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Becker Nevus: Causes, Symptoms and Treatment

Becker nevus is a benign skin condition that typically appears in adolescence, presenting as a pigmented, often hairy patch on the skin.

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Things worth knowing about "Becker Nevus"

Becker nevus is a benign skin condition that typically appears in adolescence, presenting as a pigmented, often hairy patch on the skin.

What is a Becker Nevus?

A Becker nevus (also spelled Becker naevus) is a benign, acquired skin lesion characterized by irregular pigmentation and often increased hair growth in the affected area. It is classified as an organoid nevus and typically appears unilaterally, most commonly on the shoulder, chest, or upper back. The condition is generally medically harmless but can be cosmetically bothersome for those affected.

Causes

The exact cause of Becker nevus has not been fully established. It is widely believed that an increased sensitivity of the affected skin cells to androgens (male sex hormones) plays a central role. This would explain why Becker nevus occurs significantly more often in males than females and why it typically becomes apparent during puberty. A genetic component has also been discussed, though in most cases the condition is not inherited.

Symptoms

Becker nevus typically presents with the following features:

Irregular, light to dark brown pigmented patch with jagged or irregular borders
Size can range from a few centimeters to very large areas
Increased, dark hair growth (hypertrichosis) within the affected area, particularly in males
Occasionally a slightly raised or rough skin surface texture
In rare cases, mild acne within the affected area

Pain or other physical complaints are generally absent. The lesion most commonly appears unilaterally on the shoulder, upper arm, chest, or back.

Diagnosis

Diagnosis of Becker nevus is usually made clinically, meaning through visual assessment by a dermatologist. The characteristic appearance combining pigmentation and hypertrichosis is usually sufficient. In uncertain cases, dermoscopy (epiluminescence microscopy) or a skin biopsy (tissue sample) may be performed to confirm the diagnosis. Histologically, the lesion shows an increase in melanocytes in the basal layer of the epidermis along with thickening of the skin.

Confusion with other skin lesions such as congenital melanocytic nevus or cafe-au-lait spots is possible, so professional dermatological evaluation is recommended.

Treatment

Since Becker nevus is medically harmless, treatment is usually not medically necessary. However, if the nevus is considered cosmetically bothersome, several treatment options are available:

Laser treatment: Laser therapy (e.g., Q-switched Nd:YAG laser or alexandrite laser) can lighten the pigmentation. Results are variable, and recurrence is possible.
Hair removal: Laser hair removal (e.g., diode laser) can effectively reduce hypertrichosis, usually with good results.
Dermabrasion: Mechanical abrasion of the upper skin layers, though this is used less frequently today.
Camouflage: Specialized cover-up cosmetics can conceal the patch without any medical intervention.

Complete and permanent removal of a Becker nevus is often difficult to achieve. Patients should discuss the advantages and disadvantages of each method with an experienced dermatologist.

Prognosis

Becker nevus is a benign condition with no risk of malignant transformation. There is no increased risk of developing melanoma or other skin cancers. The lesion may change slightly over time but generally remains stable. Regular skin check-ups with a dermatologist are nonetheless recommended to monitor any changes.

References

Happle R, Koopman RJ. Becker nevus syndrome. Am J Med Genet. 1997;68(3):357-361.
Grilli R, Aguilera P, Rios-Buceta L, et al. Becker nevus: a clinicopathologic study. Actas Dermosifiliogr. 2001;92(1-2):39-44.
James WD, Elston DM, Treat JR, et al. Andrews' Diseases of the Skin: Clinical Dermatology. 13th ed. Elsevier; 2019.

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