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May 2010

Becker Nevus With Ichthyotic Features

Author Affiliations

Author Affiliations: Department of Dermatology, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence.

Arch Dermatol. 2010;146(5):575-577. doi:10.1001/archdermatol.2010.79

Becker nevus is a common cutaneous hamartoma that typically manifests in childhood or adolescence as a unilateral, hyperpigmented, hypertrichotic macule or patch. Numerous skin, soft-tissue, and bony anomalies have been reported in association with Becker nevus. We describe a unique case of a Becker nevus with atypical size, location, and ichthyotic features.

An 18-year-old man presented for evaluation of a large, scaly, hyperpigmented plaque on the right thigh. The lesion first appeared at age 10 months, initially enlarging to its present size before becoming stable. He was otherwise healthy with no clinically significant medical history, developmental anomalies, or family history of similar lesions. Examination revealed a thin, dark brown plaque with adherent, platelike, brown scale covering a large portion of the right thigh, hip, and buttock (Figure 1). The border was irregular with a reticulated margin and satellite macules. Terminal hairs within the lesion were of normal size, color, texture, and number. A punch biopsy was performed, and the specimen demonstrated prominent melanin deposition within the basal and suprabasal layers of the epidermis with elongation, fusion, and blunting of the rete ridges and no evidence of congenital nevus. In addition, there was moderate hyperkeratosis associated with focal diminution of the granular layer (Figure 2). These features are histologically similar to those of ichthyosis vulgaris. A diagnosis of Becker nevus with overlying ichthyosis was rendered.

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