Becker nevus

Management Strategy

Becker nevus is asymptomatic and may come to the attention of a physician for cosmetic or diagnostic purposes. Management of asymptomatic benign lesion should comprise confirmation of diagnosis and an evaluation for any associated pathology such as developmental abnormalities that can accompany Becker nevus or within the spectrum of Becker nevus syndrome. Reported cutaneous associations include an acneiform eruption, eczematous dermatitis, hypohidrosis, lichen planus, localized lipoatrophy, localized scleroderma, polythelia, psoriasiform dermatitis, unilateral breast hypoplasia, osteoma cutis, capillary malformations, dermal melanocytosis, and neurofibromatosis type-1. Musculoskeletal associations include limb asymmetry, pectus excavatum/carinatum, scoliosis, and other vertebral defects.

Association of Becker nevus with cutaneous malignancies, including basal and squamous cell carcinoma, was described separately in three young individuals without significant risk factors. Although melanoma has been described in patients with Becker nevus, the risk of malignant transformation of the nevus itself is very low, thus enhanced screening is unnecessary.

The treatment of a Becker nevus depends on multiple factors including skin type, desired treatment end point, pigmentary involvement, hypertrichosis, and extent of musculoskeletal involvement. Becker nevus is primarily treated for pigment or hair removal with lasers. Surgical excision, oral and topical antiandrogens, topical depigmenting agents, and topical glycolic acid and a variety of light and laser sources have also been used to treat both the pigmentary and musculoskeletal manifestations of Becker nevus.