Introduction:
Nevus is a mole in medical terms. You can either be born with one or acquire a mole. There are moles forming due to sun exposure as well. They appear as pink to dark spots. An individual can have 10 to 50 moles, which are found to be colored harmless patches. However, there are more serious ones too.
There are chances of moles being benign tumors that require removal if you do not like their appearance. But you need not worry about your moles being cancerous lesions. However, an ABCDE system can be used by people to determine whether a lesion is malignant. In the ABCDE system, A indicates the asymmetry of the lesion, B for the solid border, C for the change in color, D for the diameter of the lesion, and E for Evolving capacity of the lesion. This article concentrates on Becker nevus, which occurs due to the overgrowth of pigment cells in the epidermis and the hair follicles.
What Is Becker Nevus?
Becker nevus is not an actual nevomelanocytic lesion. It is a hamartoma consisting of hair follicles and arrector pili muscles. It develops anywhere on the body, especially on the shoulder and upper trunk, during childhood or adolescence. It is also found to be associated with other cutaneous, maxillofacial, and musculoskeletal disorders.
What Are the Other Names for Becker Nevus?
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Becker’s melanosis.
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Becker’s pigmentary hamartoma.
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Nevoid melanosis.
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Pigmentary hairy epidermal nevus.
Who Is At the Risk of Becker Nevus?
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Becker nevus is more commonly found in males than females at a ratio of 5:1.
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They can occur in all skin types.
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They may form during birth or the second and third decades of life.
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The lesion can be noticed in all races and various body areas.
What Are the Causes of Becker Nevus?
The exact cause of Becker nevus is unknown. Studies have reported a change in the genes as one cause. However, its development is more commonly found in males indicating the etiology associated with the circulating male sex hormone testosterone. There are reports of multiple members of the family with Becker nevus. However, there is no strong association between heredity and Becker nevus.
What Are the Clinical Features of Becker Nevus?
The clinical features of Becker nevus include:
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The patch is localized and hyperpigmented with a hypertrichotic patch.
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Most commonly presented unilaterally.
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The most common areas where Becker's nevus can be noticed are the shoulders, chest, and scapular regions.
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The patch color can be light tan to brown but are usually uniform.
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The shape of the patch is irregular, with demarcated borders, and shows small islands of hyperpigmentation.
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Hypertrichosis is the overgrowth of hair over the patch, generally after two years of hyperpigmentation. The hair is coarse and dark. In some cases, hypertrichosis is not clinically noticeable.
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The onset is generally in early adolescence, especially during and after puberty. Hence they can be easily differentiated from congenital melanocytic nevus.
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Most children reaching puberty will present to the doctor with the patch with no symptoms but for cosmetic concerns. During this stage, there may be androgen-dependent hair growth with pruritis.
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Becker nevus can also be associated with cutaneous disorders, acneiform eruptions (papules resembling acne or pimples), lichen planus (inflammatory condition of the skin and mucous membrane), eczematous dermatitis (skin condition showing red, dry, itchy, and bumpy lesion), and tinea versicolor (fungal infection of the skin).
What Are the Complications of Becker Nevus?
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Becker Nevus Syndrome: The syndrome is characterized by Becker nevus lesions with abnormalities in the skin, muscles, and skeletal structures. In addition, the individual may present with unilateral breast hypoplasia, scoliosis (sideways curvature of the spine), vertebral defects, supernumerary nipples, asymmetry of the scapulae (shoulder bone present in the upper back region), and limb asymmetry.
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Cosmetic Disfigurement: Becker nevus in most body parts may not be cosmetically pleasing and requires camouflage when the individual steps out.
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Psychological Distress: The cosmetic disfigurement caused due to the lesion is the forestanding factor for psychological distress.
How Can Becker Nevus Be Diagnosed?
Diagnosis can be based on a clinical examination of the lesion. A biopsy is taken for microscopic examination and for differentiating from other lesions. The microscopic examination of Becker nevus reveals the following features.
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Hyperpigmentation of the basal cell layer.
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Increased number of melanocytes in the basal layer.
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Hyperkeratosis: Thickening of the outer layer of the skin.
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Acanthosis: Thickening of the epidermis and elongation of the rete ridges.
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Fusion of rete pegs (protrusion of the epithelium into the connective tissue) in focal.
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Increased number of hair follicles.
What Are the Differential Diagnoses for Becker Nevus?
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Smooth muscle hamartomas.
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Cafe-au-lait pigmentations.
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Congenital melanocytic nevus.
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Plexiform neurofibromas.
How to Treat Becker Nevus?
There is no particular treatment for Becker nevus, but it can be made less noticeable, and complications can be treated strategically.
General Measures:-
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The dark patch should be kept out of sun exposure.
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Camouflage makeup would help improve hyperpigmentation of the skin.
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Overgrown hair on the Becker nevus lesion can be removed by waxing, threading, shaving, and epilation creams.
Specific Measures:-
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Electrolysis (electric current used to destroy the hair follicles and prevent hair growth) or laser treatment can be performed to remove excessive hair.
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Pigmentation can be reduced using laser treatments.
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Oral Isotretinoin or other acne therapies can treat Becker nevus-associated acne.
How to Prevent Becker Nevus?
No preventive strategies have been developed to stop Becker's nevus from occurring.
Conclusion:
Becker nevus is a benign, asymptomatic lesion that is rarely malignant. It does not require repeated surveillance of the lesion. The best way to treat it is to approach it with cosmetic procedures. It is rare for Becker's nevus to be associated with developmental anomalies. Therefore, it is good to visit a specialist and get them diagnosed and treated.
