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May 2002

Multiple Scrotal Exophytic Papules

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Arch Dermatol. 2002;138(5):689-694. doi:10.1001/archderm.138.5.689

Histopathological examination revealed acanthosis with hyperkeratosis. No koilocytes, epithelial atypia, or plasma cells were noted. Numerous foamy histiocytes were observed in the papillary dermis, confirming the diagnosis of verruciform xanthoma. No recurrence of either lesion has been noted.

Verruciform xanthoma is a benign entity that was first described in 1971,1 and the first case in an African American individual was reported in 1978.2 Although the name of VX is attributable to the presence of lipid-laden cells in the papillary dermis, there has been only 1 case of related systemic lipid abnormalities reported in the literature.3 The most common location for VX is the oral mucosa, with fewer than 50 reported cases of nonoral lesions.4 The genitalia are the most common extraoral site of involvement,5 although, to the best of our knowledge, the present case represents the first report of multiple VXs involving the scrotum. The typical presentation of a VX is of an asymptomatic, slowly enlarging, red to yellow solitary papule that can be either sessile or pedunculated and usually develops during the third and fourth decades of life, with a second peak near the seventh decade of life.6 The clinical differential diagnosis includes condyloma accuminatum, condyloma latum, xanthoma, verrucous carcinoma, and seborrheic keratosis. The lesions of VX are considered benign; no cases of transmission have been reported; and recurrences are rare after excision or destructive methods.7,8

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