Verruciform Xanthoma 

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

Background

Verruciform xanthoma is an uncommon lesion that usually occurs on the oral mucosa of middle-aged persons or on the scrotum of middle-aged to elderly Japanese men. The most common site for verruciform xanthoma is the oral mucosa. Lesions that occur elsewhere usually arise on the perineum or on the skin with some predisposing factor, such as lymphedema[1] or an epidermal nevus.[2, 3]

Most commonly, the lesion has a verruciform appearance, but it may appear polypoid, papillomatous, or sessile. Rarely, verruciform xanthomas have been found to occur in cysts. The chief distinguishing feature of verruciform xanthoma is the presence of large numbers of lipid-laden foamy histiocytes in, and essentially limited to, the connective tissue papillae in the lesion.

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Pathophysiology

The pathophysiology of verruciform xanthoma is unknown.

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Epidemiology

Frequency

International

Verruciform xanthoma is uncommon, accounting for 0.025-0.05% of all cases in which biopsy was performed in 2 oral pathology services. To date, at least 160 cases have been reported in the oral cavity,[4, 5, 6, 7, 8, 9, 10, 11, 12] 7 on the lip,[13, 14, 15] 15 on the penis,[16, 17, 18, 19, 20, 21, 22] 7 on the vulva,[23, 24, 25] 1 in the anal region,[26] 3 on the nose or nasal vestibule,[27, 28] 2 on the ear,[29] 4 on the distal extremities (including 3 on the feet),[30] and individual cases elsewhere on the skin. At least 23 cases have been reported on the scrotum, almost all of them in Japanese men.[31, 32, 33] A single case of multiple verruciform xanthoma lesions has been reported in internal organs; the lesions were in the upper aerodigestive tract of a child with a systemic lipid storage disease.[34]

Race

  • Most cases of verruciform xanthoma are reported in whites, but blacks are also affected.[35]
  • Most scrotal cases of verruciform xanthoma occur in middle-aged to elderly Japanese men.

Sex

  • No sex predilection is apparent for verruciform xanthoma.

Age

  • Most oral cases of verruciform xanthoma occur in middle-aged persons (mean age, 40-51 y), and most scrotal cases occur in middle-aged to elderly Japanese men (mean age, 65 y). However, the age at occurrence varies widely; it can occur in persons aged 2.5-89 years.[36]
  • Verruciform xanthoma is exceedingly rare in children aged 10 years or younger.
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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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