Dermoscopic Features of Congenital Melanocytic Nevus and Becker Nevus in an Adult Male Population: An Analysis with a 10-Fold Magnification

An uncommon presentation of segmental Becker's nevus involving the T4 dermatome

This case report explores a rare manifestation of Becker's nevus, where the patient exhibited an unusual dermatomal distribution featuring a hyperpigmented, irregular patch with associated hypertrichosis on the T4 segment. While Becker's nevus is a well-known dermatological condition typically observed in the upper back region, instances of dermatomal distribution are exceptionally uncommon. This case presents a unique occurrence of segmental Becker's nevus, highlighting the atypical presentation of this condition.

Pityriasis Versicolor-A Narrative Review on the Diagnosis and Management

This narrative review presents a comprehensive overview of the diagnosis and management of pityriasis versicolor (PV), a common superficial fungal infection caused by the yeast Malassezia. PV is characterised by scaly hypopigmented or hyperpigmented patches, primarily affecting the upper trunk, neck, and upper arms. Regarding commensal interactions, Malassezia utilises nutrient sources without affecting the human host. In cases of pathogenicity, Malassezia can directly harm the host via virulence factors or toxins, or indirectly by triggering damaging host responses. The diagnosis typically relies on recognising characteristic clinical features. Due to the wide variability in its clinical presentation, recognising the differential diagnosis is critical. In this paper, we discuss the clinical differentials, with their dermatoscopic presentation, but also describe a range of helpful diagnostic techniques (microscopy, conventional and ultraviolet-induced fluorescence dermatoscopy, and confocal microscopy). Topical therapies are the primary treatment for PV, encompassing non-specific antifungal agents like sulphur with salicylic acid, selenium sulphide 2.5%, and zinc pyrithione. Additionally, specific topical antifungal medications with either fungicidal or fungistatic properties may also be incorporated into the topical treatment regimen, such as imidazoles, allylamines, and ciclopirox olamine. Systemic therapies might occasionally be used. Patient education and the promotion of good personal hygiene are pivotal to reduce the risk of recurrence. In recurrent cases, particularly during warmer and more humid periods, prolonged prophylaxis with topical agents should be considered.

An update on Becker's nevus: pathogenesis and treatment

Becker's nevus (BN) manifests as a hyperpigmented, sometimes hypertrichotic plaque/patch over the chest and shoulder, and it is in the category of benign cutaneous hamartomas. BN has elongation and fusion of the rete ridge, keratotic plugging, sebaceous hyperplasia, smooth muscle hyperplasia, and hyperpigmentation of the basal/suprabasal layer histologically. This article highlights all issues involved in pathogenesis and treatment options of BN. According to current research, postzygotic ACTB mutations induce BN and Becker's nevus syndrome (BNS). Although several therapy strategies were utilized to treat the pigmentary and hypertrichotic aspects of BN, no definitive standard treatment was identified to far, and further research is needed to better educate BN care. This article is protected by copyright. All rights reserved.

Congenital melanocytic naevi: An up-to-date overview

Congenital melanocytic naevi are hamartomas of the neuroectoderm caused by genetic mosaicism. Congenital melanocytic naevi are seen in 1-6% of all live births and commonly classified based on the projected size in adults. Congenital melanocytic naevi appear in different colours, shapes, and sizes, and occasionally present with complications. In this review, we sought to evaluate congenital melanocytic naevi, their clinical, dermatoscopic, and reflectance confocal microscopic features, behavioural pattern over time, new trends in classification, underlying genetic factors and their influence on clinical manifestations and management, associated risks, complications, magnetic resonance imaging findings and their management in the light of recent literature.

Comprehensive Treatment of a Skeletal Class III Growing Patient with Alveolar Bone Hypertrophy in the Anterior Mandible Associated with Becker's Nevus Syndrome: A Case Report

Becker's nevus is a relatively common skin lesion with brown hyperpigmentation and hypertrichosis. It may be expressed simultaneously with other cutaneous, muscular, or skeletal defects, such as hypoplasia of the breast or scoliosis, for which the term "Becker's nevus syndrome" has been proposed. An 8-year-old boy presented with a Becker's nevus on the right cheek, chin, and upper neck with alveolar bone hypertrophy in the anterior mandible, which led to an anterior crossbite and severe canting of the mandibular anterior teeth. Through orthopedic treatment using a face mask, the anteroposterior jaw relationship was improved. In phase 2 treatment, we corrected the canting of the mandibular anterior teeth with a segmental intrusion of the mandibular anterior right teeth into the hypertrophic alveolar bone area. The facial profile was improved along with acceptable occlusion, and the treatment result was stable at 1 year after the end of the treatment, without any periodontal attachment loss, root resorption of mandibular anterior teeth, or increase in the size of the hypertrophic region. This case report describes the successful comprehensive treatment of a growing patient with skeletal Class III malocclusion and multiple characteristics of Becker's nevus syndrome.

