Verruciform Xanthoma

Verruciform xanthomas typically present as asymptomatic, flat, solitary papules or plaques on the oral mucosa but also can occur on the genital mucosa and other cutaneous sites. On low-power magnification, they have a verruca vulgaris–like appearance due to characteristic acanthosis, papillomatosis, and hyperkeratosis. Additionally, there often are numerous neutrophils in the upper layers of the epidermis with overlying parakeratosis. Large foamy macrophages (xanthoma cells) fill the papillary dermis. Distinct characteristic features seen in verruca vulgaris include the presence of koilocytes, coarse hypergranulosis, papillomatosis, and rete ridges that curve inward.