What is the treatment for oral verruciform xanthomas?

Treatment of Oral Verruciform Xanthomas

Surgical excision is the recommended treatment for oral verruciform xanthomas, with excellent prognosis and no recurrence reported in long-term follow-up studies. 1

Clinical Characteristics

• Oral verruciform xanthomas (OVX) are uncommon benign lesions of the oral cavity that can present as pink, yellow, or greyish masses 2
• Most commonly affect the gingiva (46.6%), followed by tongue (26.7%) and buccal/vestibular mucosa (26.7%) 1
• Average size is approximately 0.8 cm (range 0.3-2.0 cm) 1
• Typically present in the fifth decade of life (mean age 45 years) with no significant gender predilection 1

Histopathological Features

• Characterized by varying degrees of surface parakeratosis and accumulation of foam cells (xanthoma cells) in connective tissue papillae 1
• Microscopically classified into three types based on surface architecture: verrucous (47%), papillary (20%), and flat (33%) 1
• Foam cells test positive for antibodies such as CD-68 and vimentin, suggesting derivation from monocyte-macrophage lineage 3

Treatment Approaches

• Surgical excision is the treatment of choice for oral verruciform xanthomas 1, 3
• Complete removal of the lesion is important for definitive diagnosis and treatment 2
• For extraoral verruciform xanthomas (such as genital lesions), simple surgical excision is also the standard treatment 4
• When attempted, other treatment modalities such as wire loop electrosection, pulsed dye laser, and x-ray therapy have proven unsuccessful for cutaneous verruciform xanthomas 5

Treatment Outcomes

• Prognosis following surgical excision is excellent 1, 3
• No recurrence has been reported in follow-up periods of up to 18 years 1
• No additional medical, chemical, or radiological treatments are required post-operatively 3
• Malignant transformation is rare 3

Clinical Considerations

• Histopathological examination is necessary for definitive diagnosis as the clinical features can mimic other lesions, including potentially malignant ones 2, 3
• Differential diagnosis should include verruca vulgaris, condyloma acuminatum, squamous papilloma, and potentially malignant lesions 6
• In cases where verruciform xanthomas coexist with other oral mucosal lesions (such as oral submucous fibrosis, squamous cell carcinoma, or erosive oral lichen planus), management should address both conditions 1

Pitfalls to Avoid

• Misdiagnosis as viral warts or malignancies due to similar clinical appearance 4
• Incomplete removal of the lesion, although recurrence is still uncommon 1
• Delaying biopsy for histopathological examination, which is essential for definitive diagnosis 3