This book describes Becker’s Nevus, Diagnosis and Treatment and Related Diseases

Last week a medical student came to see me for the removal of stitches for a punch biopsy done by his skin specialist in his university in Adelaide, Australia.
He has scattered hyper-pigmented rash through his back and front of chest for the past 4 months.
In spite of treatment the rash had not improved so the skin specialist decided to do a punch biopsy for histological examination under the microscope.
He was informed that the rashes were a form of Becker’s nevus which normally has overgrowth of hair but because he was an asian and devoid of hair on the chest and back, there was no overgrowth of hair on his body.
Treatment is normally by the use of laser to remove the disfiguring rashes.

Becker’s Nevus is regarded as a pigmented hamartoma of skin (benign, focal malformation); a hamartoma is a developmental anomaly occurring in childhood.
The term, Becker’s nevus, is actually wrongly named because it is is not a true nevo-melanocytic lesion.
Becker’s Nevus produces:

1. Abnormal skin discoloration,
2. Abnormal hair growth, and
3. Thickening of skin (verrucous skin surface)
   It is a rare disorder that mostly affects males.
   Becker’s Nevus occurs during one’s childhood or adolescent stage and the skin lesions are mostly seen on the shoulders and back
   Becker’s Nevus may manifest significant complications, such as acne or cosmetic disorders.
   Sometimes, melanoma (a type of skin cancer) is known to form from this skin lesion
   Becker’s Nevus is known to happen periodically and the cause is largely not known
   This disorder is not congenital (not evident at birth).
   All racial and ethnic groups are at risk and there is no specific preference observed
   Both males and females are involved, though the frequency of Becker’s Nevus is much higher in males compared to females.
   The male-to-female ratio derived from documented cases is about 6:1.
   Cause
   The cause of Becker’s Nevus formation is not known
   Genetic mutations (or genetic defects) have been suspected by doctors in some patients, but these have not been well-featured
   It is a hamartoma of ectodermal and mesodermal offshoots that is believed to be hormonally reactive given the augmented smooth muscle and peri-pubertal growth.
   Androgen receptor assays have shown marked rises in the number of androgen receptors in lesional skin when compared with contra-lateral non-lesional skin.
   The increased presence supporting increased sensitivity to androgens is the findings of:
4. Hypertrichosis,
5. Acanthosis,
6. Dermal thickening,
7. Sebaceous hypertrophy and
8. Co-localized acne.
   Symptoms:
9. It is a benign disorder that happens as a growth abnormality
10. Abnormally hyper pigmented skin is present.
11. There is also the presence of a thickened skin and unusual hair overgrowth at the site
12. The skin lesion may be painless and non-itchy
13. Becker’s Nevus can happen anywhere on the body.
    Diagnosis
    A Becker’s Nevus is diagnosed through these tools:
14. Complete medical history with a proper physical examination
15. Dermoscopy: A dermoscope is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
16. Wood’s lamp examination
17. Skin biopsy:
    Treatment
18. The doctor may select to regularly observe the benign tumor; a “wait and watch” approach may be followed.
    No treatment is normally required
19. If required, a surgical excision (or laser therapy) and complete removal of the lesion
20. If there is Becker’s Nevus linked acne, then treatment therapy for acne may be indicated
21. Laser therapy may also be indicated for hyper-pigmentation and hyper-trichosis

TABLE OF CONTENT
Introduction
Chapter 1 Becker’s Nevus
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Cafe-au-liat Spots
Chapter 8 Melasma
Epilogue