Becker's Naevus

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Synonyms: Becker melanosis, pigmented hairy naevus of Becker

Becker's naevus is a form of epidermal naevus (birthmark). It usually appears around puberty as a hyperpigmented patch, most often found on the upper trunk or shoulders.[1, 2, 3]

BECKER'S NAEVUS -ON BACK

There is overgrowth of the epidermis (upper layers of the skin), pigment cells (melanocytes) and hair follicles. It may be due to a gene defect (as yet unidentified), perhaps triggered by circulating androgens, which would explain its onset during adolescence.

  • It is more common in men.
  • One study reported a prevalence of 0.52% in men aged 17-26 years.[4]
  • A large brown area, sometimes covering half the upper back or chest. Most lesions become hairy (hypertrichosis).
  • After puberty it often becomes darker and expands, usually over a period of 1-2 years.
  • Occasionally acne may develop in the naevus.
  • Some fading (reduced pigmentation) may occur in adulthood.
  • One case of bilateral, symmetrical pigmentation is reported - this is unusual.[3]

The age of onset, site and the fixed nature of the lesion are usually enough to make the diagnosis.

  • McCune-Albright syndrome (with café-au-lait patches on the skin).
  • Pityriasis versicolor is usually symmetrical and slightly scaly.
  • Epidermis: acanthosis and hyperpigmentation of the basal layer, with elongation and fusion of adjacent rete ridges and variable hyperkeratosis.
  • Dermis: hyperplasia of the dermal smooth muscle and melanophages.
  • No treatment is necessary except for cosmetic reasons; usually reassurance and a diagnosis are enough.
  • For cosmetic treatment of the lesion:
    • Electrolysis or laser treatment may help with hair removal.
    • Laser treatment can sometimes reduce the pigmentation, but may be ineffective or may worsen the lesion.
    • Fractional resurfacing has also been used to lighten the lesions.[3]
  • For acne in the lesion, use standard acne treatments.
  • If there is doubt about the diagnosis (eg possible melanoma), urgent referral is appropriate.

The naevus remains indefinitely.[2]

This is a Becker's naevus with additional abnormalities of underlying tissues derived from ectoderm. It is a type of epidermal naevus syndrome. There may be underdevelopment or overdevelopment of underlying structures, including:

It is named after S. William Becker who first described the lesion in 1949. Becker naevus syndrome was described in 1995 by Happle.

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Original Author:
Dr Huw Thomas, Dr Richard Draper
Current Version:
Dr Naomi Hartree
Document ID:
4062 (v22)
Last Checked:
23 May 2011
Next Review:
21 May 2016

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