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Background

This rare pigmented lesion usually occurs on the upper back and is biopsied to rule out an atypical melanocytic nevus. Histologically, there is a proliferation of benign smooth muscle and it is believed that this entity may represent a spectrum with a smooth muscle hamartoma.

OUTLINE

Epidemiology  
Disease Associations  
Pathogenesis  
Laboratory/Radiologic/
Other Diagnostic Testing
 
Gross Appearance
and Clinical Variants
 
Histopathological Features
and Variants
 
Special Stains/
Immunohistochemistry/
Electron Microscopy
 
Differential Diagnosis  
Prognosis  
Treatment  
Commonly Used Terms  
Internet Links  

 

DISEASE ASSOCIATIONS CHARACTERIZATION

Becker's nevus associated with limb asymmetry.

Lucky AW, Saruk M, Lerner AB.

Arch Dermatol 1981 Apr;117(4):243 .

Becker's melanosis: associated abnormalities.

Glinick SE, Alper JC, Bogaars H, Brown JA.

J Am Acad Dermatol 1983 Oct;9(4):509-14 Abstract quote

Becker's melanosis is a distinct clinical entity. We report herein two cases with extensive lesions accompanied by subjacent and distant soft tissue and bony abnormalities. Review of the world's literature reveals several additional cases of structural abnormalities associated with Becker's melanosis.

Rather than just a dermatologic curiosity, Becker's melanosis may be a marker for underlying structural anomalies.

Becker's melanosis and hypoplasia of the breast and pectoralis major muscle.

Moore JA, Schosser RH.

Pediatr Dermatol 1985 Nov;3(1):34-7 Abstract quote

Becker's melanosis can be associated with hypoplastic abnormalities. In our patient (the first case report), it occurred in association with an absent pectoralis major muscle.

Although more common in males, this patient demonstrates that Becker's melanosis can occur in females and may be congenital.

Elephantiasis neuromatosa and Becker's melanosis.

Akyol M, Ozcelik S, Marufihah M, Elagoz S.

Department of Dermatology, Cumhuriyet University, Sivas, Turkey.

J Dermatol 1999 Jun;26(6):396-8 Abstract quote

The most characteristic lesions of neurofibromatosis are the extremely large plexiform neurofibromas involving an entire extremity, which give rise to the condition known as elephantiasis neuromatosa.

In this article, we present a patient who was diagnosed as elephantiasis neuromatosa with Becker's melanosis clinically and review the literature briefly.

 

CLINCAL VARIANTS/GROSS DISEASE CHARACTERIZATION
GENERAL

[Late Becker's nevus. One hundred cases (author's transl)] [Article in French]

Tymen R, Forestier JF, Boutet B, Colomb D.

Ann Dermatol Venereol 1981;108(1):41-6 Abstract quote

The authors make a survey of a series of a hundred Becker's nevi diagnosed in a recruiting center of the French National Service. It is a statistic study bearing on the male population, aged 17 to 26, in a French region which is supposed to be representative of the French male population of the same age.

First of all the authors focus on the various clinical descriptions since this nevus was first described by Becker in 1949, then discuss the problems raised by pathogenic interpretation and the results of microscopic studies. About this lesion, usually said to be pigmentary and hairy, and generally appearing before 20 years of age, is still very little known. Then after a short explanation of their method of study the authors give original results. A hundred Becker's nevi were diagnosed among 19,302 young men, that is to say in a proportion of 0.52 p. 100. A study of the racial, genetic and pigmentary background doesn't enable to retain general causes but rather leads to think of local causes. Half of these Becker's nevi appeared before ten years of age, the other half appearing between 10 and 20. In only one quarter of the cases can the role of the sun be pointed out. The location of the nevi is variable; they are mainly situated on the trunk and only 32 p. 100 of them are located above nipples, which was believed to be the usual place of the lesion. Pigmentation in three quarter of the cases is light brown. The average surface is 125 cm2. Hairs can be seen in only a little more than half of the cases of no lesion associated to the nevus could be found.

The study points out that Becker's nevi seem to be more various in their clinical expression and more pigment than could be thought through more classical description.

VARIANTS  

Acneform lesions in Becker's nevus.

Burgreen BL, Ackerman AB.

Cutis 1978 May;21(5):617-9 Abstract quote

Three cases of Becker's nevus are described in which acneform lesions were confined strictly within the limits of the hyperpigmentation.

