Hyperpigmented Macules: Becker Nevus

When a patient presents with a hyperpigmented macule, one of the first conditions that comesto mind is neurofibromatosis. However, a variety of normal and pathologic conditions areassociated with hyperpigmented macules. Here we present a selection of such lesions andtheir associated conditions. The collection is by no means comprehensive. For example,patients with Silver-Russell syndrome or Bloom syndrome may have multiple caf au laitmacules, but photographs of such patients are not included.

We hope this Photo Essay will serve as a reminder that hyperpigmented macules may appear in a wide variety of conditions-both benign and pathologic.

Becker Nevus

This 13-year-old boy has a Becker nevus--also called Becker melanosis, because the lesions do not contain nevus cells. This common lesion is characterized by the abrupt onset of hyperpigmentation that gradually expands; it appears at or before adolescence. The male-to-female ratio is approximately 5:1.Becker nevi are usually unilateral and are commonly located on the shoulder or upper chest.

Half of Becker nevi are associated with hypertrichosis. The hairs usually become coarser and darker with time.A variety of bone and tissue abnormalities have been reported in patients with Becker nevi (eg, arm hypoplasia, pectus excavatum, absent pectoralis major muscle), albeit in a minority of those affected.

Becker nevus is not a true nevus. The risk of melanoma developing within the lesion is the same as that for uninvolved skin.