Case and Research Letters
Becker Nevus: 4 Cases of a Rare Syndrome
Síndrome del nevo de Becker. Cuatro casos de una rara entidad
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Cuatro casos de una rara entidad" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "282" "paginaFinal" => "283" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Becker Nevus: 4 Cases of a Rare Syndrome" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 568 "Ancho" => 755 "Tamanyo" => 48046 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Mácula hiperpigmentada sobre la cual asienta vello situada a nivel escapular izquierdo. Obsérvese cicatriz quirúrgica adyacente, dado su antecedente de escoliosis severa.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L.L. Tirelli, A. Label, P.C. Luna, M. Larralde" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L.L." "apellidos" => "Tirelli" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Label" ] 2 => array:2 [ "nombre" => "P.C." "apellidos" => "Luna" ] 3 => array:2 [ "nombre" => "M." 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On the upper extremities: skin-colored papules and nodules with an infiltrated appearance, some of which are ulcerated and others with a central crust. On the lower extremities: papules coalescing to form brownish-red plaques.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "N. Calvache, D.A. Arias, V.M. Delgado" "autores" => array:3 [ 0 => array:2 [ "nombre" => "N." "apellidos" => "Calvache" ] 1 => array:2 [ "nombre" => "D.A." "apellidos" => "Arias" ] 2 => array:2 [ "nombre" => "V.M." "apellidos" => "Delgado" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731020303367" "doi" => "10.1016/j.ad.2019.07.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731020303367?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021000238?idApp=UINPBA000044" "url" => "/15782190/0000011200000003/v1_202103020923/S1578219021000238/v1_202103020923/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Becker Nevus: 4 Cases of a Rare Syndrome" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "282" "paginaFinal" => "283" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L.L. Tirelli, A. Label, P.C. Luna, M. Larralde" "autores" => array:4 [ 0 => array:4 [ "nombre" => "L.L." "apellidos" => "Tirelli" "email" => array:1 [ 0 => "ltirelli@hospitalaleman.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Label" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "P.C." "apellidos" => "Luna" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "M." "apellidos" => "Larralde" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Dermatólogas del servicio del Hospital Aleman de Buenos Aires, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Residente de dermatología del Hospital Alemán, Argentina" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Jefa del servicio de Dermatología del Hospital Alemán de Buenos Aires, Argentina" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome del nevo de Becker. Cuatro casos de una rara entidad" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 506 "Ancho" => 755 "Tamanyo" => 46686 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hyperpigmented macule on the right scapular region and shoulder, present since birth. The comedones and hair on the macule appeared at puberty.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Becker nevus (BN) is a hamartoma lesion characterized by a hyperpigmented macule with irregular, though well defined, borders, with hypertrichosis on the surface. It tends to present peripheral satellite lesions and is most frequently located on the anterior surface of the chest and on the shoulder girdle.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Although it generally involves only the skin, it may occasionally be associated with muscle and bone abnormalities, constituting Becker nevus syndrome (BNS). This syndrome was defined by Happle and Koopman<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a> 20 years ago and few cases have since been published in the literature.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Series</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case 1</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 12-year-old boy with no past personal or family history of interest presented a mildly hyperpigmented macule on the left side of the face and neck, and left arm. The lesion had been present since birth. Physical examination revealed a hyperpigmented macule with well-defined borders, with islands of healthy skin on the periphery and mild hypertrichosis with respect to the rest of the skin; the lesion involved the left cheek, neck, and left arm. The clinical picture was interpreted as BNS. The patient also presented hypoplasia of some teeth homolateral to the nevus, and facial asymmetry and scoliosis.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case 2</span><p id="par0020" class="elsevierStylePara elsevierViewall">An 18-year-old boy with a past history of severe scoliosis that had been treated surgically visited our department with a hyperpigmented macule on the left scapular region; the lesion had been present since birth (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient reported that the lesion had become more pigmented and hairier over time.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Case 3</span><p id="par0025" class="elsevierStylePara elsevierViewall">A 15-year-old boy visited our department with a hyperpigmented macule that involved the area of the right shoulder and scapula; the lesion had been present since birth. The nevus showed a higher density of closed comedones and moderate hypertrichosis compared with the resto of the skin (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The patient also presented moderate scoliosis, leading to a diagnosis of BNS.