Genital verruciform xanthoma: A rare differential to genital warts

Verruciform xanthoma is a rare, benign mucocutaneous growth, usually seen in the oral cavity, but uncommonly also seen on genital skin. It presents as a flat or raised skin lesion, varying in colour with an irregular surface. These lesions can mimic stigmata of sexually transmitted infections such HPV-genital warts, condyloma latum or cause concern for inflammatory or malignant conditions, with histopathology being crucial for diagnosis and to avoid anxiety or invasive procedures. Underlying cause of these lesions remains uncertain, but no link to HPV has been identified. We present an 89 year old male referred to the sexual health service for concern of genital wart, despite low risk sexual history. Following removal and analysis to ensure non-malignant, the patient has been well since, with no recurrence.