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| LETTER TO EDITOR |
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| Year : 1997 | Volume
: 63
| Issue : 6 | Page : 387-389 |
Smooth muscle hamartoma associated with bilateral becker's nevus
DM Thappa, CS Sirka, S Srikanth
,
Correspondence Address:
D M Thappa
PMID: 20944390
How to cite this article:
Thappa D M, Sirka C S, Srikanth S. Smooth muscle hamartoma associated with bilateral becker's nevus. Indian J Dermatol Venereol Leprol 1997;63:387-9 |
How to cite this URL:
Thappa D M, Sirka C S, Srikanth S. Smooth muscle hamartoma associated with bilateral becker's nevus. Indian J Dermatol Venereol Leprol [serial online] 1997 [cited 2013 May 22];63:387-9. Available from: http://www.ijdvl.com/text.asp?1997/63/6/387/4628 |
To the Editor
Becker's nevus is a "concurrent melanosis and hypertrichosis in the distribution of nevus unius lateris", occurring in the second or third decade of life, mostly in men [1],[2] Quite frequently, no hypertrichosis is seen in the nevus. This may be the reason for considering the so called "progressive cribriform and zosteriform hyperpigmentation", a non hypertrichotic variant of Becker's melanosis. Recently, we had a case of smooth muscle hamartoma in association with Becker's nevus, probably representing the extreme form of Becker's nevus.
A 34-year-old female presented with asymptomatic lesions over the arms, left thigh and chest of 12 years duration. Family history was non-contributory. Physical examination revealed bilateral asymmetrical involvement of both the upper arms, left thigh and chest by multiple, irregular, non hypertrichotic, hyperpigmented macular lesions studded with nimerous soft to firm follicular papular lesions [Figure 1]. No tenderness or squirming was observed on palpation.
A biopsy specimen obtained from the representative skin lesion showed thick, long, straight bundles of smoothe muscles in the mid and deep dermis, some of them were in relation to the hair follicles. Masson trichrome stain, stained these muscle fibres densely red and the collagen blue. The epidermis showed a moderate increase in the basal layer pigmentation. No nevus cells were seen in the dermis. On the basis of the above findings, we modified our clinical diagnosis of Becker's nevus to Becker's nevus with smooth muscles hamartoma.
The constituent epidermal, melanocytic and pilar elements of Becker's nevus may demonstrate a spectrum of hamartomatous changes. [3],[4] Unilateral hyperpigmented patches with irregular border, perifollicular accentuation and hypertrichosis distributed both within and immediately surrounding the pigmented patches are the characteristic features of Becker's nevus. Occasionally, the hypertrichotic element never appears. [2],[3] Almost similar features was observed in our case, though, they were bilateral and occurred in a female. On the other hand, smooth muscle hamartoma presents as an asymptomatic single patch, most commonly in the limbar region. [5] It may present at birth or arise in childhood or early adulthood. Usually, there are small, follicular papules throughout the patch, although the entire lesion may be slightly elevated. Our case did show these follicular papular lesions in the patches but the number and site of lesions were atypical for smooth muscle hamartoma. Histologically, the epidermal changes of increased pigmentation of the basal cell layer without any evidence of nevus cells were compatible with the diagnosis of Becker's nevus. But the thick, long straight, well defined bundles of smooth muscle fibres scattered throughout the dermis were more extensive than described in the Becker's nevus and these features were typical of smooth muscle hamartoma. These smooth muscle bundles in leiomyomas are rather more tightly interlacing and appear grossly as discrete nodules which are painful an tender [4] Thus, probably, our case represented an association of Becker's nevus with smooth muscle hamartoma, an extreme form of Becker's nevus.
| References | |  |
| 1. | Becker S.W. Concurrent melanosis and hypertrichosis in distribution of nevus unius lateris, Arch Dermatol Syph 1949; 60: 155-160.  |
| 2. | Atherton DJ. Naevi and other development defects, In : Champion RH, Burton JL, Ebling FJG, editors, Textbook of Dermatology, Vol.1, 5the edn., London, Blackwell Scientific Publications. 1992; 462 and 466. |
| 3. | Lever WF, Schaumburg - Lever G. Histopathology of the Skin, 7th edn., Philadelphia, JB Lippincott company. 1990; 727-774. |
| 4. | Thappa DM, Garg BR, Prasad RRA, Ratnakar C. Multiple leiomyoma cutis associated with Becker's nevus, j Dermatol (Tokyo), 1996; 23: 719-720. |
| 5. | Weedon D Tumours of smooth and striated muscle, In : Symmers WStC, Weedon D, editors, Systemic Pathology - the skin, Vol.9, 3rd edn., Edinburgh, Churchill Livingstone, 1992; 915-922. |
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