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Spectrum of Becker's melanosis changes is greater than believed.

To the Editor.— Slifman et al 1 address the issue of Becker's melanosis and its relationship to smoothmuscle hamartoma of the skin. They contend that these entities represent opposite ends of a spectrum of cutaneous hamartomatous changes and seek to confine the term Becker's melanosis to acquired pigmented lesions not showing smooth muscle accentuation. We believe that these hamartomas represent distinct clinicopathologic entities. Whether they are acquired or not should not determine classification. Since many of the tissues involved are hormonally, maturationally, and environmentally sensitive, it is not surprising that the Becker's portion of the spectrum flourishes at puberty (and, perhaps, neonatally under androgenic stimulation). In fact, review of some reports of congenital smooth-muscle hamartomas indicate that these lesions were clinically diagnosed as Becker's melanosis at the outset. 2,3 Becker's melanosis is not purely acquired. 4 The incidence of congenital Becker's melanosis may be far higher than that determined by