within and in close proximity to the patch. Hair density is highly variable and occasionally, hypertrichosis does not occur.
  • The central area in the patch may thicken, and acne vulgaris may develop.
  • Once present, the patch remains indefinitely, although minimal pigmentary fading may occur in adulthood.
  • Occasionally, Becker nevus may be associated with smooth muscle hamartoma. Rarely, hypoplasia of underlying structures, such as unilateral breast hypoplasia, has been reported.[4]
  • Other associations seen with Becker nevus include unilateral or ipsilateral pectoralis major aplasia, ipsilateral limb shortening, ipsilateral foot enlargement, spina bifida, scoliosis, pectus carinatum, localized lipoatrophy,[5] congenital adrenal hyperplasia,[6] polythelia,[7] and accessory scrotum.[8]
  • Becker nevus is considered a benign process; however, an association with melanoma was discussed in a series of 9 patients in whom both Becker nevus and melanoma developed. In this series, 5 patients developed melanoma on the same body site as the Becker nevus, but in 1 patient only did melanoma develop within the Becker nevus.
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Physical

See History.

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Causes

See Pathophysiology.

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Contributor Information and Disclosures
Author

Jason K Rivers, MD, FRCP(C)  Clinical Professor, Department of Dermatology and Skin Science, University of British Columbia; Consulting Staff, Vancouver General Hospital and St Paul's Hospital; Medical Director, Pacific Dermaesthetics

Jason K Rivers, MD, FRCP(C) is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, British Columbia Medical Association, Canadian Dermatology Association, Canadian Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Coauthor(s)

Marni C Wiseman, MD, FRCPC  Assistant Professor, University of Manitoba, CancerCare Manitoba

Marni C Wiseman, MD, FRCPC is a member of the following medical societies: Canadian Dermatology Association and Canadian Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Günter Burg, MD  Professor and Chairman Emeritus, Department of Dermatology, University of Zürich School of Medicine; Delegate of The Foundation for Modern Teaching and Learning in Medicine Faculty of Medicine, University of Zürich, Switzerland

Günter Burg, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, International Society for Dermatologic Surgery, North American Clinical Dermatologic Society, and Pacific Dermatologic Association

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Lester F Libow, MD  Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Becker SW. Concurrent melanosis and hypertrichosis in a distribution of nevus unius lateris. Arch Dermatol. 1948;60:155-60.

  2. 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. Nov 2008;59(5):834-8. [Medline].

  3. Fretzin DF, Whitney D. Familial Becker's nevus. J Am Acad Dermatol. Mar 1985;12(3):589-90. [Medline].

  4. Sirka CS, Puhan MR, Behera S, Mohanty P, Nanda M. Becker's nevus with ipsilateral breast hypoplasia. Indian J Dermatol Venereol Leprol. Mar-Apr 2009;75(2):202-3. [Medline].

  5. Van Gerwen HJ, Koopman RJ, Steijlen PM, Happle R. Becker's naevus with localized lipoatrophy and ipsilateral breast hypoplasia. Br J Dermatol. Aug 1993;129(2):213. [Medline].

  6. Lambert JR, Willems P, Abs R, Van Roy B. Becker's nevus associated with chromosomal mosaicism and congenital adrenal hyperplasia. J Am Acad Dermatol. Apr 1994;30(4):655-7. [Medline].

  7. Urbani CE, Betti R. Polythelia within Becker's naevus. Dermatology. 1998;196(2):251-2. [Medline].

  8. Szylit JA, Grossman ME, Luyando Y, Olarte MR, Nagler H. Becker's nevus and an accessory scrotum. A unique occurrence. J Am Acad Dermatol. May 1986;14(5 Pt 2):905-7. [Medline].

  9. Kopera D, Hohenleutner U, Landthaler M. Quality-switched ruby laser treatment of solar lentigines and Becker's nevus: a histopathological and immunohistochemical study. Dermatology. 1997;194(4):338-43. [Medline].

  10. Nelson JS, Applebaum J. Treatment of superficial cutaneous pigmented lesions by melanin-specific selective photothermolysis using the Q-switched ruby laser. Ann Plast Surg. Sep 1992;29(3):231-7. [Medline].

