Verruciform xanthoma: report of three patients with comparative dermoscopic study

Abstract

We report three cases of verruciform xanthoma (VX) in male patients aged 82, 88 and 39 years, respectively. The clinical appearance was of a mulberry-like area consisting of small papillae, which is typical of and specific to VX, and the diagnosis were histologically confirmed in all cases. Dermoscopy revealed that each surface papilla contained linear or hairpin vessels, which were surrounded by a marginal whitish rim. These structures are thought to correspond to dilated vessels in dermal papillae and papillated acanthotic epidermis, respectively. Furthermore, observation under compression (similar to diascopy) revealed yellow dots and debris, reflecting lipid-laden foam cells. In order to compare these findings with those of other disorders with similar findings, two patients with xanthogranuloma, six with sebaceous naevus, and three with senile sebaceous hyperplasia were examined. The dermoscopic findings in these patients were not similar to those of VX. Therefore, we believe that the above dermoscopic findings are specific to VX and could be helpful in diagnosis.

Yellow and orange in cutaneous lesions: clinical and dermoscopic data

“…Most cases described have arisen on anogenital skin, and they may develop as a reactive phenomenon. Dermoscopic description has shown yellow dots and debris surrounded by a marginal whitish rim …”

“…Plane and tuberous xanthomata: DND Verruciform xanthoma: yellow dots and debris surrounded by a marginal whitish rim. 15 Cutaneous non-Langerhans cell histiocytosis: JXG: In early lesions 'setting sun' appearance; in late stages 'clouds' of pale yellow to orange-yellow globules and whitish streaks. Sometimes branched vessels [18][19][20] Solitary reticulohistiocytoma:'setting sun' pattern [20][21][22] Cutaneous mastocytoma: yellow-orange spot pattern or yellow-orange blot 23,24 Yellow tattoo: yellow homogeneous colour Skin conditions that can occasionally be yellow…”

“…Dermoscopic description has shown yellow dots and debris surrounded by a marginal whitish rim. 15 Cutaneous non-Langerhans cell histiocytosis is a group of disorders defined by the proliferation of histiocytes that do not easily fit into the usual categories of biological behaviour as tumours or inflammatory lesions. They are manifested as papules, plaques or nodules often yellowish due to the presence of foamy lipid-laden histiocytes.…”

Dermoscopy and reflectance confocal microscopy in verruciform xanthoma of the glans penis

“…To date, few cases on genital site have been reported. 1 Its histopathological features of epidermal hyperplasia and large foam cells in dermal papillae correlated well to the bulbous islands of pleomorphic keratinocytes in the thickened epidermis and the homogeneous filling of papillae with vessels. These reflectance confocal microscopy features allow for a distinction of verruciform xanthoma from squamous cell carcinoma, which is included in its differential diagnosis.…”

Characteristic dermoscopic features of verruciform xanthoma: Report of three cases

“…1j). Ohnishi et al 2 stated that none of the other yellow lesions had the marginal whitish rims or linear/hairpin vessels in the papillae seen in VX.…”