Becker nevus is a nevoid melanosis, that can cause a significant esthetic problem, and when is associated with other anomalies like musculoskeletal anomalies and ipsilateral hypoplasia of the chest or limb, it’s called Becker nevus syndrome.
An association has been seen with bone, vascular and neural anomalies. Other non-cutaneous abnormalities associated with Becker nevus are pectus carinatum, scoliosis, spina bifida, aplasia of pectoralis muscle, hallux valgus, hypoplasia of breast. Mayo Clinic reported a Becker nevus with an underlying desmoid soft-tissue tumor, and they concluded that is important to inspect the deep tissue, not only the surface of the Becker Nevus, because you don’t know what you can find. The literature supports that every patient with Becker nevus should be well verified to associated anomalies.
The most common locations of the disease are the trunk, scapular regions, anterior chest and shoulders, others regions are less commonly affected, such as the lower limbs. The nevus can presents a variable amount of hair , and it is described like an irregular plaque or patch, hyperpigmented and with an unilateral distribution. Only a few cases were found with bilateral involvement in the literature.
Becker nevus may be present from birth or may occur in adolescence, and usually the young males are affected, with a male to female ratio of 5:1. In Becker nevus has been evidenced that the androgen receptor density is raised, and the androgen receptor activity is disturbed.
This disturbed androgen activity is responsible for the hyperpigmentation and the hypertrichosis of the nevus. Hyperpigmentation and hypertrichosis are less common in females due to the lower quantity of circulating androgens. In the International Literature have not been described Becker nevus on the pretibial area.
Schepis et al. described a patient who had on the right forearm the lesion, and he was also diagnosed by mental retardation and coeliac disease. The patient had numerous clinic abnormalities associated with 5q deletion, confirmed with genetic tests.
Ho Quoc et al. described a new treatment for Becker nevus syndrome: breast lipofilling. The female patients seek medical advice when they have ipsilateral breast hypoplasia. They had two cases that they treated with fat grafts. They have noticed after one year that the breast symmetry and the thoracic nevus color was improved. With the lipofilling technique the patient’s quality of life improved, and the treatment is natural and with good results for thoracic anomalies.
Suzan Demir et al. presented a case of a 24-year-old woman, with a brown discoloration on the breast, and was diagnosed with Becker nevus and ipsilateral breast hypoplasia.
The patient problems had started 11 years ago, when he saw a little spot, and expanded every year.
To be more interesting, he sad that her left breast underlying tissue had not grown for some years.
On examination they observed an irregular brown patch, approximately 10 cm diameter, and magnetic resonance imaging showed hypoplasia of the left breast. Histopathological examination of the patch showed minimal dermal fibrosis, minimal acanthosis, mononuclear cell infiltration around vessels. Immunohistochemical examination evidenced androgen positive staining, resulting that Becker nevus could be androgen dependent nevus.
We present a series of five cases, from our clinic, where we watched localization, moment of appearance and dimension of the patches. All of the patients were males, four of them presented the lesion at thorax, and only one patient had the lesion on the face. The presence of hypertrichosis was seen only on one patient. Ii din lucrarea pe care am trimis o la Reziderma
Hernandez-Quiceno et al. described a case of an 11 years old female patient in association with pectus excavatum, and with an umbilical hernia history, surgically treated. Her skin lesion was congenital, situated on the left mandibular area. The diameter of the patch was 3 x 4 centimeters, with hypertrichosis and irregular borders. Pectus excavatum, left breast hypoplasia umbilical hernia and Becker nevus association established the diagnostic of Becker nevus syndrome. The patient was treated with spironolactone, and an improvement was seen on the left breast after therapy.
An interesting association was found between Becker nevus, lichen planus and vitiligo, a case report described by Sanjeev et al. at a thirty five years old male patient. The first lesion appeared at age of 15, and was a hypertrichotic, hyperpigmented plaque, on the right thorax.