  11. Raulin C, Schönermark MP, Greve B, Werner S. Q-switched ruby laser treatment of tattoos and benign pigmented skin lesions: a critical review. Ann Plast Surg. Nov 1998;41(5):555-65. [Medline].

  12. Trelles MA, Allones I, Moreno-Arias GA, Vélez M. Becker's naevus: a comparative study between erbium: YAG and Q-switched neodymium:YAG; clinical and histopathological findings. Br J Dermatol. Feb 2005;152(2):308-13. [Medline].

  13. Choi JE, Kim JW, Seo SH, Son SW, Ahn HH, Kye YC. Treatment of Becker's nevi with a long-pulse alexandrite laser. Dermatol Surg. Jul 2009;35(7):1105-8. [Medline].

  14. Meesters AA, Wind BS, Kroon MW, Wolkerstorfer A, van der Veen JP, Nieuweboer-Krobotová L. Ablative fractional laser therapy as treatment for Becker nevus: a randomized controlled pilot study. J Am Acad Dermatol. Dec 2011;65(6):1173-9. [Medline].

  15. Bhawan J, Chang WH. Becker's melanosis: an ultrastructural study. Dermatologica. 1979;159(3):221-30. [Medline].

  16. Burgreen BL, Ackerman AB. Acneform lesions in Becker's nevus. Cutis. May 1978;21(5):617-9. [Medline].

  17. Copeman PW, Jones EW. Pigmented hairy epidermal nevus (Becker). Arch Dermatol. Sep 1965;92(3):249-51. [Medline].

  18. Danarti R, Konig A, Salhi A, Bittar M, Happle R. Becker's nevus syndrome revisited. J Am Acad Dermatol. Dec 2004;51(6):965-9. [Medline].

  19. Do JE, Kim YJ, Kang HY. Hypohidrosis colocalized with Becker's naevus. Br J Dermatol. Apr 2007;156(4):766-7. [Medline].

  20. Entwisle BR, Nurse DS. Becker's melanosis and hypertrichosis. Australas J Dermatol. Dec 1967;9(2):198-203. [Medline].

  21. Fehr B, Panizzon RG, Schnyder UW. Becker's nevus and malignant melanoma. Dermatologica. 1991;182(2):77-80. [Medline].

  22. Glinick SE, Alper JC, Bogaars H, Brown JA. Becker's melanosis: associated abnormalities. J Am Acad Dermatol. Oct 1983;9(4):509-14. [Medline].

  23. Goldman MP, Fitzpatrick RE. Treatment of benign pigmented cutaneous lesions. Cutan Laser Surg. 1994;106-41.

  24. Nanni CA, Alster TS. Treatment of a Becker's nevus using a 694-nm long-pulsed ruby laser. Dermatol Surg. Sep 1998;24(9):1032-4. [Medline].

  25. Ohtsukam H. Ruby laser treatment of pigmented skin lesions. Jpn J Plast Reconstr Surg. 1992;29:231-7.

  26. Person JR, Longcope C. Becker's nevus: an androgen-mediated hyperplasia with increased androgen receptors. J Am Acad Dermatol. Feb 1984;10(2 Pt 1):235-8. [Medline].

  27. Tate PR, Hodge SJ, Owen LG. A quantitative study of melanocytes in Becker's nevus. J Cutan Pathol. Dec 1980;7(6):404-9. [Medline].

  28. Tse Y, Levine VJ, McClain SA, Ashinoff R. The removal of cutaneous pigmented lesions with the Q-switched ruby laser and the Q-switched neodymium: yttrium-aluminum-garnet laser. A comparative study. J Dermatol Surg Oncol. Dec 1994;20(12):795-800. [Medline].

  29. Tymen R, Forestier JF, Boutet B, Colomb D. [Late Becker's nevus. One hundred cases (author's transl)]. Ann Dermatol Venereol. 1981;108(1):41-6. [Medline].

  30. Urbanek RW, Johnson WC. Smooth muscle hamartoma associated with Becker's nevus. Arch Dermatol. Jan 1978;114(1):104-6. [Medline].

 
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Becker nevus of chest wall with associated hypertrichosis. Courtesy of Jason K. Rivers, MD.
Becker nevus demonstrating smooth muscle bundles in the dermis. Courtesy of Jason K. Rivers, MD.
 
 
 
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