Clinicopathological profile of hyperpigmented skin lesions- A prospective study

Introduction: Hyperpigmentation is one of the most common reac?on to inflammatory, benign and malignant lesions of the skin. These disorders comprise heterogeneous group of diseases of epidermal and dermal hyperpigmenta?on divided into various types according to e?ology and pathology. Correct diagnosis of these hyperpigmented lesions is linked to histopathologic examina?on of skin biopsies with clinical correla?on. Aim: To study the spectrum of hyperpigmented skin lesions with reference to age and sex distribu?on. Materials and Methods: This prospec?ve cohort study was conducted at Department of Pathology, at Alluri Sitaramaraju Academy of Medical Sciences, Eluru, Andhra Pradesh, India, which included 80 pa?ents who were clinically diagnosed with hyperpigmented skin lesions in all age groups from July 2014 to August 2016. Frequency and percentage sta?s?cs was used to present the results. Results: Out of 80 cases, 34 cases of inflammatory lesions, 23 cases of benign lesions and 23 cases of malignant lesions were reported. Among the post inflammatory lesions the majority were classical Lichen planus. Conclusion: Most common lesion was lichen planus and its variants with highest incidence in females and age group greater than 60 years. Histopathological diagnosis with clinical correla?on aids in effec?ve management of the pa?ents.

Becker's Nevus Syndrome with Ipsilateral Limb Hyperplasia / 대한피부과학회지

No abstract available.

Síndrome de nevo de Becker con características ictiosiformes / Becker's nevus syndrome with ichthyosiformes features

El nevo de Becker, es un hamartoma cutáneo benigno de etiología desconocida, que se presenta como una mácula hiperpigmentada de bordes geográficos. Por lo general, se ubica en la región torácica superior y su compromiso tiende a ser unilateral. Ocasionalmente el nevo de Becker se asocia a anomalías en el tejido óseo, muscular o cutáneo, siendo la ictiosis una característica muy infrecuente. La presencia de alguna de estas anomalías asociadas a un Nevo de Becker determina el síndrome del Nevo de Becker. Paciente de sexo masculino de 18 años, que consultó por un cuadro iniciado en la infancia, caracterizado por la aparición de manchas cafés, escamosas, pruriginosas que inicialmente se ubicaron en las extremidades inferiores y con el tiempo fueron apareciendo en tronco, región lumbar y glútea. Mediante la correlación clínico-patológica se llegó al diagnóstico de Nevo de Becker, con características ictiosiformes. Se realizaron estudios complementarios con ecocardiograma Doppler y radiografía de tórax, que resultaron normales y una ecotomografía Doppler color de tórax anterior que mostró una leve ginecomastia bilateral con discreto aumento del botón mamario derecho y una leve hipoplasia del pectoral mayor derecho diagnosticándose Síndrome de Nevo de Becker. La mayoría de los reportes de Síndrome de nevo de Becker describen anomalías como escoliosis o hipoplasia unilateral de la mama, con escasos reportes sobre ictiosis. Se reporta este caso por su presentación atípica con múltiples nevos de Becker, compromiso de hemicuerpo inferior y su asociación ictiosiforme poco descrita en la literatura.

Becker's nevus is a benign cutaneous hamartoma of unknown etiology; it appears as a hyperpigmented macula with geographical borders. Usually it is located in the upper thoracic region, unilaterally. Occasionally Becker nevus is associated with abnormalities in the bony, muscle or skin tissue, being ichthyosis an unusual feature. The presence of some of these anomalies associated with Becker´s nevus determine the Becker´s nevus syndrome. Male patient of 18 years old who had a clinical history that begun in childhood, characterized by the appearance of brown, scaly, itchy patch that initially were located in the lower extremities and eventually were appearing in the trunk, lumbar and gluteal area. The clinical-pathological correlation led us to the diagnosis of Becker´s nevus with ichthyosiform features. Additional studies were performed such as Doppler echocardiography and chest radiograph, both normal. Color Doppler ultrasonography of anterior chest showed a slight bilateral gynecomastia with discrete increase of the right breast and a slight hypoplasia of the right major pectoral, determining a Becker´s nevus syndrome. Most reports of Becker´s nevus syndrome described abnormalities such as scoliosis or unilateral breast hypoplasia, few cases have been reported with ichthyosis. This case is reported for its atypical presentation with multiple Becker´s nevus, compromise of the lower body and its ichthyosiform association, rarely described in the literature.

