Becker's nevus (BN), or Becker melanosis, is a benign cutaneous hamartoma characterized by a hyperpigmented, often hypertrichotic patch, typically developing during adolescence. First described by Samuel William Becker in 1949[1], Becker’s nevus has since been recognized as a condition with a clear male predominance and a suspected hormonal influence in its pathogenesis. The lesion most commonly affects the upper trunk and shoulders but can appear in other regions. Although usually an isolated dermatologic finding, Becker’s nevus can be associated with musculoskeletal and breast abnormalities in a condition known as Becker nevus syndrome (BNS)[2]. Becker’s nevus is primarily dermatological, there have been rare reports of craniofacial involvement, including dental anomalies such as malocclusion, delayed eruption, and facial asymmetry, particularly in cases of Becker nevus syndrome. These anomalies likely reflect underlying mesodermal dysregulation during embryogenesis. Therefore, multidisciplinary evaluation, including dental or orthodontic assessment, may be indicated in selected patients with suspected syndromic features[3].

Herein, we present a case of a typical Becker's nevus in an adolescent male and discuss the clinical presentation along with oral manifestations , differential diagnosis, histopathology,  management strategies, supplemented by a review of the literature ([Table. 1]).

A 12 year old male patient reported to the department of Pediatric and Preventive dentistry, University College of Medical Sciences, GTB hospital with the chief complaint of pain in his right upper back tooth region since 30 days. The patient’s past history was notable for a well defined asymptomatic hyperpigmented patch on his right thigh region ([Fig. 1]a), which was diagnosed as becker’s nevus. On intraoral examination , dental caries was seen in relation to right and left upper first permanent molars, grossly decayed lower left permanent molar, presence of crowding in his lower anterior teeth,  hyperpigmented gingiva in relation to upper and lower anterior region, palatal petechiae noted at  the junction of hard and soft

palate ([Fig. 1]b,c). Dental management including root canal treatment on right upper first permanent molar was done ([Fig. 1]d). Additionally application of pit and fissure sealant in right lower first permanent molar and oral prophylaxis was performed ([Fig. 1]e). The patient was asked to recall after 1 month and 3 months. 

Becker’s nevus typically arises during adolescence, aligning with hormonal changes during puberty, and shows a strong male predominance with a male-to-female ratio of approximately 2.3:1[4, 5]. Becker melanosis has an estimated prevalence of 0.5% among men. The lesion usually presents during puberty, but rarely, cases of Becker melanosis presenting at birth or early childhood have been reported; familial occurrence of Becker melanosis has been reported. Some studies have shown a higher incidence among Black individuals[6]. The pathogenesis is thought to be androgen-mediated. Studies have demonstrated an increased density of androgen receptors in lesional skin compared to adjacent unaffected skin[7]. This may explain both the hypertrichosis and the pubertal onset of BN. BN typically appears as a unilateral, hyperpigmented patch, often with irregular borders and associated hypertrichosis. In our case, the lesion was unilateral, hyperpigmented with irregular borders in the thigh region. Common locations include the chest, scapular region, upper arms, and sometimes the face or legs. The lesion is usually asymptomatic, though some patients report mild pruritus during early stages.

While BN is usually an isolated skin finding, in Becker nevus syndrome (BNS), the nevus is associated with hypoplasia of the breast, pectoral muscles, or underlying skeletal abnormalities[3]. Our case presented with isolated skin finding in the thigh region with mild pruritis. Histopathological examination of BN typically reveals acanthosis, elongation of rete ridges, basal layer hyperpigmentation, and smooth muscle hyperplasia . The number of melanocytes is not increased, distinguishing it from congenital melanocytic nevi. immunohistochemical studies have shown increased expression of some markers like epidermal Ki-67, melan-A, and keratin 15 in the lesional and perilesional skin compared to normal skin[8]. Differential diagnosis includes Congenital melanocytic nevus – present at birth, often darker and thicker; Café-au-lait macule – uniformly light brown without hair growth; pigmented epidermal nevus – often verrucous with a linear distribution; nevus spilus – characterized by speckled pigmentation on a lighter background and post-inflammatory hyperpigmentation – history of preceding trauma or inflammation. Management is primarily conservative, with reassurance about the benign and non-progressive nature of BN. Cosmetic concerns may prompt intervention. Options include: Laser therapy – Q-switched Nd:YAG and ruby lasers may help reduce pigmentation, while long-pulsed alexandrite and diode lasers can target hair[9, 10]. Topical agents – Hydroquinone and tretinoin may be tried but have limited efficacy. Surgical excision – Generally not recommended due to lesion size and risk of scarring. The psychological impact, particularly in adolescents, should not be underestimated, and counseling should be offered when necessary.

Becker’s nevus typically presents with minimal direct dental implications; however, it may be associated with underlying musculoskeletal anomalies, such as hemihypertrophy or scoliosis, which can influence craniofacial development and occlusion. However, there is insufficient literature on dental complications associated with beckers nevus , a thorough evaluation for facial asymmetry or related syndromic features is essential. Multidisciplinary coordination ensures accurate diagnosis and optimal treatment planning[3].