Penis and scrotum
Inflammatory lesions
Cutaneous verruciform xanthoma

Authors: Antonio Cubilla, M.D., Alcides Chaux, M.D. (see Authors page)

Revised: 30 March 2018, last major update February 2010

Copyright: (c) 2002-2018,, Inc.

PubMed Search: Cutaneous verruciform xanthoma

Cite this page: Cubilla, A., Chaux, A. Cutaneous verruciform xanthoma. website. Accessed November 20th, 2018.
Definition / general
  • Mean age 52 years
  • Usually in oral mucosa, penis and rarely in scrotum
  • Uncertain etiology, although probably a reactive process following epithelial damage
  • Initial keratinocyte damage attracts neutrophils, then dermal dendrocytes phagocytosize necrotic keratinocyte debris (Am J Surg Pathol 1998;22:479)
  • Foam cells most likely derived from CD68+ dermal dendritic cells
  • Some cases are PUVA related (PUVA is Psoralen + UVA treatment for eczema, psoriasis, vitiligo and mycosis fungoides)
  • Consistently HPV- (Arch Pathol Lab Med 2005;129:e62)
Clinical features
  • Slow growing, painless, solitary exophytic tumors measuring 0.5 - 2.0 cm
Case reports
Clinical images

Images hosted on PathOut server:

Granular, elevated
tan white mass
of distal shaft and
coronal sulcus

Gross description
  • Solitary, raised or polypoid with cup shaped craters
  • Can simulate a verruciform penile tumor such as condyloma (typical or giant) or warty or verrucous carcinoma
Microscopic (histologic) description
  • Foam cell aggregates in vascularized submucosa or papillary dermis, associated with verrucous epithelial hyperplasia with acanthosis, papillomatosis, hyperkeratosis with no granular layer and prominent parakeratosis between papillae (Am J Surg Pathol 1998;22:479)
  • Cup shaped craters are filled with parakeratotic cells blending into keratinocytes
  • Also variable neutrophilic infiltrate near surface of epidermis between plump parakeratotic cells and keratinocytes
  • Bandlike plasma cell infiltrate at base of epidermis
  • Absence of atypical epithelial changes
Microscopic (histologic) images

Images hosted on PathOut server:

Papillary epithelial hyperplasia and stromal histiocytes with foamy cytoplasm in papillary cores

Scrotum: crater shaped verrucoid lesion

Scrotum: numerous
foamy macrophages
between elongated
rete ridges

Palate: 57 year old man with papillary lesions

Images hosted on other servers:

H&E and CD68

Tongue: focal parakeratosis, mild epithelial acanthosis and xanthoma cells

Tongue: CD68

Positive stains
Negative stains
Electron microscopy description
  • Xanthoma cells contain membrane bound lysosomes, myelin figures and fragmented desmosomes
Differential diagnosis