Verruciform Xanthoma

This rare but distinctive lesion, first described in 1971 [166], forms most commonly in the oral cavity [82, 135]. Extraoral locations include the male and female genitalia. There is no association with HPV in the vast majority of cases studied. Verruciform xanthomas are seen at all ages, but are most frequent in the fifth to seventh decades. Incidence is roughly equal between the sexes. They usually present as solitary, painless, discrete nodules that may be the colour of the surrounding mucosa, reddish or pink. They can be sessile or pedunculated and the surface can be domed or flat, and can be keratotic or papilliferous. They usually have sharply defined margins and are typically less than a centimetre in diameter. They do not appear to be related to any local irritating factors and most cases are asymptomatic. The gingival margin accounts for 85% of cases. Other common sites include the hard palate, tongue, buccal mucosa and a variety of other intraoral sites.

Microscopy typically shows corrugated, hyperplas-tic epithelium with elongated, broad rete ridges that extend to a straight, well-defined lower border [127]. There are deep clefts within the epithelium that often contain keratinised plugs. The surface shows parake-ratinised spikes, which often stain a deep orange colour. There may be secondary candidal infestation of the surface keratin layers [125]. The characteristic feature is the presence of vacuolated, foamy xanthoma-tous cells, which fill the papillary corium. These xan-thoma cells can occasionally extend into the overlying epithelium or into the deeper corium. The xantho-ma cells have been shown to be derived from cells of monocyte/macrophage lineage [121].

The lesions are entirely benign and recurrence following even conservative surgery is very rare.

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