A descriptive observational study on clinical and dermoscopic features of benign melanocytic neoplasms

Background

Benign melanocytic neoplasms have nests of melanocytic cells and show characteristic dermoscopic features. Clinical and dermoscopic features have not been studied previously in the Indian population.

Aims

To study the clinical, epidemiological and dermoscopic patterns of benign melanocytic neoplasms.

Methods

This was a descriptive, observational, single centre study. In 107 patients with melanocytic neoplasms, 167 lesions were clinically examined and studied under the dermoscope and histopathological examination was done when indicated. The lesions were broadly divided as acquired and congenital. Five main dermoscopic patterns were seen-globular, homogenous, reticular, parallel and streaks. If there were two of these patterns in a particular lesion, it was termed 'mixed pattern'. The presence of three or more patterns was called 'multicomponent pattern'. Various other features were also observed.

Results

The majority of patients belonged to the third decade with a female preponderance. History of increased UV exposure and family history was significant in acquired nevi. The dermoscopic pattern progressed from predominantly reticular in junctional nevi to predominantly globular in compound nevi and lesser pigment in intradermal nevi, with more vascular structures. The congenital melanocytic nevi showed additional features of comedo- like lesions, milia- like cysts, perifollicular pigmentary changes and increased colour variation. Even though colour variation was observed in both acquired and congenital lesions, no signs of dysplasia were seen on histopathology.

Limitations

A larger sample size is required, with follow up of lesions. No parallel studies in brown skinned population were found for exact comparison.

Conclusion

Benign melanocytic proliferations are often neglected in our country. This study will help in understanding the course, clinical features and dermoscopic patterns of various benign melanocytic neoplasms, and will be a step forward towards research in our population. To the best of our knowledge, this is the first study of its kind in India.

Becker's Nevus Coexisting with Morphea: A Rare Case Report

Becker's nevus (BN) is an acquired unilateral hyperpigmented hairy macule, whereas morphea is a chronic connective tissue disease of unknown etiology, characterized by skin thickening with increased quantities of collagen in the indurated lesion, usually involving the upper trunk and proximal extremity. The occurrence of both disease in the same anatomical site and individual was not reported previously. We report this rare case in a 17-year-old, Indian girl and was diagnosed after clinical histopathology and dermoscopic correlation. Morphea can be an interesting incidental occurrence within a large plaque of BN.

Dermoscopic Pigment Network: Characteristics in Non-melanocytic Disorders

Brown-black pigment network is the hallmark dermoscopic feature of melanocytic lesions. Several non-melanocytic disorders also exhibit a pigment network as one of their main or useful dermoscopic diagnostic features. This article presents a compilation of such disorders to the readers describing their essential dermoscopic features with an emphasis on the characteristics of the pigment network exhibited by them.

Clinical characteristics of Becker's nevus in children: report of 118 cases from Italy

We performed a retrospective study covering a 10-year period (January 1997-January 2007) on children referred to our unit or followed up for Becker's nevus (BN). The aim of this study was to better define the characteristics of BN in childhood, when this hypermelanosis is more frequent than the limited number of studies might suggest. Our data show that BN in children has predilection sites similar to those in adults, but hypertrichosis is rarer. Sun exposure does not appear to play an etiopathogenetic role. The higher incidence in men reported in adult case studies was not found in children. During and after puberty, androgenic stimulation is known to play a pathogenetic role in BN, especially in men, but our cases were mostly younger than 6 years old.

Absence of clinical and dermoscopic differences between congenital and noncongenital melanocytic naevi in a cohort of 2-year-old children

BACKGROUND

Congenital melanocytic naevi (CMN) are present at birth. Some naevi, tardive congenital naevi (TCN), become clinically apparent only after birth, during the first years of life. The number of naevi continues to increase due to the appearance of acquired melanocytic naevi (AMN). When AMN begin to appear has not been well defined.

