Background: Verruciform xanthoma is a benign verrucous lesion characterized by epithelial acanthosis and lipid-laden foamy histiocytes in the connective tissue papillae. It typically presents as a papillomatous, polypoid, or sessile lesion. Verruciform xanthoma is most commonly observed within the oral cavity. However, albeit less frequently, it develops on the penis, scrotum, or vulva.

Purpose:  We describe the clinical and pathologic findings of a man who developed a verruciform xanthoma on his scrotum. We also summarize the associated conditions, the differential diagnosis, the postulated pathogenesis, and the treatment options for this tumor.

Materials and methods:  The features of a man with a scrotal verruciform xanthoma are presented. Using PubMed, the following terms were searched and relevant citations assessed: anogenital, foam cells, penis, scrotum, verruciform, verruciform xanthoma, vulva, and xanthoma. In addition, the literature on verruciform xanthoma is reviewed.

Results:  Our patient developed an asymptomatic, exophytic, red filiform papule on his scrotum. A shave biopsy, attempting to remove the entire lesion, was performed. Based on correlation of the clinical presentation and histopathologic findings, a diagnosis of verruciform xanthoma was established. The patient applied mupirocin 2% ointment to the biopsy site, which subsequently healed without complication or recurrence.

Conclusion:  Verruciform xanthoma is a benign tumor commonly located within the oral cavity and characterized by the development of a small verrucous, papillomatous, polypoid, or sessile growth. Extraoral sites of verruciform xanthoma often include the penis, scrotum, or vulva; we introduce the term 'Vegas' (Verruciform Genital-Associated) xanthoma for these lesions. The lesions are often mistaken for viral warts or malignancies.  Although the mechanism of pathogenesis is unknown, verruciform xanthoma may have a multifactorial etiology involving inflammation, local immunosuppression, and/or metabolic dysfunction. It has also been postulated that verruciform xanthoma is a secondary reaction to trauma-induced epithelial damage or degeneration. A biopsy for histopathologic examination is required to diagnose verruciform xanthoma. The treatment of verruciform xanthoma typically involves simple surgical excision.

Background: Hair is susceptible to exogenous sources of discoloration. There are several exogenous etiologies for yellow hair discoloration, including tobacco.

Purpose: We describe the clinical features of five men with tobacco-associated yellow discoloration of their mustache, a condition known as "smoker's mustache." We also review the characteristics of men with tobacco-associated yellow discoloration of their scalp or mustache hair.

Materials and methods: The features of five men with smoker's mustache are presented. Using PubMed, the following terms were searched and relevant citations assessed: 4-4'-methylenedianiline, acid, dithranol, MDA, mustache, nicotine, picric, resorcin, smoker, tar, tobacco, and yellow. In addition, the literature on smoker's mustache is reviewed.

Results: Smoker's mustache was an incidental finding and not the reason for patients presenting for medical attention. The condition was asymptomatic. In our patients, 60% (3 of 5) also had tobacco-related clinical findings on the distal soft tissue and/or nails of their fingers.

Conclusion: Smoker's mustache refers to tobacco-associated discoloration of the hair of the upper lip of men. It is an asymptomatic condition that usually presents as an incidental finding. Indeed, patients tend to be unaware of the condition until it is brought to their attention. In addition to hair manifestations, patients may also demonstrate other tobacco-associated skin and nail findings, particularly brown or yellow-brown discoloration of their fingertip and/or fingernail. We postulate that discontinuation of smoking would eventually result in spontaneous resolution of the condition. However, all of our patients were determined to continue smoking.