Indian Journal of Dermatology
: 2021  |  Volume : 66  |  Issue : 4  |  Page : 437--438

Becker's nevus of the scalp

Hyun-Min Seo, Se Kwang Park, Se Uk Oh, Ju Wang Jang, Tae Lim Kim, Hyung Kwon Park, Joung Soo Kim 
 Department of Dermatology, Hanyang University Guri Hospital, Guri, Korea

Correspondence Address:
Joung Soo Kim
Department of Dermatology, Hanyang University Guri Hospital, Guri

How to cite this article:
Seo HM, Park SK, Oh SU, Jang JW, Kim TL, Park HK, Kim JS. Becker's nevus of the scalp.Indian J Dermatol 2021;66:437-438

How to cite this URL:
Seo HM, Park SK, Oh SU, Jang JW, Kim TL, Park HK, Kim JS. Becker's nevus of the scalp. Indian J Dermatol [serial online] 2021 [cited 2023 Feb 7 ];66:437-438
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Full Text

Becker's nevus (BN) is a common cutaneous hamartoma, but it is often misdiagnosed or overlooked.[1] It usually begins during the second decade of life as a well-circumscribed hyperpigmented patch with an irregular border. The lesion gradually enlarges with hypertrichosis over several years. Although BN exists at birth in some cases, most cases are first noted at puberty. Because of its androgen dependency, BN becomes more prominent after puberty.

A 36-year-old man visited our clinic due to a hyperpigmented plaque on the occipital area of his scalp for the past 6 months. He reported mild itching, and physical examination revealed a slightly indurated and hyperpigmented plaque. Histopathologic examination showed mild acanthosis with blunted rete ridges and increased epidermal melanin pigment, especially at the bases of the rete ridges. Hyperplasia and hypertrophy of arrector pili muscles in the mid dermis were also observed, which may be seen in BN. In addition, there was mild lymphoid infiltration surrounding the follicles of the papillary dermis. Based on the clinical and histological findings, the patient was diagnosed with BN of the occipital scalp, a novel location.

Becker's nevus usually develops around puberty on the shoulder or upper body, although it can occur on other areas of the body. It is sometimes present from birth. Pigmentation (darkening of skin color) is subtle at first, but the nevus often darkens and expands after puberty. The resulting birthmark is usually large, brown, and on one side of the body. The nevus can grow more hair than the surrounding skin. In some cases, acne develops within the nevus.[2]

One study, which was consistent with the previous, reported 118 cases of BN in children and found that the trunk was the most commonly involved area followed by the arms, legs, buttocks, and neck, but only one case (0.8%) was seen on the face.[3] To the best of our knowledge, BN of the face has been described in the literature in only seven cases and BN of the scalp has not yet been reported.[4] The present case with scalp localization is a unique report in the literature.

Initially, the present case was difficult to diagnose as BN. In addition, because the nevus occurred in an atypical site where hair already existed, we could not determine if there was hypertrichosis after puberty. However, the basal layer pigmentation and hamartoma of the arrector pili observed on the histologic examination facilitated the diagnosis of BN.

In conclusion, physicians should be aware that BN can present on atypical sites. Therefore, if a hyperpigmented plaque develops on an unexpected site with hair already present, such as the scalp, BN should be included in the differential diagnosis.

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Conflicts of interest

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