Case Report

DOI: 10.7241/ourd.20144.97

BECKER’S NEVUS AND IPSILATERAL ACANTHOSIS

NIGRICANS

Vijay Zawar1, Tarang Goyal2, Sneha Kamra3

1
Department of Dermatology, Godavari foundation medical College, DUPMC,
Maharashtra, India
2
Department of DVL, Muzaffarnagar Medical College & Hospital, Uttar Pradesh,
India
Source of Support:
3
Consultant Dermatologist, Bhopal, Madhya Pradesh, India
Nil
Competing Interests:
None Corresponding author: Prof. Tarang Goyal [email protected]

Our Dermatol Online. 2014; 5(4): 388-390 Date of submission: 29.06.2014 / acceptance: 04.09.2014

Abstract
There is paucity in world literature regarding the simultaneous occurrence of Becker’s nevus and ipsilateral acanthosis nigricans in the same
individual. There is only case reported previously in world literature. We speculate that our case may further strengthen the view of probable,
more than a chance, association of these two entities and suggest need for further exploration of the role of androgen receptors in such cases.

Key words: Beckers nevus; ipsilateral acanthosis nigricans; hypoplasia of breast

Cite this article:

Zawar V, Goyal T, Kamra S. Becker’s nevus and ipsilateral acanthosis nigricans. Our Dermatol Online. 2014; 5(4): 388-390.

Introduction coarser than the ones in the right axilla. The pigmented lesion
The case of ipsilateral Beckers nevus and acanthosis in left axilla was clinically suggestive of acanthosis nigricans
nigricans is presented here for the extreme rarity of a distinct (Fig. 2). Additional findings noted on clinical examination were
morphological presentation of two different pigmentary hypoplasia of only areola of ipsilateral breast, with scoliosis
disorders in the same patient. Various theories have been in the lumbar region and interestingly, a marginal elongation
proposed for the simultaneous co-existance of the same with and slight overcurvature of the nail of his left index finger
hormone dependant theory being the most plausible explanation. (Fig. 3). He was a right handed person. There was no evidence
of acanthosis nigricans in other areas as right axilla, neck,
Case Report groins, periumbilical areas or forehead. He was investigated
A 15-years-old healthy boy presented with asymptomatic by a physician for detailed endocrinal evaluation and also by
gradually progressing brownish-black pigmentation on left side an orthopedician for bony abnormalities, which were said to
of anterior chest since last 4 years. On examination, a well- be insignificant from investigational and treatment point of
defined, large hyperpigmented macule with irregular borders view. His complete blood count, blood sugar levels, urinalysis,
starting from the midline on the left side involving mammary glycosylated haemoglobin level, glucose tolerance test and
area, extending superiorly upto left infra-clavicular area and plasma insulin levels were all normal. His thyroid status was
anterior left shoulder and also seen involving the antero-medial normal. No hormonal abnormalities were clinically suspected
side of left arm. There was slight extension even on the right and investigated. His X-ray chest and abdomino-pelvic
parasternal area. There was coarse hypertrichosis in the sternal ultrasound were normal. X-ray Spine revealed slight scoliosis
area as well as acneiform lesions present within the pigmented in the thoraco-lumbar region. There was no evidence of internal
area (Fig. 1). This clinically was clearly a Becker’s nevus. On malignancy. Skin biopsy from pigmented area on chest showed
more careful examination, he interestingly, had an ipsilateral mild acanthosis and hyperkeratosis with regular elongation of
smooth velvety irregular hyperkeratotic plaque with skin tags rete ridges in epidermis with hyperpigmentation in the basal
in the left axillary region. The right side of axilla was normal. layer confirming BN (Fig. 4).
The hair in left axilla were much enlarged, pigmented and

388 © Our Dermatol Online 4.2014 www.odermatol.com

In axillary area, hyperkeratosis, papillomatosis and acanthosis with acanthosis nigricans was confirmed. We councelled the
were seen with increased pigmentation in the basal layer seen, patient regarding BN and prescribed topical Tretinoin cream
confirming AN. Thus, a clinical diagnosis of Becker’s nevus 0.1% for AN.

Figure 2. Ipsilateral papillomatous hyperkeratotic plaque

in the left axilla with skin tags suggestive of acanthosis
nignricans.
Figure 1. A well defined hyperpigmented macular lesion
of Becker’s nevus in left mammary area extending on to
the anterior shoulder and arm with hypertrichosis and
acneiform lesions.

Figure 3. Increased longitudinal curvature and length of

left index finger nail. Figure 4. Histopathology showing acanthosis, elongation of
rete ridges and hyperpigmentation in basal layer
confirming Becker’s nevus. H&E (10x10)

Discussion (melanocyte), dermal (smooth muscle), and appendageal (hair

Becker naevus (BN) was first described by Becker in 1949, follicle) components [5]. Some of the associated abnormalities
as two cases where hypertrichosis and hyperpigmentation reported are breast hypoplasia, aplasia of underlying pectoralis
occurred on upper back unilaterally [1].Subsequently, term major, scoliosis, ipsilateral limb shortening, ipsilateral foot
Becker Naevus syndrome [2] was proposed to encompass several enlargement, spina bifida,supernummary nipples, short limbs
developmental anomalies which were found to be associated and segmental odontomaxillary dysplasia. Congenital adrenal
with BN. Also they made this entity independent from the more hyperplasia, polythelia and accessory scrotum have also been
generalised term of Hairy Epidermal nevus syndrome [3]. BN reported [2-6].
is an irregular well defined macular area, which is frequently Acathosis nigricans (AN) typically presents as symmetric,
associated with hypertrichosis and acneiform lesions. The overall brown black, velvety, hypertrophic, verrucous, papillomatous
incidence being 0.5% in males [4], it is usually more prominent plaques most commonly involving the intertriginous sites
around puberty. It has been postulated to be an ectodermal including axillae, groins, sides of neck. Of the 8 types of AN,
and mesodermal hamartoma, with increased epidermal unilateral nevoid form is perhaps the rarest form reported [7].

© Our Dermatol Online 4.2014 389

Both sporadic and familial occurrences have been described for with AN and suggest need for further exploration of the role of
AN and it is to be demonstrating a para-dominant inheritance androgen receptors in such cases.
[7,8]. Unilateral Acanthosis nigricans is an extremely rare form The case is presented here for the extreme rarity of a distinct
of AN that manifests at any age at or before puberty and has a morphological presentation of two different pigmentary
morphologic pattern similar to other forms of AN. It is generally disorders in the same patient.
not associated with syndromes, endrocrinopathies, drugs,
or malignancies and is said to be inherited as an irregularly
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