The combined phenomenon has not been reported previously, and we conceive it to be either a rare variant of the anomaly or a still rarer coincidence of Becker's nevus and nevus comedonicus.

Becker's nevus and an accessory scrotum. A unique occurrence.

Szylit JA, Grossman ME, Luyando Y, Olarte MR, Nagler H.

J Am Acad Dermatol 1986 May;14(5 Pt 2):905-7 Abstract quote

A case of Becker's nevus occurring in association with an accessory scrotum is described. Recent studies have shown the presence of androgen receptors in Becker's nevus in concentrations comparable to those in genital skin.

We postulate that the simultaneous occurrence of both these developmental anomalies was manifested because of androgen sensitivity and stimulation.

Familial Becker's nevus.

Panizzon R, Schnyder UW.

Department of Dermatology, University Hospital, Zurich, Switzerland.

Dermatologica 1988;176(6):275-6 Abstract quote

The authors describe 4 patients with Becker's nevus (BN) in two families. Another 4 patients of the german literature are also presented. Together with the first two published cases of BN, familial BN is now known in 10 patients.

All three clinical types of BN could be noticed.

Guttate psoriasis sparing Becker's melanosis--a case report.

Weiss RM, Schulz EJ.

Division of Dermatology, University of the Witwatersrand, Johannesburg, South Africa.

Dermatologica 1990;180(3):160-2 Abstract quote

A young man with Becker's melanosis developed typical guttate psoriasis following an attack of tonsillitis.

The psoriatic lesions spared the area of melanosis, suggesting that there may be local factors within an area of Becker's melanosis which inhibit the development of psoriasis.

Giant Becker's naevus with ipsilateral areolar hypoplasia and limb asymmetry.

Crone AM, James MP.

Department of Dermatology, Royal Berkshire Hospital, Reading, UK.

Clin Exp Dermatol 1997 Sep;22(5):240-1 Abstract quote

We report a case of giant Becker's naevus, ipsilateral areolar hypoplasia and limb asymmetry in a 48-year-old male.

This is the first case in which Becker's naevus with areolar hypoplasia has been reported to be associated with other defects.

Melanosis naeviformis of Becker and scoliosis: a coincidence?

Maessen-Visch MB, Hulsmans RF, Hulsmans FJ, Neumann HA.

Department of Dermatology, University Hospital Maastricht, The Netherlands.

Acta Derm Venereol 1997 Mar;77(2):135-6 Abstract quote

Melanosis naeviformis of Becker (MNB) can be associated with hypoplasia of soft tissue or extremities, spina bifida and scoliosis of the vertebral column.

We have investigated 50 patients (42 men, 8 women) with MNB radiologically. Scoliosis was diagnosed in 13 patients (26%). The curves of scoliosis varied from 11 degrees to 17 degrees. Physical examination revealed no gross asymmetries of the trunk, extremities or breasts. No correlation was seen between the age of patients and the scoliotic curve. In one family the father and oldest son had MNB with scoliosis and the other son and daughter had MNB without scoliosis.

Since only mild scoliosis is found in patients with MNB, X-ray examination of the vertebral column has no therapeutic consequences.

Congenital Becker's nevus with a familial association.

Book SE, Glass AT, Laude TA.

Department of Dermatology, State University of New York Health Science Center, Brooklyn, USA.

Pediatr Dermatol 1997 Sep-Oct;14(5):373-5 Abstract quote

Becker's nevus is a unilateral, hyperpigmented cutaneous hamartoma usually with hypertrichosis. It occurs predominantly in boys, becoming apparent during adolescence, although several cases of congenital Becker's nevus have been reported. Rarely it may be familial and as such is transmitted in an autosomal dominant pattern.

We report a 16-month-old black boy with a hyperpigmented patch on his right shoulder and upper pectoral area that extended down his arm. The patient's father has a similar lesion with hair on his left shoulder which has been present since childhood. Histology of the child's lesion was consistent with Becker's nevus.

We believe this to be the first reported case of a congenital Becker's nevus with a familial association.

Lymphangioma associated with Becker's nevus: a report of coincident hamartomas in a child.

Oyler RM, Davis DA, Woosley JT.

Department of Dermatology, University of North Carolina, Chapel Hill 27599, USA.

Pediatr Dermatol 1997 Sep-Oct;14(5):376-9 Abstract quote

Lymphangiomas are hamartomas which often occur during childhood. Their classification is primarily size dependent and predicts their clinical course. Larger lesions can be life threatening, but for many patients with lymphangiomas, cosmetic disfigurement is the primary concern. Treatment options are limited and have shown only variable success. Repetitive surgical excision may be necessary.

