Angoori Gnaneshwar Rao
Department of Dermatology, SVS Medical College, Mahbubnagar, Telangana, India
|Date of Web Publication||4-Sep-2015|
Angoori Gnaneshwar Rao
F12, B8, HIG-II APHB, Baghlingampally, Hyderabad, Telangana
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Becker's nevus is a focal epidermal hypermelanotic disorder. It morphologically presents as unilateral, hyperpigmented, hypertrichotic patch on upper trunk, proximal upper extremities and arms. However, Becker's nevus presenting as bilateral, symmetrical patches is rare. Herein, we report a rare case of giant Becker's nevus with bilateral symmetrical presentation in an adult male.
Keywords: Becker′s nevus, bilateral, giant, lasers, symmetrical
|How to cite this article:|
Rao AG. Bilateral symmetrical congenital giant Becker's nevus: A rare presentation. Indian J Dermatol 2015;60:522
What was known?
Becker′s nevus presents as unilateral, hyperpigmented and hypertrichotic patch.
| Introduction|| |
Becker's nevus (BN) was first described by S W Becker in 1949 which he conceived it to be concurrent melanosis and hypertrichosis in the distribution of nevus unius lateris.  It is characterized by unilateral hyperpigmented macules and patches distributed on proximal extremities with or without hypertrichosis. It is usually unilateral but there are few reports of bilateral involvement described in the literature. Herein, we report bilateral symmetrical giant BN in a young adult.
| Case Report|| |
A 23-year-old male presented to us for pigmented patches on both shoulders and arms since birth. The patches were small in childhood which gradually increased in size and turned darker over the years and growth of the hair on the dark patches was also noticed. No history of similar problem in the family is reported. There is no associated itching. Cutaneous examination revealed large hyperpigmented patches involving both scapular and suprascapular region, both shoulders, arms, extensor aspect of forearms. The patches merged in the upper part of middle of the spine and covered by fine hair. The borders were irregular and less pigmented [Figure 1]. Spine, underlying muscles and bones were apparently normal. Systemic examination did not reveal any abnormality. He was provisionally diagnosed with giant BN. However, giant congenital melanocytic nevus was considered in the differential diagnosis. Routine blood chemistry, X-ray chest, X-ray spine ultrasonography of the abdomen were all unremarkable. Histopathological examination of a skin biopsy taken from the hyperpigmented patch showed atrophic epidermis with increased pigmentation of basal layer and few lymphocytes in the dermis [Figure 2]. Both clinical and histopathological features corroborated in establishing the diagnosis of BN. In view of the large size of the nevus and its presence since birth and symmetrical distribution, the patient was finally diagnosed with bilateral symmetrical congenital giant BN. He was referred to laser center for further management.
|Figure 1: (Original) Becker's nevus involving both scapular and suprascapular region, both shoulders, arms, extensor aspect of forearms|
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|Figure 2: (Original) Microphotograph. H and E stain ×100 showing atrophic epidermis with increased pigmentation of basal layer and few lymphocytes in the dermis|
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| Discussion|| |
BN presents with varied clinical presentations. Most often it is acquired; however, autosomal dominant mode of inheritance with variable penetrance has been hypothesized. A prevalence of 0.5% was recorded in a study involving 19,302 male French recruits between the ages of 17 and 26 years.  BN is more common in males with a male to female ratio of 5:1.  It is known that there is disturbance in the androgen receptor activity in BN as evidenced by increased androgen receptor density.  Moreover, it is said to be responsible for hypertrichosis and hyperpigmentation of the nevus. BN commonly presents as unilateral hyperpigmented irregular patch or plaque with variable amount of hair, located over shoulder, scapula, chest and back. Nonetheless, there have been few reports of BN in the literature with bilateral involvement. ,,,,,, To our knowledge, there are only four cases of giant BN reported in the literature with bilateral symmetrical presentation [Table 1]. Similarly, BN in the index case also made bilateral symmetrical presentation albeit with giant size. The nevi covering scapular, suprascapular region, back of both arms and dorsum of left hand is distinctive. Furthermore, the hypertrichosis on the nevi noted in 50% of BN was also observed in the reported case and is attributable to circulating androgens. Notably, for the same reason there is less hypertrichosis and hyperpigmentation in female patients with BN.  Various non-cutaneous abnormalities have been described in association with BN that include aplasia of pectoralis muscle, hypoplasia of breast, limb shortening, scoliosis, congenital adrenal hypoplasia, spina bifida, hallux valgus and pectus carinatum. , However, there was no such association in the index case.
|Table 1: (Original) Showing details of published case reports of patients with bilateral symmetrical giant Becker's nevus |
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The main concern of the patients with BN is the cosmetic appearance. The therapeutic modalities are limited. Laser therapies in vogue include erbium yttrium garmet (Er YAG) laser and Q-switched laser.  The patients of BN without underlying muscular or skeletal abnormalities should be reassured regarding the benign nature of the condition.
| References|| |
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What is new?
Becker′s nevus presenting as bilateral symmetrical hyperpigmented and hypertrichotic patches.
[Figure 1], [Figure 2]