Becker's nevus associated with basal cell carcinoma: an unusual presentation in a sun-protected area*

Dear Editor, Becker’s nevus is a relatively common, hyperpigmented patch, frequently associated with hypertrichosis.1 Males are more commonly affected than females, with an incidence of around 0.25%.2 Becker’s nevus may be associated with various cutaneous and skeletal anomalies. However, basal cell carcinoma (BCC) is a slow-growing; locally invasive tumour arising from pluripotent stem cells within the basal cell layer of the epidermis.2 It typically arises in areas of chronic sun exposure. Herein, the authors describe a sporadic case of Becker’s nevus with isolated BCC over a sun-protected site in a young male aged 27 years, which has not previously been reported. A 27-year-old male presented with a history of a single, widespread, brownish, flat lesion on the right upper chest. He had had the lesion for 15-16 years and it had remained unchanged throughout. The patient was not overtly concerned about the lesion. In addition, he complained of a well-defined, dark-coloured, elevated skin lesion over the brownish flat lesion. This dark-coloured, elevated lesion had emerged 3 months previously, increasing suddenly in size. During this period, the lesion’s surface frequently exhibited erosions that bled spontaneously and then healed within a few days, only to recur again. There was no history of trauma, excessive sun exposure or previous inflammation in this area. The patient had been in his usual state of good health and his family history was inconsistent. On physical examination, there was a brownish to hyperpigmented patch of 12×10 cm2 in size, with irregular, well-defined margins located on the right upper chest extending from the right mid-clavicular line to the right mid-axillary line. It was associated with hypertrichosis, without any signs of photo-damage. Over the lateral aspect of this large, brownish, macular lesion, there was a hyperpigmented plaque, 3-4cm in size, with a small crust in the centre of the lesion (Figure 1). Induration and tenderness manifested upon palpation. It also bled when touched and was not associated with any lymphadenopathy. Further examination and routine investigations revealed no associated cutaneous or systemic anomalies. However, dermoscopy could not be performed as no dermoscopes were available at the institution.