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LETTER TO THE EDITOR
Year : 2016  |  Volume : 7  |  Issue : 4  |  Page : 329-330  

Giant bilateral Becker's nevus appearing as gladiator arm armor


Department of Dermatology, Venereology and Leprosy, Dr. PN Behl Skin Institute and School of Dermatology, New Delhi, India

Date of Web Publication5-Jul-2016

Correspondence Address:
Sarvesh S Thatte
Department of Dermatology, Venereology and Leprosy, Dr. PN Behl Skin Institute and School of Dermatology, New Delhi-110 048
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5178.185469

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How to cite this article:
Bhushan P, Thatte SS. Giant bilateral Becker's nevus appearing as gladiator arm armor. Indian Dermatol Online J 2016;7:329-30

How to cite this URL:
Bhushan P, Thatte SS. Giant bilateral Becker's nevus appearing as gladiator arm armor. Indian Dermatol Online J [serial online] 2016 [cited 2019 Dec 12];7:329-30. Available from: http://www.idoj.in/text.asp?2016/7/4/329/185469

Sir,

Becker's nevus is a cutaneous hamartoma, characterized by unilateral, hyperpigmented and hypertrichotic patch that commonly affects the upper trunk. It is cutaneous mosaic condition that sometimes has increased androgen activity.[1] Although Becker's nevus is usually a solitary lesion, multiple Becker's nevi have been reported in literature. However, bilateral Becker's nevus is rarely reported in the literature.

A 22-year-old man came to our outpatient department with complaints of dark patch over chest, back, and both upper limbs since 8 years with coarse thick hair over a few areas. Lesion started as a brown patch over both shoulders, which gradually increased to present size. On clinical examination, diffuse, well-defined, brown to dark patches having blotchy to feathery margins were present over chest, both scapulae and shoulder and both upper extremities. Patches were confluent over the chest, whereas over the back they were separated by thin midline [Figure 1] and [Figure 2]. They were surrounded by typical irregular macular pigmentation. Hypertrichosis was evident over both scapular regions. There was no evidence of any acneform lesions, or of thickening and induration of the skin. Other mucocutaneous examination was not significant. Clinical diagnosis of Becker's nevus was made. Skin biopsy confirmed the diagnosis of Becker's nevus. X-ray of neck, both upper limbs, and chest was done for any underlying skeletal involvement. X-ray of neck revealed marginal osteophytes over cervical vertebrae that suggested very early onset of degenerative bony changes beneath the Becker's nevus [Figure 3]. X-rays of other areas were normal.
Figure 1: Giant bilateral Becker's nevus in gladiator arm armor distribution

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Figure 2: Bilateral Becker's nevus over back separated by thin midline

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Figure 3: Marginal osteophytes suggesting very early onset of degenerative bony changes of cervical vertebrae beneath the Becker's nevus

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William Becker first described Becker's Nevus as “Concurrent melanosis and hypertrichosis in distribution of nevus unius lateris.” [2] Becker's nevus is five times more common in males as compared with females. It usually starts in the second or third decade of life and commonly occurs over anterior or posterior aspect of chest and shoulder. Sometimes lower trunk and extremities as well as face may also be involved.[1] Apart from classical sites with hypertrichosis, Becker's nevus can occur at atypical sites without hypertrichosis.

Bilateral Becker's nevus over shoulder area without any systemic involvement has been reported earlier.[3] Dasegowda et al. reported a case of bilateral Becker's nevus over both thighs, groins, vulva, and neck that was associated with various systemic involvement in a 15-year-old female patient. The patient was mentally retarded, short statured, and deaf. Skeletal abnormality in the form of arachnodactyly, syndactyly, hallux valgus, and crowning of lateral toes was present.[4] Issa et al. reported a case of giant Becker's nevus that had distribution similar to our case but did not extend beyond arms on both sides. The patient also had associated epidermal nevus.[5]

Our patient had bilateral giant Becker's nevus in a distribution similar to gladiator arm armor along with marginal osteophytes over cervical vertebrae that suggested early onset of degenerative changes. Such extensive lesions and degenerative spinal changes are seldom reported in the literature. We present this case to highlight the rare presentation and emphasize on thorough examination and radiological investigation to detect any underlying abnormality in a cosmetically concerned condition.

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Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Moss C, Shahidullah H. Naevi and other developmental defects. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook's Textbook of Dermatology. 8th ed. UK: Wiley-Blackwell; 2010. p. 18.1-18.107.  Back to cited text no. 1
    
2.
Becker SW. Concurrent melanosis and hypertrichosis in distribution of nevus unius lateris. Arch Derm Syphilol 1949;60:155-60.  Back to cited text no. 2
    
3.
Bansal R, Sen R. Bilateral Becker's nevi. Indian J Dermatol Venereol Leprol 2008;74:73.  Back to cited text no. 3
    
4.
Dasegowda SB, Basavaraj G, Nischal K, Swaroop M, Umashankar N, Swamy SS. Becker's nevus syndrome. Indian J Dermatol 2014;59:421.  Back to cited text no. 4
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5.
Issa G, Blalock TW, Lesher JL. Patient with giant Becker's nevus and epidermal nevus. Dermatol Reports 2011;3:e23.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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