OBJECTIVES

To investigate the clinical and dermoscopic features of the melanocytic naevi present in 2-year-old children and to search for and highlight any differences between CMN present at birth (BPN) and naevi appearing after birth during the first 2 years of life (FLN).

METHODS

A nonrandomized observational study was performed. A total of 133 melanocytic naevi in 103 children aged 21-26 months were analysed by clinical and dermoscopic examination.

RESULTS

Of the subjects, 76% of children had one naevus, 20% had two naevi, 3% had three naevi and 1% had four naevi. Of the naevi, 76 were BPN and 57 were FLN. The naevi with the largest diameters were significantly associated with BPN (P = 0·025). Polycyclic edges (P = 0·0378) were observed with a higher frequency in BPN than in FLN. The predominant dermoscopic patterns were globular (BPN 51%; FLN 58%) and reticular (BPN 28%; FLN 14%).

CONCLUSIONS

The number of naevi present in the first 2 years of life is small, and over half have already appeared at birth. They are distributed widely over the skin. BPN are larger than FLN, but most naevi are small. There was no significant difference in the dermoscopic features between the 133 BPN and FLN. The predominant patterns were globular and reticular. We could not identify defined criteria that allowed us to diagnose CMN with certainty and distinguish them from TCN and AMN.

Epidermal nevi

Nevi or nests of cells may be made up of a variety of cell types. The cell types that live in the epidermis include epidermal cells or keratinocytes, sebaceous glands, hair follicles, apocrine and eccrine glands, and smooth muscle cells. This article discusses epidermal or keratinocyte nevi, nevus sebaceous, nevus comedonicus, smooth muscle hamartomas, and inflammatory linear verrucous epidermal nevi. Syndromes associated with epidermal nevi are also reviewed.

Becker nevus on the lower limb: case report and review of the literature

BACKGROUND

Becker nevus is a hamartoma with brown hyperpigmentation and hypertrichosis that usually affects young males. It has a predilection for the upper half of the trunk and proximal upper extremity.

OBJECTIVE

This is a case report of a 38-year-old male with a Becker nevus without hypertrichosis on the lower limb and a review of the literature.

RESULTS

Including our case report, 12 cases of Becker nevus on the lower limb were identified in the English literature (8 males and 4 females). It has never been reported below the knee. In males, the lesion was not associated with other anomalies, and all but two showed hypertrichosis (six of eight). In 50% (two of four) of women, it was associated with localized lipoatrophy. In one woman, it presented without hypertrichosis.

CONCLUSION

The presence of Becker nevi on the lower limb is unusual, and hypertrichosis is not always a feature. Larger studies are required to look into the true prevalence of this presentation and its prognostic value as a marker for other anomalies.

Giant bilateral becker nevus: a rare presentation

A 14-year-old boy had giant confluent brown patches that were bilaterally distributed on his back, chest, and upper arms, and partially covered by dark coarse hairs. A clinical diagnosis of Becker nevus was made and confirmed histopathologically. We report this patient for the rarity of presentation. Different clinical features of Becker nevi, associated findings, differential diagnoses, and treatment options are discussed.

The ?EpiEnlist? project: a dermo-epidemiologic study on a representative sample of young Italian males. Prevalence of selected pigmentary lesions

BACKGROUND

Few studies on the prevalence and incidence of many skin conditions in the general population are available because it is difficult to submit to dermatologic examination large samples of seemingly healthy population.

OBJECTIVE

The aim of this study was to estimate the prevalence of several skin conditions among a sample that is deemed to be representative of the general population of young men living in southern Italy.

PATIENTS/METHODS

Potential conscripts resident in the coastal regions of southern Italy and called at the age of 18 to the Draft's Council Medical Unit in Taranto underwent a clinical and instrumental examination to evaluate their psycho-physical fitness to compulsory service in Italian Navy. From January 1998 to April 2004 a dermo-epidemiologic project named EpiEnlist (EPIdemiology in ENLISTed Men) project was carried out by the Department of Dermatology of the Italian Navy Hospital in Taranto under the auspices of the Italian Group for Epidemiological Research in Dermatology. All the subjects showing skin lesions evocative of neurofibromatosis (NF), congenital melanocytic nevus (CMN), Becker nevus (BN), and vitiligo were referred to the Department of Dermatology of the Italian Navy Hospital for confirming the diagnosis. The confirmed cases were recorded in a predefined patient's card, containing the main anamnestic, clinical, instrumental, and laboratory data.