Clinicopathological Features and Immunohistochemical Alterations of Keratinocyte Proliferation, Melanocyte Density, Smooth Muscle Hyperplasia and Nerve Fiber Distribution in Becker's Nevus

BACKGROUND: Although Becker's nevus (BN) is a relatively common disease, the systematic studies of clinicopathological and immunohistochemical results are poorly reported. OBJECTIVE: To investigate the clinicopathological features and immunohistochemical alterations of keratinocyte proliferation, melanocyte density, smooth muscle hyperplasia and nerve fiber distribution in BN. METHODS: Clinical and pathological data were collected in 60 newly-diagnosed BN cases. Immunohistochemical stain of Ki-67, Melan-A, keratin 15, smooth muscle actin and protein gene product 9.5 was performed in 21 cases. RESULTS: The median diagnostic and onset age was 17 and 12 years, respectively. Skin lesions usually appeared on the upper trunk and upper limbs. The pathological features included the rete ridge elongation and fusion and basal hyperpigmentation. Epidermal Ki-67, Melan-A and keratin 15 expression and dermal nerve fiber length were significantly higher in lesional and perilesional skin than in normal skin (p<0.05~0.01), while smooth muscle actin expression was upregulated only in skin lesion (p<0.05). CONCLUSION: Although the clinical diagnosis of BN is often straightforward, histopathology is helpful to differentiate from other pigmentary disorders. The hyperproliferation of keratinocytes, melanocytes, arrector pili muscle and dermal nerve fibers could be involved in the pathogenesis of BN.

A Case of Becker Nevus Syndrome with a Tooth Defect andFibrous Dysplasia of the Sphenoid Bone / 대한피부과학회지

Becker nevus syndrome is a phenotype characterized by the presence of a Becker nevus in association with unilateral hypoplasia of the breast or other cutaneous, muscular or skeletal defects. We report an interesting case of Becker's nevus syndrome associated with fibrous dysplasia of the sphenoid bone, tooth abnormalities and facial asymmetry.

A Case of Progressive Cribriform and Zosteriform Hyperpigmentation Associated with Becker's Nevus and Melanonychia / 대한피부과학회지

Progressive cribriform and zosteriform hyperpigmentation (PCZH) was first described in 1978 by Rower and his colleagues as having the following clinical characteristics: a single area of uniformly-tan, cribriform, macular pigmentation in a zosteriform distribution, an histologically mild increase of melanin pigment in the basal cell layer and complete absence of nevus cells, no preceding history of skin rash, injury or inflammation, onset after birth with gradual extension - age at onset was in the second decade of life, lack of other associated cutaneous or internal abnormalities. We hereby report an atypical case of PCZH in a 16-year-old boy, who presented with multiple, cribriform and zosteriform hyperpigmented lines on his right arm and leg. This is the first ever reported case which has an association with Becker's nevus and melanonychia.

A Case of Becker's Nevus Associated with Ipsilateral Hypoplasia / 대한피부과학회지

Becker's nevus is a cutaneous hamartoma characterized by unilateral hairy hyperpigmentation and can be associated with subjacent and distant soft tissue and bony abnormalities. Ipsilateral breast hypoplasia is a rare abnormality in Becker's nevus, suggesting that increased androgenic receptors or early postzygotic mutation may play a role in the pathogenesis of Becker's nevus. We report a case of Becker's nevus associated with ipsilateral breast hypoplasia in a 24-year-old female.

Becker's Nevus with Underlying Neurofibroma / 대한피부과학회지

Becker's nevus is a common and acquired focal epidermal melanotic hypermelanosis characterized by a large, unilateral patch showing hyperpigmentation and hypertrichosis on the shoulder, back or chest of a man around puberty. In some cases, it is associated with hamartomatous proliferation of pilosebaceous or dermal component including smooth muscle, connective tissue and nerve sheath. According to these findings, some authors suggested that Becker's nevus could be an organoid hamartoma accompanied by variable proliferation of epidermal and dermal components. We herein report a case of Becker's nevus associated with underlying neurofibroma in a 30-year-old man, which might be another evidence supporting that suggestion.

