Becker’s nevus

Published on 18/03/2015 by admin

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Becker’s nevus

Michael P. Loosemore, Adisbeth Morales-Burgos, Elnaz F. Firoz, Bahar F. Firoz and Leonard H. Goldberg

Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports

image

Becker’s nevus, also called pigmented hairy epidermal nevus, is a cutaneous hamartoma that can have increased epidermal (melanocyte), dermal (smooth muscle), and appendageal (hair follicle) components. Classically, Becker’s nevus is first noticed around puberty on the shoulders and chest in males, but may be congenital, involve any area of the body, and occur in women. The prevalence in postpubertal males is approximated to be 0.5%, or 1 in 200.

Management strategy

Becker’s nevus is usually asymptomatic and may come to the attention of a physician for cosmetic or diagnostic purposes. It is important to examine the patient for developmental defects that may accompany Becker’s nevus and occur within the spectrum of Becker’s nevus syndrome, one of several epidermal nevus syndromes. Reported associations include, but are not limited to:

Associations of Becker’s nevus with cutaneous cancers have been reported. Both basal cell carcinoma and intraepithelial squamous cell carcinoma (Bowen’s disease) have been described separately in two young women without significant risk factors (i.e., photodamage, papillomavirus infection, arsenic exposure). Although melanoma has been described in patients with Becker’s nevus, the risk of malignant transformation appears to be very low. Regular screening for melanoma is unnecessary.

Traditional surgical approaches to remove Becker’s nevus are either unsuccessful or result in significant scarring. Laser technology offers the clinician a means to reduce both the pigmentation and the hypertrichosis often seen in Becker’s nevus, and therefore may improve the cosmetic appearance of the lesion. Management of asymptomatic, benign lesions should be based on confirming the diagnosis and fully documenting any associated pathology.

Specific investigations

The diagnosis of Becker’s nevus can be made on clinical examination. Although skin biopsy is diagnostic, it is often unnecessary. Familial Becker’s nevus has been regularly reported and it would be prudent to inquire about other family members, especially same-sex siblings.

In some instances, differentiating between large congenital melanocytic nevus and Becker’s nevus may be difficult. Dermoscopy may help in equivocal cases. Network, focal hypopigmentation, skin furrow hypopigmentation, hair follicles, perifollicular hypopigmentation, and vessels are the main dermoscopic features of Becker’s nevus.

First-line therapies

Treatment requested by patients can be divided into two components:

Reduction of hyperpigmentation

image Erbium:YAG laser C
image Long-pulse alexandrite laser D
image Erbium-doped fiber laser (Fraxel) D
image Q-switched ruby laser (QSRL) D

Third-line therapies

image Spironolactone E
image Corrective camouflage E

[/level-membership-for-dermatology-category][not-level-membership-for-dermatology-category]

Becker’s nevus

Michael P. Loosemore, Adisbeth Morales-Burgos, Elnaz F. Firoz, Bahar F. Firoz and Leonard H. Goldberg

Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports

image

Becker’s nevus, also called pigmented hairy epidermal nevus, is a cutaneous hamartoma that can have increased epidermal (melanocyte), dermal (smooth muscle), and appendageal (hair follicle) components. Classically, Becker’s nevus is first noticed around puberty on the shoulders and chest in males, but may be congenital, involve any area of the body, and occur in women. The prevalence in postpubertal males is approximated to be 0.5%, or 1 in 200.

Management strategy

Becker’s nevus is usually asymptomatic and may come to the attention of a physician for cosmetic or diagnostic purposes. It is important to examine the patient for developmental defects that may accompany Becker’s nevus and occur within the spectrum of Becker’s nevus syndrome, one of several epidermal nevus syndromes. Reported associations include, but are not limited to:

Associations of Becker’s nevus with cutaneous cancers have been reported. Both basal cell carcinoma and intraepithelial squamous cell carcinoma (Bowen’s disease) have been described separately in two young women without significant risk factors (i.e., photodamage, papillomavirus infection, arsenic exposure). Although melanoma has been described in patients with Becker’s nevus, the risk of malignant transformation appears to be very low. Regular screening for melanoma is unnecessary.

Traditional surgical approaches to remove Becker’s nevus are either unsuccessful or result in significant scarring. Laser technology offers the clinician a means to reduce both the pigmentation and the hypertrichosis often seen in Becker’s nevus, and therefore may improve the cosmetic appearance of the lesion. Management of asymptomatic, benign lesions should be based on confirming the diagnosis and fully documenting any associated pathology.

Specific investigations

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