| Summary: | Becker’s nevus (BN) is a cutaneous hamartoma which is characterized by circumscribed hyperpigmentation with hypertrichosis. Recent studies have revealed that BN patients harbored postzygotic <i>ACTB</i> mutations, which were restricted to arrector pili muscle lineage. We screened for <i>ACTB</i> mutations in 20 Chinese patients with BN and found that recurrent mutations (c.C439A or c.C439T) in <i>ACTB</i> were detected in the majority of BN patients. However, more than 20% of the patients were negative for <i>ACTB</i> mutations, suggesting a possible genetic heterogeneity in Becker’s nevus. Interestingly, these mutations were also detected in dermal tissues outside the arrector pili muscle. We further performed genotype–phenotype correlation analysis, which revealed that lesions above the waistline, including the trunk above the anterior superior spine level, upper limbs and face, or covering more than 1% BSA were more likely to be positive for <i>ACTB</i> mutations. Altogether, our results provide further evidence of postzygotic <i>ACTB</i> mutations in BN patients and suggest a possible genotype–phenotype correlation of BN.
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