Treatment of a Becker's Nevus Using a Q-Switched ND: YAG Laser / 대한피부과학회지

BACKGROUND: Becker's nevus is a relatively common pigmented smooth muscle harmatoma that develops during adolescence and occurs primarily in young men. The nevus, characterized by hypertrichosis and hyperpigmentation, is usually located unilaterally over the shoulder, upper arm, and scapula. These nevi are not only cosmetically undesirable but also psychologically distressing, as traditional surgical therapies have been either unsuccessful or have resulted in scarring. OBJECTIVE: We evaluated the clinical improvement of 14 patients with a becker's nevus who were treated with a Q-switched (QS) frequency doubled ND: YAG laser in order to decrease pigmentation. METHODS: Our study was designed by analyzing the clinical improvement of outpatients with becker's nevus via clinical examination and photography. RESULTS: The results were as follows; Male to female ratio of 2.5: 1. The mean age was 19.7 years old and the subjects in most of the studies were young adult. The mean age of onset was 5.7 years old (below 5 years old: n=8, 57%). We treated 14 patients with a QS ND: YAG laser. The patients' response to treatment was; excellent; 14%, good; 36%, fair; 21%, and poor; 29%. Conparison, was made, of the positive clinical improvement in patients who received treatment once (n=10) and those who received treatment more than twice (n=4). Multiple treatments (75%) showed superior improvement compared with single treatment (40%). The clinical improvement, the according to the area of lesions, was the best in the neck (100%) and the worst in the trunk (25%). The lesions were accompanied by hair in 6 cases. Among these, the excellent or good cases were 33%. The other patients (8 cases) without hairs had more positive results (63%). Treatment effects according to laser fluence were not shown to be significant. During the study, the most common complication was hyperpigmentation (36%), followed by transient erythema (14%). Scarring or hypopigmenatation had resulted in none. CONCLUSION: Our data suggested that QS ND: YAG laser irradiation is an effective and safe method to treat the hyperpigmentation characteristic of a becker's nevus. Long-term further evaluation will be necessary to determine whether the favorable results observed in these patient will be permanent.

A Case of Acquired Cutaneous Smooth Muscle Hamartoma

Smooth muscle hamartoma was first described by Stokes in 1923 as the disease characterized by increase of well-defined bundles of smooth muscle fibers in the dermis. It can be either congenital or acquired. Acquired ones are aften in association with Becker's nevus. We present a case of acquired smooth muscle hamartoma that did not show any pigmentation or hair growth.

Giant Becker's Nevus with Agminated Lentigine / 대한피부과학회지

We report a case of a 27-year-old male showing Becker's nevus on his trunk and lower extremities. It represented symmetrically bilateral and extensive(about 50% of body surface) involvement. In addition to the usual clinical findings of Becker's nevus, grouped small darker spots were noted on the lesion of the buttock featuring agminated lentigine. Histologic findings of the brownish pigmented lesion consisted of mild acanthosis, hyperkeratosis, elongation of rete ridges, increase of basal layer pigmentation, and numerous terminal hair follicles. A dark macule in agminated lesions on the buttock showed more dense basal layer pigmentation and more regular elongation and fusion of rete ridges consistent with the histologic findings of lentigo simplex. This report describes a rare case of a giant Becker's nevus involving 50% of body surface in a bilateral and symmetrical distribution with associated agminated lentigine.

Giant Becker's Nevus with Agminated Lentigine / 대한피부과학회지

We report a case of a 27-year-old male showing Becker's nevus on his trunk and lower extremities. It represented symmetrically bilateral and extensive(about 50% of body surface) involvement. In addition to the usual clinical findings of Becker's nevus, grouped small darker spots were noted on the lesion of the buttock featuring agminated lentigine. Histologic findings of the brownish pigmented lesion consisted of mild acanthosis, hyperkeratosis, elongation of rete ridges, increase of basal layer pigmentation, and numerous terminal hair follicles. A dark macule in agminated lesions on the buttock showed more dense basal layer pigmentation and more regular elongation and fusion of rete ridges consistent with the histologic findings of lentigo simplex. This report describes a rare case of a giant Becker's nevus involving 50% of body surface in a bilateral and symmetrical distribution with associated agminated lentigine.

A Case of Becker's Nevus Associated with Ipsilateral Breast Hypoplasia / 대한피부과학회지

We report a case of Becker's nevus associated with ipsilateral breast hypoplasia in a 13-year-old female. Three years esrlier, she noticed a palrn-size hyperpigmented area on her left chest. The lesion showed a well defined geographic border. No hypertrichosis was seen. Hypoplasia was apparent on the left breast. A histopathologic finding showed a slightly hyperpigmented epidermis and some rectangular rete ridges with flat bases.

A Case of Becker's Nevus Associated with Smooth Muscle Hamartoma / 대한피부과학회지

We report a case of Becker's nevus associated with smooth muscle hamartoma, in a 21-year-old male patient, which shows clinically match-head sized, flat topped, round to oval, grouped papules with hairs on the outer surface of the right arm, and microscopically reveals numerous bundles of smooth muscle fiber in the dermis.