Becker Melanosis Treatment & Management

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

Surgical Care

Therapeutic intervention for Becker nevus primarily is for cosmetic reasons. Patients present with complaints related to hypertrichosis and/or hyperpigmentation.

Q-switched ruby laser (694 nm) has been used with variable success in the treatment of both the hypertrichosis and hyperpigmentation of Becker nevus.[9, 10, 11] Histopathologic analysis of lesional skin after laser treatment showed selective damage of superficially located melanocytes but a persistence of adnexal melanocytes. Remaining pigment cells may account for the transient improvement noted clinically.

A prospective study[12] demonstrated the superiority of an Er:YAG laser (n= 11) over a Q-switched Nd:YAG system (n = 11) in the treatment of Becker nevus. Evaluation 2 years after treatment showed that 54% of subjects treated with the Er:YAG laser showed complete clinical clearance, while a clearance of greater than 50% occurred in 100% of the subjects. By comparison, none of the patients who received 3 treatments with the Nd:YAG laser system cleared completely and only one person had marked improvement.

A long-pulsed 755-nm alexandrite laser was evaluated in 11 Korean patients with Becker nevus.[13] Two patients had excellent responses, 5 had good responses, and 4 had fair responses. Hair density simultaneously decreased with treatment in all patients.

Eleven adult patients with Becker nevus were included in a prospective, randomized, controlled, observer-blinded, split-lesion trial. In each patient, 2 similar square test regions were randomized to either ablative factional laser therapy at 10 mJ/microbeam, coverage 35-45%, and topical bleaching (to reduce laser-induced postinflammatory hyperpigmentation), or topical bleaching alone. Treatment was moderately effective in some patients. However, postinflammatory hyperpigmentation and relatively negative patient-reported outcomes still preclude ablative fractional laser therapy from being a standard therapy.[14] These results have been observed by this author, and the concern of both postinflammatory hyperpigmentation and hypopigmentation should be discussed with the patient prior to treatment.

Also see the Medscape Reference article Laser Treatment of Benign Pigmented Lesions.

Proceed to Follow-up
 
 
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].

 
Previous
Next
 
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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.