eMedicine Specialties > Dermatology > Diseases of Pigmentation

Becker Melanosis

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
Coauthor(s): Marni C Wiseman, MD, FRCPC, Assistant Professor, University of Manitoba, CancerCare Manitoba
Contributor Information and Disclosures

Updated: Nov 12, 2008

Introduction

Background

In 1948, S. William Becker described 2 young men with acquired melanosis and hypertrichosis in a unilateral distribution.1 Since then, this condition has been termed Becker nevus.

Pathophysiology

The pathogenesis of Becker nevus remains uncertain.

Androgens may play a role as evidenced by its peripubertal development, male preponderance, hypertrichosis, occasional development of acneform lesions within the patch, and rare association with accessory scrotum in the genital region. In addition, a significant increase in the number of androgen receptors in lesional skin has been reported.

Frequency

International

A study of 19,302 men aged 17-26 years revealed a prevalence of 0.52%.

Sex

Males are affected more often than females.

Age

Although Becker nevus usually is a sporadic condition that manifests in the peripubertal period, both congenital and familial cases2 have been described.

Clinical

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 (Media File 1).
    • 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.
  • Associated findings
    • Occasionally, Becker nevus may be associated with smooth muscle hamartoma. Rarely, hypoplasia of underlying structures, such as unilateral breast hypoplasia, has been reported.
    • 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,3 congenital adrenal hyperplasia,4 polythelia,5 and accessory scrotum.6
    • 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.

Physical

See History.

Causes

See Pathophysiology.

More on Becker Melanosis

Overview: Becker Melanosis
Differential Diagnoses & Workup: Becker Melanosis
Treatment & Medication: Becker Melanosis
Follow-up: Becker Melanosis
Multimedia: Becker Melanosis
References
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References

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

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

  3. 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].

  4. 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].

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

  6. 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].

  7. 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].

  8. 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].

  9. 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].

  10. 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].

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

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

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

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

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

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

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

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

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

  20. 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].

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

  22. 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].

  23. 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].

  24. 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].

  25. 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].

  26. 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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Further Reading

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Keywords

Becker's nevus, Becker nevus, Becker's pigmented hairy nevus, Becker pigmented hairy nevus, nevus spilus tardus, pigmented hairy epidermal nevus

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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, Pacific Dermatologic Association, Royal College of Physicians and Surgeons of Canada, and Women's Dermatologic Society
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.

Medical Editor

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.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
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.

Managing Editor

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.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine 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, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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