Verruciform xanthoma associated with squamous cell carcinoma

Verruciform xanthoma (VX) is a rare lesion of unknown etiology that is typi cally solitary and predominantly located within the oral cavity. Less commo nly, they arise on the skin, with the majority of cases occurring in anogen ital sites. They can be confused clinically with verruca vulgaris, condylom a, leukoplakia, verrucous carcinoma, and squamous cell carcinoma. Histologi c features include acanthosis with uniform elongation of the rete ridges an d xanthomatous cells that lie in and are typically confined to the papillar y dermis. Although epidermal atypia is not a characteristic finding, we des cribe an unusual case of VX that has features of both VX and squamous cell carcinoma. In addition, there was a VX with typical histologic characterist ics located at a separate site in the same patient. This case is also the f irst to our knowledge to be reported on the neck and axilla and is the thir d case associated with cutaneous graft versus host disease secondary to bon e marrow transplant for acute lymphoblastic leukemia.