Diagnosis: Becker nevus
An adolescent boy presented with a unilateral hyperpigmented, hairy patch on the shoulder, which had been present for several years. The lesion was asymptomatic but caused cosmetic concern. Clinical examination revealed a well-defined area of increased pigmentation with terminal hair growth, characteristic of a Becker nevus.
A 15-year-old boy presented with a unilateral hyperpigmented patch on his right shoulder that had been present for approximately three years. The lesion was asymptomatic but was causing significant cosmetic concern. On examination, the patch was well-defined, hyperpigmented, and covered with coarse terminal hair.Location: Unilateral, typically on the shoulder, chest, or back.Appearance: Irregularly shaped, brown to tan-colored macule or patch.Hair Growth: Terminal hair present within the lesion.Size: Varies from a few centimeters to larger patches.Symptoms: Generally asymptomatic, without associated pruritus or pain.
The patient reported that the lesion began as a small brown spot that gradually enlarged over the years. There were no known triggers, and he had not sought prior treatment for this condition. His past medical history was unremarkable, with no history of skin disorders or significant family history of dermatological conditions. He denied any recent sun exposure or changes in skin care products.Onset: Lesion started at age 12, gradually increasing in size.Triggers: No identifiable triggers or exacerbating factors.Treatments: No prior treatments attempted for the lesion.Family History: No significant family history of similar skin lesions.Social History: Active lifestyle, participates in outdoor sports.
Acute / First-Line ManagementCosmetic treatment options include laser therapy (e.g., Q-switched Nd:YAG laser) for hyperpigmentation.Topical hydroquinone 4% may be used to lighten the pigmentation, applied twice daily.Workup and Diagnostic ConfirmationClinical diagnosis is usually sufficient; however, a biopsy may be considered if the diagnosis is uncertain, to rule out other conditions.Histopathological examination typically shows increased melanocytes and hair follicles.Long-Term ManagementRegular follow-up to monitor for changes in the lesion.Patient education regarding sun protection to prevent further pigmentation.Consideration of surgical options for excision in cases of significant cosmetic concern.
Nevi: Common moles, usually smaller and uniformly colored without terminal hair.Melanoma: Malignant transformation can present as an irregularly shaped, changing lesion with possible symptoms.Post-inflammatory hyperpigmentation: Often follows inflammation or trauma; usually has a history of preceding injury.Acne vulgaris: May lead to post-inflammatory changes but typically presents with comedones and papules.Dermatofibroma: Firm, elevated nodules often with a brownish hue; typically asymptomatic and located on the extremities.Lentigo: Small, well-defined spots usually due to sun exposure; typically not hairy.Psoriasis: Presents with silvery scales and is usually accompanied by itch, differing from the asymptomatic nature of the lesion.Hairy leukoplakia: Associated with Epstein-Barr virus; presents as white patches rather than hyperpigmented lesions.
High-Yield PearlsAsymptomatic: Becker nevus is typically asymptomatic and often presents in adolescence.Location: Lesions are commonly found on the shoulder, chest, or back.Hair Growth: Notable for increased terminal hair growth within the lesion, which can aid in diagnosis.Cosmetic Concern: Management is often driven by cosmetic preferences rather than medical necessity.Diagnosis: Clinical diagnosis is usually adequate; histological confirmation is rarely needed.Becker nevus is a benign, hyperpigmented lesion characterized by hair growth, primarily presenting in adolescent males.
Tags: Becker nevus, pigmentary