We report a cystic lymphangioma of the axilla occurring in association with a Becker's nevus in an infant. Although Becker's nevi have been described in association with other hamartomas, primarily those of smooth muscle, an association with cystic lymphangioma has not been previously reported.

We offer a brief discussion of possible developmental mechanisms for their coexistence. In our patient the simultaneous occurrence of a lymphangioma and a Becker's nevus appears to be a localized event, as no other developmental abnormalities are evident.

Polythelia within Becker's naevus.

Urbani CE, Betti R.

Service of Dermatology, San Raffaele Resnati Hospital, Italy.

Dermatology 1998;196(2):251-2 Abstract quote

We report a case of accessory mammary tissue of type 2a (or polythelia) entirely localized within a Becker's naevus of mixed type in a 32-year-old Caucasian woman.

Polythelia was congenital in origin while Becker's naevus appeared during puberty. Renal ultrasonographic studies, laboratory examinations and other instrumental investigations were either normal or negative.

Although the association of accessory mammary tissue with Becker's naevus has previously been reported--also in the form of mammorenal and acromammorenal syndromes--this is the first case characterized by an anatomic overlap between the two anomalies. It may be the expression of a common disturbance acting early in embryogenesis in the specific developmental fields involved.

Congenital melanosis and hypertrichosis in bilateral distribution.

Ferreira MJ, Bajanca R, Fiadeiro T.

Dermatology Department, Hospital do Desterro, Hospitais Civis de Lisboa, Lisbon, Portugal

Pediatr Dermatol 1998 Jul-Aug;15(4):290-2 Abstract quote

We report a 4-year-old Caucasian girl with congenital skin lesions consisting of hyperpigmented macules that were bilateral and roughly symmetrical, covered with terminal hair and located on the scapular regions, shoulders, and arms. A cutaneous biopsy specimen showed the histologic pattern of Becker nevus.

We discuss the classification of this case in the context of the published literature.

Becker's melanosis in a woman

Sylvia Hsu, MD
Joy Y. Chen, MD
Paul Subrt, MD

Houston, Texas

J Am Acad Dermatol 2001;45:S195-6. Abstract quote

Becker's melanosis is a relatively common, benign hamartoma, which is usually characterized by a hyperpigmented, hypertrichotic patch on the upper trunk or proximal upper extremities of males, with its onset during the peripubertal years. Commonly, there is an associated smooth muscle hamartoma on histology. We present a woman with a Becker's melanosis on the leg without hypertrichosis.

We believe that the spectrum of Becker's nevus is greater than commonly thought and that cases similar to ours are not rare, but have been diagnosed as other conditions.

 

HISTOLOGICAL TYPES CHARACTERIZATION
GENERAL  

Smooth muscle hamartoma associated with Becker's nevus.

Urbanek RW, Johnson WC.

Arch Dermatol 1978 Jan;114(1):104-6 Abstract quote

Two cases of smooth muscle hamartoma with Becker's nevus are reported. Clinically and histologically the lesions resemble Becker's nevi with the exception that on histologic examination a hamartomatous proliferation of smooth muscle is prominent.

The dermal component in melanosis naeviformis Becker.

Haneke E.

J Cutan Pathol 1979 Feb;6(1):53-8 Abstract quote

Histological investigations were performed in 11 subjects suffering from melanosis naeviformis Becker.

Apart from the well-known epidermal alterations such as basal hyperpigmentation, slight acanthosis and growth of coarse hair, dermal changes were found in each case. The dermis was considerably thickened and contained numerous small and/or large bundles of smooth muscle without relation to cutaneous adnexa. Thus, melanosis naeviformis Becker can be considered an organoid nevus with epidermal, melanocytic and dermal components.

A quantitative study of melanocytes in Becker's nevus.

Tate PR, Hodge SJ, Owen LG.

J Cutan Pathol 1980 Dec;7(6):404-9 Abstract quote

A case of Becker's nevus is presented. Dopa-oxidase stains performed on involved and on noninvolved nearby skin revealed a substantial increase in the number of melanocytes in the nevus.

Becker's melanosis: an organoid hamartoma.

Chapel TA, Tavafoghi V, Mehregan AH, Gagliardi C.

