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Year : 2020  |  Volume : 11  |  Issue : 2  |  Page : 294-295  

Extensive becker's melanosis in a checkerboard mosaic pattern


Department of Dermatology, Venereology and Leprology, R.N.T. Medical College, Udaipur, Rajasthan, India

Date of Web Publication9-Mar-2020

Correspondence Address:
Lalit K Gupta
Department of Dermatology, Venereology and Leprology, R.N.T. Medical College, Udaipur - 313 001, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/idoj.IDOJ_137_19

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How to cite this article:
Makhija R, Gupta LK, Khare AK, Mittal A. Extensive becker's melanosis in a checkerboard mosaic pattern. Indian Dermatol Online J 2020;11:294-5

How to cite this URL:
Makhija R, Gupta LK, Khare AK, Mittal A. Extensive becker's melanosis in a checkerboard mosaic pattern. Indian Dermatol Online J [serial online] 2020 [cited 2020 Jul 8];11:294-5. Available from: http://www.idoj.in/text.asp?2020/11/2/294/261217



An 18-year-old, healthy male presented with multiple well-defined asymptomatic hyperpigmented patches with irregular margins and satellite macules symmetrically affecting both upper extremities and trunk. Lesions were present since birth but started increasing in extent and degree of pigmentation for past 2 years. Lesions were confluent over bilateral upper extremities and shoulders, separated in midline covering both scapulae over back [Figure 1] and in a checker board like pattern over chest [Figure 2]. Hypertrichosis was present over lesions on the chest. No musculoskeletal abnormalities were detected on physical and radiological examination. The patient was in good general health. Hair, nail, and mucosae were normal. None of the family members had similar lesions. Histopathological examination revealed moderate acanthosis and increased basal cell layer pigmentation consistent with a diagnosis of Becker's melanosis [Figure 3]. Becker's melanosis is an uncommon cutaneous hamartomatous mosaic condition, characterized by unilateral, hyperpigmented, and hypertrichotic patch that commonly affects the upper trunk. In the majority of cases, it appears around puberty but very rarely may present since birth.[1] Multiple and giant lesions in a bilaterally symmetric distribution are extremely rare and usually present as Becker's nevus syndrome.[2],[3] Our patient had multiple and atypically large bilaterally symmetrical lesions exhibiting checkerboard pattern of mosaicism since birth, an extremely rare presentation of Becker's melanosis.
Figure 1: Hyperpigmented macules over back

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Figure 2: Hyperpigmented macules over both upper extremities and exhibiting checkerboard pattern on the chest

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Figure 3: Acanthosis with increased basal cell layer pigmentation (H and E, 400×)

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The exact reason for the exhibition of checkerboard pattern in our case is not definitely clear, but has been reported in past in Becker's nevus[4] as well as systematized speckled lentiginous nevus and probably represents one of the several configurations of cutaneous mosaicism like narrow band and broad band Blaschko's lines, phylloid pattern, and patchy pattern without midline separation.[5] The pattern is most appreciable on trunk and difficult to appreciate on limbs probably due to anatomical differences.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Kinsler VA, Sebire NJ. Congenital naevi and other developmental abnormalities affecting the skin. In: Griffiths C, Barker J, Bleiker T, Chalmers R, Creamer D. editors. Rook's Textbook of Dermatology. 9th ed. UK: Wiley Blackwell; 2016. p. 75.1-24.  Back to cited text no. 1
    
2.
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. 2
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3.
Chiramel MJ, Menon R, David BG, Gulia SP. Congenital bilateral symmetric Becker's nevus with neurological involvement. Indian J Paediatr Dermatol 2016;17:232-4.  Back to cited text no. 3
  [Full text]  
4.
Ramot Y, Maly A, Zlotogorski A. A rare case of multiple Becker's nevi in a checkerboard mosaic pattern. J Eur Acad Dermatol Venereol 2014;28:1573-4.  Back to cited text no. 4
    
5.
Happle R. Mosaicism in human skin: Understanding the patterns and mechanisms. Arch Dermatol 1993;129:1460-70.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 1], [Figure 2], [Figure 3]



 

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