Verruciform xanthoma (VX) is a benign reactive lesion usually seen in adults in their 4th or 5th decade of life. Its appearance varies and can present as an exophytic, verrucous, polypoid, granular, pebbly, raised, depressed, or a plaque-like lesion. The most common site (70% of cases) is oral cavity where it can involve keratinized mucosa of palate, gingiva, or alveolar ridge. Skin of anogenital region is another common location where it is often mistaken for condyloma acuminatum. The photograph shows VX arising on penile shaft. Pathogenesis: Mechanical trauma as well as epithelial damage caused by inflammatory skin conditions are thought to play a role in its pathogenesis. Keratinocyte necrosis releases intracellular lipids which are phagocytized by the macrophages and incite an inflammatory response. VX may be seen in association with epidermolytic acanthoma, seborrheic keratosis, epidermal nevi, lymphedema, discoid lupus erythematosus, and epidermolysis bullosa. Human papillomavirus is not considered to play a role.