Cutis 1981 Apr;27(4):405-6, 410, 415 Abstract quote

Herein we have reported the histologic findings in two cases of Becker's melanosis. In one patient the lesion showed hyperplasia or hair muscles and in the other patient the lesion was associated with an underlying neurofibroma. The proliferative changes seen in the epidermis and dermis in Becker's melanosis can best be explained by the concept of an organoid hamartoma with involvement of the epidermis, pilar structures, and some other dermal components. The localization of the plexiform neurofibroma within the Becker's nervus is a unique observation. It may fall within the spectrum of an organoid hamartoma or it may only represent a chance occurrence.

 

SPECIAL STAINS/
IMMUNOPEROXIDASE/
OTHER
CHARACTERIZATION
SPECIAL STAINS  
ELECTRON MICROSCOPY  

Becker's melanosis: an ultrastructural study.

Bhawan J, Chang WH.

Dermatologica 1979;159(3):221-30 Abstract quote

Becker's melanosis is an uncommon condition characterized by hypertrichosis, hyperpigmentation of the epidermis, dermal melanophages and absence of nevus cells. Ultrastructural examination of such a melanotic lesion from a young white man revealed giant melanosomes.

In addition, normal-sized melanosomes were found singly in the keratinocytes of the involved skin. Dermal venules were surrounded by multiple layers of basement membrane.

 

DIFFERENTIAL DIAGNOSIS KEY DIFFERENTIATING FEATURES

Progressive cribriform and zosteriform hyperpigmentation.

Rower JM, Carr RD, Lowney ED.

Arch Dermatol 1978 Jan;114(1):98-9 Abstract quote

Five cases of progressive cribriform and zosteriform hyperpigmentation are described. The following criteria were fulfilled: (1) uniformly tan cribriform macular pigmentation in a zosteriform distribution; (2) a histologic pattern that consisted of a mild increase in melanin pigment in the basal cell layer and complete absence of nevus cells; (3) no history of rash, injury, or inflammation to suggest postinflammatory hyperpigmentation; (4) onset well after birth with gradual extension; and (5) lack of other associated cutaneous or internal abnormalities.

This appears to be a newly described entity, although it resembles a Becker's nevus without hypertrichosis or an typical cafe au lait spot. We believe that such progressive cribriform and zosteriform pigmentation is not uncommon.

Congenital smooth muscle hamartoma.

Berger TG, Levin MW.

J Am Acad Dermatol 1984 Oct;11(4 Pt 2):709-12 Abstract quote

Smooth muscle hamartoma is a rare congenital cutaneous hyperplasia of the arrectores pilorum muscles. Clinically it may mimic a solitary mastocytoma or congenital nevocellular nevus. The pattern histopathologically is distinct from all other benign muscle tumors of the skin and is mimicked only by the smooth muscle hyperplasia present in Becker's nevus.

 

PROGNOSIS AND TREATMENT CHARACTERIZATION
PROGNOSTIC FACTORS  
TREATMENT  

Treatment of a Becker's nevus using a 694-nm long-pulsed ruby laser.

Nanni CA, Alster TS.

Washington Institute of Dermatologic Laser Surgery, Washington, DC, USA.

Dermatol Surg 1998 Sep;24(9):1032-4 Abstract quote

Becker's nevus is an uncommon pigmented smooth muscle hamartoma that develops during adolescence and occurs primarily in young men. The nevus is characterized by hypertrichosis and hyperpigmentation and is usually located unilaterally over the shoulder, upper arm, and scapula.

We describe a patient with a Becker's nevus who was treated with a long-pulsed ruby laser in order to decrease hair density and pigmentation.

Henry JB. Clinical Diagnosis and Management by Laboratory Methods. Twentieth Edition. WB Saunders. 2001.
Rosai J. Ackerman's Surgical Pathology. Ninth Edition. Mosby 2004.
Sternberg S. Diagnostic Surgical Pathology. Fourth Edition. Lipincott Williams and Wilkins 2004.
Robbins Pathologic Basis of Disease. Sixth Edition. WB Saunders 1999.
DeMay RM. The Art and Science of Cytopathology. Volume 1 and 2. ASCP Press. 1996.
Weedon D. Weedon's Skin Pathology Second Edition. Churchill Livingstone. 2002
Fitzpatrick's Dermatology in General Medicine. 5th Edition. McGraw-Hill. 1999.
Weiss SW and Goldblum JR. Enzinger and Weiss's Soft Tissue Tumors. Fourth Edition. Mosby 2001.


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