RESULTS

Because the recording of the various conditions started and ended in different times, the total number of examined subjects varied. NF type 1 was diagnosed in 6 of 34 740 subjects [prevalence 1:5735 or 0.017%; 95% confidence interval (95% CI), 0.0008-0.0037], CMN in 157 of 23 354 (prevalence 1:148 or 0.67%; 95% CI, 0.57-0.79). BN was observed in 70 of 27 954 young men (prevalence 1:399 or 0.25%; 95% CI, 0.15-0.35), and its mean age of appearance was 11.9 years (minimum 5-maximum 17). In 41 subjects (58.6%), the age of appearance was over 10 years. Vitiligo was recorded in 60 of 34 740 persons (prevalence 1:579 or 0.17%; 95% CI, 0.13-0.22). In 40 subjects with vitiligo, the blood test was done: in 40% of these circulating autoantibodies, mainly anti-thyroid (25.6%) and anti-smooth muscle (17.3%) autoantibodies were detected, but only in 5% of cases, a thyroid disease was diagnosed, and no other sign of autoimmune diseases was observed.

CONCLUSIONS

The epidemiological data of the skin conditions considered in the present study can be considered roughly in agreement with those reported in the available surveys. Because they were obtained in a large sample of Italian young males from the general population, they can be useful for therapeutic and preventive interventions by the public health organizations.

Congenital Melanocytic Nevus: An Epidemiologic Study in Italy

BACKGROUND

The prevalence of congenital melanocytic nevi (CMN) among newborns ranges between 0.2 and 6% in the worldwide literature. In the only available study from Italy the rate was 1% at birth and 1.4% at 2 years of age. Some surveys performed among samples of children and adolescents in other countries showed a prevalence which ranged from 1.4 to 4.4%. Additional data on the frequency in adults are not available.

OBJECTIVE

The aim of this study was to estimate the prevalence of CMN in a large sample of a young male Italian population, which is deemed to be representative of the general population of the same age and sex.

METHODS

The potential conscripts resident in the coastal regions of southern Italy, enlisted for the compulsory service in the Italian Navy, were called at the age of 18 to the Draft's Council Medical Unit of the Italian Navy in Taranto to evaluate their psychophysical fitness to recruitment. All the subjects examined from September 2002 to March 2004 showing skin lesions evocative of CMN were referred by general practitioners of the Draft's Council Medical Unit to the Department of Dermatology of the Italian Navy Hospital for confirming the diagnosis, which was based on the clinical features and the personal history. The confirmed cases were recorded in a predefined patient card, containing the main anamnestic and clinical data. Since the screening of small CMN in such a large sample of subjects was believed to be difficult, only CMN with a diameter >or=1.5 cm were recorded.

RESULTS

In 23,354 examined persons 157 CMN were diagnosed, with a prevalence of 0.67% (Bayesian 95% confidence interval 0.57-0.79); 126 (80.3%) CMN were medium-sized (>or=1.5 and <or=19.9 cm in diameter), and 31 (19.7%) were large (>or=20 cm in diameter). Three CMN (1.9%) were located on the face, 23 (14.6%) on the chest, 24 (15.2%) on the abdomen, 36 (22.9%) on the back, 48 (30.5%) on the lumbar area, 15 (9.5%) on the upper limb, 19 (12.1%) on the lower limb and 15 (9.5%) on the shoulder. No CMN was located on the head. In 19 cases (12.1%) >or=2 adjacent anatomical sites (shoulder/chest, shoulder/arm, etc.) were involved. In 73 moles (46.4%) terminal hairs were present. Eight CMN (5.1%) showed a zosteriform (i.e. segmental) feature. None of the examined subjects reported a personal history of malignant melanoma (MM), and no person with a history of MM was observed among all the enlisted men referred to the Department of Dermatology during the time of the study.

CONCLUSION

The prevalence of CMN in the Italian young male general population is roughly in agreement with the rates detected in general populations from other European studies. The observations of this study also suggest that the risk of appearance of MM, at least in childhood and adolescence, is limited for medium-sized CMN.