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An atypical presentation of a verruciform xanthoma is discussed. Usually the surface of the lesion is rougher and more warty, and the lesions generally are larger. The foregoing case, however, serves to illustrate that all lesions, regardless of how small or innocuous, should be examined microscopically to determine a diagnosis and to develop a proper treatment plan. Rarely can a definitive diagnosis be made entirely on the basis of the clinical characteristics of the lesion.

Verruciform xanthoma, a rare histopathologic entity first described by Shafer in 1971, consists of two major elements—a papillomatous proliferation of epithelial or epidermal cells and xanthomatous foam cell infiltrates present in the papillary dermis. Verruciform xanthoma is usually found on the oral mucosa, 1 but it also occurs, on rare instances, on the skin of the vulva, 2 groin, 3 and penis, 4 and has been reported to develop in an epithelial nevus. 5 I describe three patients with verruciform xanthoma arising on the scrotum. Report of Cases Case 1.— A 76-year-old healthy man had lesions on the scrotum of one year's duration. Physical examination showed a 7-mm

• Verruciform xanthoma is an uncommon lesion confined mainly to the oral mucosa. Only two extraoral cases have been reported, and these involved the genitalia. Clinically, verruciform xanthoma is a raised lesion with a papillary or granular surface, usually located on the gingiva or alveolar mucosa. Microscopically, it is characterized by epithelial cell proliferation and by the accumulation of xanthoma cells in the upper lamina propria. Five new cases are reported and analyzed together with an additional 29 cases found in a review of the literature. (Arch Dermatol1981;117:563-565)

• Verruciform xanthoma is an unusual lesion that was initially reported in 1971. Clinically, it is a verrucous, vascular, epithelial plaque or papillomatous growth commonly found on oral or mucosal tissues. Histologically, it is characterized by a verruciform epithelium with abundant parakeratosis and by foam cells occupying the vascularized dermal papillae. This is the second extramucosal verruciform xanthoma reported. Our patient had several unique features. She is the youngest patient described to date, her lesion is the largest reported, and the lesion occurred in an epithelial nevus-type eruption on a phocomelic extremity. Light and electron microscopic studies disclosed abnormal keratinization, mast cell proliferation, and the previously described foam cells. We believe that the verruciform xanthoma in our patient represents part of a reaction to the epithelial nevus occurring in association with a developmental anomaly. ( Arch Dermatol 1982;118:686-691)

• We describe herein a patient with a verruciform xanthoma of the penis. This histologically distinctive lesion is usually confined to the oral mucosa, although two cases occurring on the vulva have recently been reported. To our knowledge, this lesion has not been previously described in other sites. Biopsy for histopathologic examination is required to aid in the identification of this unusual entity. Verruciform xanthomas have been benign, although a squamous cell carcinoma subsequently developed in one patient whose oral lesions were associated with leukoplakia. (Arch Dermatol1981;117:516-518)