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

Abstract

IntroductionVerruciform 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.MethodsPubMed was used to search the following term: verruciform xanthoma. The relevant papers were obtained and reviewed.ResultsThere 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.ConclusionVerruciform 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.

Verruciform and Condyloma-like Squamous Proliferations in the Anogenital Region

“…Extraoral lesions are rare and usually arise on the vulva, penis, scrotum, and extremities. 88 Most patients present with a solitary lesion, although coexistence of multiple lesions can occur. Verruciform xanthomas are well-demarcated, yellowishorange papules or plaques with verruciform surfaces ranging from 0.2 to 2 cm in diameter.…”

Genital verruciform xanthoma: lessons from a contemporary multi‐institutional series

“…Verruciform xanthoma (VX) is a benign squamous proliferation that presents clinically as a well-circumscribed white, yellow or erythematous papule or plaque with a verrucous surface and a flat or pedunculated base. 3,4 Lesions arising in the oral cavity are most common, and have been described in significant numbers in some series. 4,5 However, an infrequent subset arises at cutaneous sites, 6 often involving the genitals, 7 where they can pose diagnostic challenges clinically as well as histopathologically.…”

“…2 Beyond the oral cavity, VX also occurs on the extremities, anal and genital sites. 3 Due to the rarity of VX in the anogenital region, VX may be misclassified as one of the more commonly encountered warty lesions in this area, particularly condyloma acuminatum, or for larger lesions, verrucous carcinoma and other variants of squamous cell carcinoma. Case reports of unusual VX presentations, pitfalls and rare syndromic associations (as well as meta-analyses thereof) dominate the literature, such that from the standpoint of prospective routine diagnosis the spectrum of expected clinical and histological features are uncertain.…”

Not another genital wart?

“…Extraoral cases are commonly associated with other conditions such as lymphoedema or epidermal naevi, including inflammatory linear verrucous epidermal naevus and CHILD (congenital hemidysplasia with ichthyosiform erythroderma and limb defects) syndrome, an epidermal naevus syndrome defined by congenital hemidysplasia with ichthyosiform erythroderma and limb defects . In scrotal VX, reported coexisting conditions include arteriovenous haemangioma, epidermolytic acanthoma, and graft‐versus‐host disease following bone marrow transplant for acute lymphoblastic leukaemia, along with patients post‐renal transplant and patients with psoriasis receiving psoralen ultraviolet A photochemotherapy …”