Published on 18/03/2015 by admin
Filed under Dermatology
Last modified 22/04/2025
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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
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.
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:
Cutaneous
– acneiform eruptions
– hypohidrosis
– lichen planus
– localized lipoatrophy
– localized scleroderma
– polythelia (supernumerary nipples)
– psoriasiform dermatitis
– unilateral breast hypoplasia
– osteoma cutis
Musculoskeletal
– limb asymmetry
– pectus excavatum or carinatum
– scoliosis, including other vertebral defects
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.
Danarti R, König A, Salhi A, et al. J Am Acad Dermatol 2004; 51: 965–9.
A review of ipsilateral breast hypoplasia, other cutaneous anomalies, musculoskeletal abnormalities, and maxillofacial findings that may be observed in Becker’s nevus syndrome. The concept of paradominant inheritance is presented to explain occasional familial aggregation in this syndrome.
Happle R, Koopman RJ. Am J Med Genet 1997; 68: 357–61.
Proposes term ‘Becker nevus syndrome’ to describe association of Becker’s nevus with developmental defects such as unilateral breast hypoplasia and other cutaneous, muscular, or skeletal defects in 23 cases.
Fehr B, Panizzon RG, Schnyder UW. Dermatologica 1991; 182: 77–80.
Report of nine patients with Becker’s nevus and malignant melanoma. Five melanomas were on the same body site as the Becker’s nevus, but only one arose within the nevus itself.
Park SB, Song BH, Park EJ, Kwon IH, Kim KH, Kim KJ. Ann Dermatol 2011; 23 (Suppl 2): S247–9.
An 18-year-old female was reported to have osteoma cutis accompanying her Becker’s nevus.
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.
Fretzin DF, Whitney D. J Am Acad Dermatol 1985; 12: 589–90.
The first two published cases of familial Becker’s nevus.
Ingordo V, Iannazzone SS, Cusano F, Naldi L. Dermatology 2006; 212: 354–60.
Assessed the use of optical dermoscopy with tenfold magnification in differentiating between large congenital melanocytic nevus and Becker’s nevus.
Treatment requested by patients can be divided into two components:
reduction of hyperpigmentation or
removal of excess hair
Trelles MA, Allones I, Moreno-Arias GA, Vélez M. Br J Dermatol 2005; 152: 308–13.
Twenty-two patients with Becker’s nevi were studied, 11 with each laser. Both erbium:YAG and Nd:YAG safely treated the lesions. For pigment removal, one pass with erbium:YAG was superior to three treatment sessions with Nd:YAG.
Choi JE, Kim JW, Seo SH, Son SW, Ahn HH, Kye YC. Dermatol Surg 2009; 35: 1105–8.
Eleven Korean patients with Becker’s nevi and skin types III to V were treated with the 755 nm long-pulse alexandrite laser with a spot size of 15–18 mm, fluence of 20–25 J/cm2, a pulse duration of 3 ms, and no cooling spray. Two patients had an excellent response, five good, and four a fair response. There was one case of partial hypertrophic scarring and some patients had mild hypopigmentation, and all outcomes were noted to be cosmetically acceptable.
Glaich AS, Goldberg LH, Dai T, Kunishige JH, Friedman PM. Arch Dermatol 2007; 143: 1488–90.
Two male patients with Becker’s nevi were treated with the 1550 nm wavelength erbium-doped fiber laser between 6 and 10 mJ at 4-week intervals and between five and six treatment sessions. Greater than 75% of the pigment had faded by 1 month in both patients. There was no improvement in hypertrichosis.
Raulin C, Schönermark MP, Greve B, Werner S. Ann Plast Surg 1998; 41: 555–65.
This review recommends three to ten treatments at monthly intervals with QSRL at fluences between 7 and 20 J/cm2 for hyperpigmentation. Although QSRL for long-term removal of associated hypertrichosis is not recommended, long-pulsed (755 nm) alexandrite laser has produced promising results.
Tse Y, Levine VJ, McClain SA, Ashinoff R. J Dermatol Surg Oncol 1994; 20: 795–800.
An area of Becker’s nevus was anesthetized and bisected, and each half treated with either QSRL or QSNd:YAG at 532 nm. Clinical lightening occurred in 63% and 43% of the lesion, respectively, at fluences of 8.4 and 2.8 J/cm2. QSRL caused intraoperative pain, while QSNd:YAG caused postoperative discomfort.
Wind BS, Meesters AA, Kroon MW, Beek JF, van der Veen JP, van der Wal AC, et al. Dermatol Surg 2012; 38: 437–42.
Eighteen patients with pigment disorders were randomized to either a non-ablative 1550 nm fractional laser at 15 mJ/microbeam with 14–20% coverage (patients with ashy dermatosis and postinflammatory hyperpigmentation) or an ablative 10 600 nm fractional laser at 10 mJ/microbeam with 35–35% coverage (Becker’s nevi) and treated for three to five sessions. Biopsies were performed 3 months after the last treatment to assess fibrosis formation. Non-ablative fractional laser did not exhibit any fibrosis, while 50% of patients treated using ablative fractional laser showed fibrosis.
The ruby laser in the normal or long-pulsed mode has been used for laser epilation. A common side effect is hypopigmentation of adjacent skin, which can be used when treating hypertrichosis of a Becker’s nevus.
Nanni CA, Alster TS. Dermatol Surg 1998; 24: 1032–4.
A single case report that showed reduction in pigmentation and a 90% reduction in hair growth after three treatments with the long-pulsed ruby laser. Improvement was maintained for 10 months.
The QSNd:YAG laser operating at 532 nm has been shown to reduce pigmentation in Becker’s nevus, but does not appear to be as successful as the ruby laser.
Electrolysis is a well-established method of epilation, but its use in removing hair from Becker’s nevus has not been described.
Hoon Jung J, Chan Kim Y, Joon Park H. Woo Cinn Y. J Dermatol 2003; 30: 154–6.
Spironolactone, an anti-androgenic agent, was administered for the treatment of breast hypoplasia associated with Becker’s nevus in one case. After 1 month, breast enlargement was observed only in the hypoplastic breast.
Becker’s nevus is thought to be an androgen-dependent lesion, as it becomes more prominent after puberty, displays increased hairiness in males, and contains an increased number of androgen receptors and androgen-receptor messenger RNA compared to surrounding skin.
Tedeschi A, Dall’Oglio F, Micali G, Schwartz RA, Janniger CK. Cutis 2007; 79: 110–12.
Corrective camouflage using a variety of water-resistant and light to very opaque products was used in two patients with Becker’s nevi. Parents were satisfied with the cosmetic cover results. Corrective make-up may be a valid adjunctive therapy for patients undergoing long-term treatments or in whom conventional therapy is ineffective.
Treatment of Skin Disease Comprehensive Therapeutic Strategies 4e
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Erbium:YAG laser
Long-pulse alexandrite laser
Erbium-doped fiber laser (Fraxel)
Q-switched ruby laser (QSRL)
Normal mode ruby laser
Frequency-doubled QSNd:YAG
Electrolysis
Spironolactone
Corrective camouflage
