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LETTER TO EDITOR
  
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





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;63:387-389


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 2020 Sep 25 ];63:387-389
Available from: http://www.ijdvl.com/text.asp?1997/63/6/387/4628


Full Text

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

1Becker S.W. Concurrent melanosis and hypertrichosis in distribution of nevus unius lateris, Arch Dermatol Syph 1949; 60: 155-160.
2Atherton 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.
3Lever WF, Schaumburg - Lever G. Histopathology of the Skin, 7th edn., Philadelphia, JB Lippincott company. 1990; 727-774.
4Thappa DM, Garg BR, Prasad RRA, Ratnakar C. Multiple leiomyoma cutis associated with Becker's nevus, j Dermatol (Tokyo), 1996; 23: 719-720.
5Weedon 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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