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

Dermatol Online J. 2015 Aug 15;21(8):13030/qt7kb930rf.


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.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Biopsy
  • Dermis / pathology
  • Diagnosis, Differential
  • Genital Diseases, Male / etiology
  • Genital Diseases, Male / pathology*
  • Histiocytes / pathology
  • Humans
  • Keratosis / etiology
  • Keratosis / pathology
  • Male
  • Middle Aged
  • Models, Biological
  • Mupirocin / therapeutic use
  • Neutrophils / pathology
  • Scrotum / pathology*
  • Xanthomatosis / etiology
  • Xanthomatosis / pathology*


  • Anti-Bacterial Agents
  • Mupirocin