Verruciform Xanthoma Clinical Presentation

  • Author: Hong Li, MD; Chief Editor: William D James, MD   more...
 
Updated: Jan 13, 2012
 

History

  • Patients usually present with a history of an asymptomatic or tender lesion on the skin or mucosa.
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Physical

  • The clinical appearance of a verruciform xanthoma is not diagnostic; the diagnosis is almost always made at histologic examination. Depending on the nature of the individual lesion, verruciform xanthoma may clinically resemble any verrucous, papillary, or lichenoid oral lesion, particularly any such lesion that is also hyperkeratotic. It is frequently misdiagnosed at clinical examination as a papilloma.
    • The lesion may appear as a verrucous, papillary, or flat-to-lichenoid process varying from 0.2-2 cm in diameter, although one lesion 4 cm in diameter has been reported.
    • Depending on the degree of keratinization, the xanthoma may appear gray to reddish pink.
    • The process may be pedunculated but is usually sessile. At least 2 cases occurring in cysts have been reported.
  • Although almost any part of the mouth could be involved, the alveolar ridge and gingiva have been noted as preferential sites. Because of this preference, mild trauma has been proposed to play a role in the etiopathogenesis.[37]
  • The lesions that occur on the oral mucosa or scrotum are usually not associated with any predisposing disorder.
  • The lesions that occur on the feet are often associated with lymphedema.
  • The skin lesions that occur outside of the perineum are often associated with another disease process.
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Causes

  • The etiopathogenesis of verruciform xanthoma is unknown. Many authors consider it to be a reactive process rather than a true neoplasm. Damage to the squamous cells with increased epithelial cell turnover, leading to the deposition of epithelial cell debris that is engulfed by macrophages in the corium may lead to the development of this lesion. Rawal et al report that the histologic changes in verruciform xanthomas resemble those of a chronic reactive process.[49]
  • An immunologic etiology has also been proposed. Khaskhely et al reported a case of verruciform xanthoma associated with human papillomavirus (HPV). Several etiopathogenic mechanisms may produce this disorder.[50]
  • Ide et al report on the development of verruciform xanthoma related to oxidized low-density lipoprotein, suggesting that macrophage-dependent debris disposal may perpetuate verruciform xanthoma.[51]
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Contributor Information and Disclosures
Author

Hong Li, MD  Pathologist and Dermatopathologist

Hong Li, MD is a member of the following medical societies: American Society for Clinical Pathology and College of American Pathologists

Disclosure: Nothing to disclose.

Coauthor(s)

W Clark Lambert, MD, PhD  Professor and Head, Dermatopathology, Departments of Pathology and Dermatology, UMDNJ-New Jersey Medical School

W Clark Lambert, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Dermatological Association, American Society of Dermatopathology, International Academy of Pathology, Medical Society of New Jersey, Sigma Xi, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Evan R Farmer, MD  Clinical Professor of Pathology and Dermatology, Department of Pathology, Virginia Commonwealth University School of Medicine

Evan R Farmer, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society of Dermatopathology, and International Society of Dermatology

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD  Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology

Disclosure: Amgen Honoraria Consulting; Celgene Honoraria Safety Monitoring Committee

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

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