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Case 4</span><p id="par0030" class="elsevierStylePara elsevierViewall">A 44-year-old man visited our department with a large hyperpigmented macule on the left scapular region; the lesion was the result of the coalescing of smaller macules (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Clear asymmetry in the trophism of the underlying soft tissue was also observed. A chest x-ray revealed marked scoliosis and the clinical picture was interpreted as BNS.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">BN was first described by SW Becker in 1949. It is an androgen-sensitive hamartoma. It usually presents from birth, although it occasionally only becomes visible over time, typically at puberty, when it may become more pigmented and hairier, due to hormone stimulation.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This change is more evident in males. In their series of 118 cases, Patrizi et al<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> also found a certain link between evidence of BN and exposure to sunlight.</p><p id="par0040" class="elsevierStylePara elsevierViewall">BNS is the association of BN with underlying musculoskeletal malformations. It is a rare entity that affects both sexes equally, although this varies in different studies.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Because BN is more frequently found on the thoracic region, especially the pectoral and scapular regions, it is associated with different abnormalities in this location, including as scoliosis, mammary hypoplasia, and muscular hypotrophy. In general, these disorders are ipsilateral to the nevus.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–10</span></a> The entity should be distinguished from Poland syndrome, which is characterized by hypoplasia or unilateral absence of pectoral muscles, ribs, breast, or nipple, together with homolateral syndactyly. It is occasionally associated with compromised internal organs.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,12</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The clinical spectrum of involvement ranges from subtle manifestations that are difficult to detect clinically, to clear abnormalities, which are generally the reason for a medical consultation. In this regard, women consult more frequently when the BNS involves the breast, due to the resulting asymmetry in the anterior thorax.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">BNS forms part of what are known as epidermal nevus syndromes, together with Schimmelpenning syndrome, nevus comedonicus syndrome, Proteus syndrome, and CHILD syndrome. These syndromes are caused by a hamartomatous proliferation derived from the embryonic ectoderm as the result of anomalous growth of different epidermal structures, depending on the case in question.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">They tend to occur due to sporadic mutations. Heterozygotic individuals are phenotypically normal but may transmit the mutation over several generations, whereas the disease manifests in the presence of 2 somatic mutations during embryogenesis, with a paradominant inheritance pattern.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,6</span></a> Its genetic basis is not fully understood, although it is thought to be caused by a lethal postzygotic mutation of an autosomal gene that survives in mosaic form.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Indeed, this entity manifests with characteristics of mosaic phenotype, presenting as a solitary lesion with serrated edges or, less commonly, as a segmented or flag-like lesion. Thus, in members of the same family, it is possible to find individuals with BNS and others with only BN.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Case Series" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Case 1" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Case 2" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Case 3" ] 3 => array:2 [ "identificador" => "sec0025" "titulo" => "Case 4" ] ] ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-07-23" "fechaAceptado" => "2019-11-12" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Tirelli LL, Label A, Luna PC, Larralde M. Síndrome del nevo de Becker. Cuatro casos de una rara entidad. Actas Dermosifiliogr. 2021;112:282–283.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 568 "Ancho" => 755 "Tamanyo" => 48046 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hyperpigmented macule with hair over the left shoulder. Note the adjacent surgical scar due to the history of severe scoliosis.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 506 "Ancho" => 755 "Tamanyo" => 46686 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hyperpigmented macule on the right scapular region and shoulder, present since birth. The comedones and hair on the macule appeared at puberty.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 507 "Ancho" => 755 "Tamanyo" => 41575 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Adult patient who presented macules that simulate grouped hyperpigmented islands located on the left scapular region.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Síndrome del nevo de Becker: comunicación de tres casos" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. 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