Verruciform Genital-Associated (Vegas) Xanthoma: report of a patient with verruciform xanthoma of the scrotum and literature review.

BACKGROUND Verruciform xanthoma is a benign verrucous lesion characterized by epithelial acanthosis and lipid-laden foamy histiocytes in the connective tissue papillae. It typically presents as a papillomatous, polypoid, or sessile lesion. Verruciform xanthoma is most commonly observed within the oral cavity. However, albeit less frequently, it develops on the penis, scrotum, or vulva. PURPOSE   We describe the clinical and pathologic findings of a man who developed a verruciform xanthoma on his scrotum. We also summarize the associated conditions, the differential diagnosis, the postulated pathogenesis, and the treatment options for this tumor. MATERIALS AND METHODS   The features of a man with a scrotal verruciform xanthoma are presented. Using PubMed, the following terms were searched and relevant citations assessed: anogenital, foam cells, penis, scrotum, verruciform, verruciform xanthoma, vulva, and xanthoma. In addition, the literature on verruciform xanthoma is reviewed. RESULTS   Our patient developed an asymptomatic, exophytic, red filiform papule on his scrotum. A shave biopsy, attempting to remove the entire lesion, was performed. Based on correlation of the clinical presentation and histopathologic findings, a diagnosis of verruciform xanthoma was established. The patient applied mupirocin 2% ointment to the biopsy site, which subsequently healed without complication or recurrence. CONCLUSION   Verruciform xanthoma is a benign tumor commonly located within the oral cavity and characterized by the development of a small verrucous, papillomatous, polypoid, or sessile growth. Extraoral sites of verruciform xanthoma often include the penis, scrotum, or vulva; we introduce the term 'Vegas' (Verruciform Genital-Associated) xanthoma for these lesions. The lesions are often mistaken for viral warts or malignancies.  Although the mechanism of pathogenesis is unknown, verruciform xanthoma may have a multifactorial etiology involving inflammation, local immunosuppression, and/or metabolic dysfunction. It has also been postulated that verruciform xanthoma is a secondary reaction to trauma-induced epithelial damage or degeneration. A biopsy for histopathologic examination is required to diagnose verruciform xanthoma. The treatment of verruciform xanthoma typically involves simple surgical excision.