CLINICAL TOPIC - Becker's Naevus
Becker's naevus (hairy pigmented mole) is a permanent birthmark which appears as a large hyperpigmented and hairy patch, most often found on upper trunk or shoulders, although it can appear on the arms, legs and even the face.
It arises from the overgrowth of epidermis, melanocytes and hair follicles, and it is thought to be a genetic predisposition possibly triggered by circulating androgens (such as testosterone) which is why it often appears in puberty and mostly in men.
Once it appears, it often expands and becomes darker in adolescence, and may be associated with development of acne.
Although some degree of fading may be observed in adulthood, Becker's naevus remains indefinitely.
When it first appears, it is advisable to check the Becker's naevus with your doctor because very rarely, they may be associated with other abnormalities which form "Becker's naevus syndrome" but in most patients this is extremely unlikely.
TREATMENT
Becker's neavus is a benign skin condition that requires no treatment, and the only considerations are purely cosmetic.
Despite anecdotal reports that some cosmetic improvement may have been achieved using lasers, even if it starts to fade initially, Becker's naevus is extremely likely to re-pigment, and any more aggressive treatments (laser or surgical) have a very high chance to simply result in scaring.
This is why most doctors advise that Becker's neavus is currently untreatable.
While some other birthmarks, such as Portwine stains, are successfully treated with lasers, this is not the case with Becker's naevus.
Furthermore, using lasers on any mole-type pigmented lesion, whether in terms of removing the hair or attempting to fade the colour, in our opinion is contraindicated because although some fading may occur, it will also result in decreased ability to spot any changes.
Although Becker's naevus has no more probability of turning into a skin cancer than any other mole, it is important to maintain the pigmentation in all moles because they sometimes undergo cancerous transformation, especially when associated with repeated sun burn.
Therefore, when we treat skin with lasers and IPL we always make a conscious effort to cover up all the moles with the white marker thus making sure they are not inadvertantly faded in treatment.
This is the rationale behind not even recommending treatment of Becker's naevus with lasers, especially considering overwhelming evidence that laser therapies not only rarely result in very minor improvement, but often make the lesion worse.
LIVING WITH BECKER'S NAEVUS
For management of Becker's naevus we advise diligent sun protection using high factor sun screen.
It bears a mention that over the years we have received multiple inquires from people who seek definitive treatment for this condition despite multiple medical opinions suggesting that the condition is untreatable.
While it's easy for doctors to say that something which is not dangerous is simply untreatable, and to recommend a "change in attitude" or "getting a tattoo", this may not be what the patient hopes to hear.
Patient reactions to Becker's neavus vary from person to person, usually depending on the lesion size and placement.
Richard Gere, who has Becker's naevus on his upper back, has always freely displayed it on the big screen.
However, most patients with very large Becker's naevi report being extremely unhappy with it.
It is a very difficult situation for both doctor and patient - whilst there is no medical danger and in that sense the prognosis is excellent, the psychological consequences of this condition are not to be dismissed.
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