Abstract
Verrucous xanthoma is a benign histiocytic lesion of macrophage derivation. We describe a woman with a non-mucosal verruciform xanthoma located on her right thumb and review the features of patients with verruciform acral-associated xanthoma. A 69-year-old woman presented with a lesion on her right thumb of eight years duration that had been previously treated with liquid nitrogen cryotherapy without resolution. An initial biopsy was consistent with the surface of a callous. A second biopsy demonstrated a verruciform xanthoma. The patient elected to apply lactic acid 12% twice daily and pare the lesion with a pumice stone once weekly; this resulted in flattening of the xanthoma-associated hyperkeratosis. Acral verruciform xanthoma has, albeit rarely, been described on the hands and feet of individuals. Including the patient in this report, six individuals have been reported with verrucous xanthoma on the hands and 12 individuals have been reported with a verrucous xanthoma on the feet. Verruciform xanthoma most commonly occurs on the oral mucosa. Genital lesions are also a frequent site. Acral-distributed verruciform xanthoma is rare; we propose that a verruciform xanthoma that occurs on acral sites be referred to as a verruciform acral-associated (Vacas) xanthoma.
Highlights
Verruciform xanthoma is a benign, usually solitary, lesion
Acral-distributed verruciform xanthoma is rare; we propose that a verruciform xanthoma that occurs on acral sites be referred to as a verruciform acralassociated (Vacas) xanthoma
Non-oral verruciform xanthoma is commonly located in the genital region and referred to as a verruciform genital-associated (Vegas) xanthoma
Summary
Verruciform xanthoma is a benign, usually solitary, lesion. It typically occurs on the oral mucosa. The most common location is the penis and scrotum in men or the vulva in women This variant has been referred to as a verruciform genital-associated (Vegas) xanthoma [2]. Cutaneous examination shows a verrucous 20 x 10 millimeter plaque on the palmar distal right thumb and lateral nail fold (Figure 1). A deeper and wider, 3-millimeter biopsy using the punch technique was performed of the larger, palmar portion of the lesion on the distal right thumb. In addition to lymphocytes in the papillary dermis, there were foamy histiocytes (Figure 3) These pathologic changes establish the diagnosis of a verruciform xanthoma. Flattening of the overlying hyperkeratosis was observed at a follow-up examination two months later
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