Vegas (Verruciform Genital-Associated) Xanthoma: A Comprehensive Literature Review

Abstract

Introduction: Verruciform xanthoma is a wart-like benign lesion. The classic histologic appearance consists of foamy histiocytes within elongated dermal papillae and epithelial acanthosis. The lesion most commonly occurs in the oral cavity, but has been reported in extra-oral sites such as the penis, scrotum, and vulva. The clinical and histologic characteristics of verruciform genital-associated (Vegas) xanthomas of the penis, scrotum, and vulva are reviewed.

Methods: PubMed was used to search the following term: verruciform xanthoma. The relevant papers were obtained and reviewed.

Results: There have been 193 cases of genital-associated verruciform xanthomas. There were 164 in men and 29 in women. Similar to verruciform xanthomas of the oral mucosa, they presented as asymptomatic lesions, demonstrated foam cells in the dermal papillae, and were typically managed successfully with surgical excision.

Conclusion: Verruciform xanthoma is a benign lesion characterized by a wart-like growth that is most commonly seen in the oral mucosa. Verruciform xanthomas of the genital region have been coined Vegas xanthomas. Vegas xanthomas have been reported in association with a variety of diseases, as well as in healthy individuals. Biopsy is required for diagnosis, and complete surgical excision is typically curative.

Keywords: VEGAS xanthoma; Verruciform xanthoma; Verruciform xanthoma of the penis; Verruciform xanthoma of the scrotum; Verruciform xanthoma of the vulva.

Fig. 1

Distant (a) and closer (b) views showing a pedunculated papule protruding from the patient’s left side of the scrotum of an 83-year-old heterosexual monogamous man who had no history of sexually transmitted diseases and no reported HIV risk factors. He presented with an asymptomatic lesion of 3-year duration. Cutaneous examination revealed a flesh-colored 8 × 5 mm wart-like elongated papule localized to the left side of his scrotum. A snip excision was performed for biopsy and removal of the lesion

Fig. 2

Microscopic examination of the lesion from the 83-year-old man was performed. Low magnification (a) shows a pedunculated tumor with acanthosis, papillomatosis, and elongation of the rete ridges. Intermediate magnification (b, c) reveals parakeratosis and neutrophilic inflammation in the dermis. High magnification (d) reveals numerous foamy histiocytes in the widened dermal papillae. Correlation of the clinical features and the pathologic changes establish a diagnosis of verruciform xanthoma. The lesion was completely removed at the time of biopsy, and the patient applied mupirocin 2% ointment to the site. The excision site has since completely healed without recurrence. (Hematoxylin and Eosin: a = ×2, b = ×10, c = ×20, d = ×40)